Publications by authors named "Linda B Haramati"

129 Publications

Performance of the Vancouver Risk Calculator Compared with Lung-RADS in an Urban, Diverse Clinical Lung Cancer Screening Cohort.

Radiol Imaging Cancer 2020 Mar 27;2(2):e190021. Epub 2020 Mar 27.

Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 (A.K., R.P., E.M., L.B.H.); and Department of Diagnostic Radiology, University of Maryland, Baltimore, Md (C.S.W.).

Purpose: To compare the performance of the Vancouver risk calculator (VRC) with the American College of Radiology's Lung CT Screening Reporting and Data System (Lung-RADS) for a lung cancer screening cohort in an urban, diverse clinical setting.

Materials And Methods: This study included a total of 486 patients with lung nodules (63 years ± 5.2 [standard deviation], 261 female patients), 448 of whom had lung nodules that were subsequently classified as benign and 38 of whom had those that were classified as malignant. The mean follow-up time was 40.0 months ± 14. Institutional review board approval was obtained for this Health Insurance Portability and Accountability Act-compliant retrospective study, and a waiver of informed consent was received. All patients undergoing lung cancer screening who underwent an initial baseline screening CT between December 2012 and June 2016 that demonstrated a nodule and had at least 1 year of follow-up comprised the study population. Each examination was assigned a Lung-RADS score between 2 and 4B, with 4A and 4B considered as showing positive results. The VRC calculates the risk of cancer at different thresholds using nine variables related to patient and imaging characteristics. Analysis was performed per patient based on the largest nodule. Lung-RADS and VRC using the 5% threshold were compared to assess diagnostic performance in determining the risk of developing lung cancer in a patient with a nodule found at screening CT. The McNemar test was used to compare differences in performance between Lung-RADS and VRC.

Results: Lung-RADS resulted in nine false-positive and 16 false-negative findings, whereas VRC with a 5% threshold resulted in 29 false-positive and 10 false-negative findings. Overall sensitivity and specificity for Lung-RADS was 58.0% and 98.0%, and for VRC with a 5% threshold was 73.7% and 93.5%, respectively ( = .313, < .001, respectively).

Conclusion: The VRC performs well in an urban, diverse lung cancer screening program. Further studies may be directed at determining whether its use in conjunction with Lung-RADS leads to improved lung cancer detection. CT, Lung, Thorax© RSNA, 2020.
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http://dx.doi.org/10.1148/rycan.2020190021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983652PMC
March 2020

COVID-19 Imaging: What We Know Now and What Remains Unknown.

Radiology 2021 Feb 9:204522. Epub 2021 Feb 9.

From the Department of Radiology University of Wisconsin School of Medicine and Public Health (J.P.K.); Department of Diagnostic Imaging Rhode Island Hospital and Warren Alpert Medical School of Brown University (H.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (A.B.); Department of Radiology Icahn School of Medicine at Mount Sinai 1 Gustave Levy Place, New York, NY 10029 (M.C.); Montefiore Medical Center Albert Einstein College of Medicine Departments of Radiology and Medicine 111 East 210 Street Bronx, NY 10467 (L.B.H.); Department of Radiology Mayo Clinic 200 First St SW Rochester, MN 55905 (D.F.K.); Department of Radiology Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 (B.P.L.); Department of Medical Imaging University of Arizona College of Medicine Tucson, AZ (G.R.); Scienze Radiologiche, Department of Medicine and Surgery University of Parma V. Gramsci 14, 43126, Parma Italy (N.S.).

Infection by SARS-CoV-2 virus ranges from asymptomatic to severe and sometimes fatal disease, most frequently the result of acute lung injury. The role of imaging has evolved during the pandemic, initially with CT as alternative and possibly superior test compared to RT-PCR, to a more limited role based on specific indications. Several classification and reporting schemes were developed for chest imaging early during the pandemic for patients with suspected COVID-19 to aid in triage when the availability of RT-PCR testing was limited and its performance unclear. Interobserver agreement for categories with findings typical of COVID-19 and those suggesting an alternative diagnosis is high across multiple studies. Furthermore, some studies looking at the extent of lung involvement on chest radiography and CT showed correlations with critical illness and need for mechanical ventilation. In addition to pulmonary manifestations, cardiovascular complications such as thromboembolism and myocarditis have been ascribed to COVID-19, sometimes contributing to neurologic and abdominal manifestations. Finally, artificial intelligence has shown promise in both diagnosis and prognosis of COVID-19 pneumonia both with respect to radiography and CT.
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http://dx.doi.org/10.1148/radiol.2021204522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879709PMC
February 2021

Call for a New Radiology Subspecialty in Imaging-Based Screening.

J Am Coll Radiol 2021 Jan;18(1 Pt B):198-201

Division Lead and Fellowship Director, Cardiothoracic Imaging at Montefiore Medical Center/Albert Einstein College of Medicine. Director, Lung Cancer Screening Program, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.

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http://dx.doi.org/10.1016/j.jacr.2020.09.026DOI Listing
January 2021

Imaging of pulmonary hypertension in adults: a position paper from the Fleischner Society.

Eur Respir J 2021 Jan 5;57(1). Epub 2021 Jan 5.

Université Paris Saclay, Inserm UMR S999, Dept of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France.

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mmHg and classified into five different groups sharing similar pathophysiologic mechanisms, haemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH: Is noninvasive imaging capable of identifying PH? What is the role of imaging in establishing the cause of PH? How does imaging determine the severity and complications of PH? How should imaging be used to assess chronic thromboembolic PH before treatment? Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH.
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http://dx.doi.org/10.1183/13993003.04455-2020DOI Listing
January 2021

Imaging of Pulmonary Hypertension in Adults: A Position Paper from the Fleischner Society.

Radiology 2021 Mar 5;298(3):531-549. Epub 2021 Jan 5.

From the Department of Thoracic Imaging, Hôpital Calmette, Boulevard Jules Leclercq, 59037 Lille, France (M.R.J.); Department of Medicine, University of British Columbia and Centre for Heart Lung Innovation, St Paul's Hospital, Vancouver, Canada (C.J.R.); Department of Radiology, UW-Madison School of Medicine and Public Health, Madison, Wis (M.L.S.); Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.N.C.L.); Division of Imaging, Department of Infection Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, England (J.M.W.); Department of Respiratory Medicine, Hannover Medical School and German Centre of Lung Research (DZL), Hannover, Germany (M.M.H.); Department of Radiology, Saint Louis University School of Medicine, St Louis, Mo (P.O.A.); Department of Radiology, Medical College of Wisconsin, Milwaukee, Wis (L.R.G.); Department of Radiology, Vancouver General Hospital, Vancouver, Canada (J.M.); Department of Radiology and Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Radiology, Fujita Health University School of Medicine, Toyoake, Japan (Y.O.); Division of Cardiothoracic Surgery, University of California, San Diego, La Jolla, Calif (P.T.); Edinburgh Imaging, Queens Medical Research Institute, University of Edinburgh, Edinburgh, Scotland (E.J.R.v.B.); Department of Library and Knowledge Services (S.L.K.) and Department of Radiology (D.A.L.), National Jewish Health, Denver, Colo; Department of Radiology, Duke University School of Medicine, Durham, NC (G.D.R.); and Université Paris Saclay, Inserm UMR S999, Department of Pneumology, AP-HP, Pulmonary Hypertension Reference Center, Hôpital de Bicêtre, Le Kremlin Bicêtre, France (M.H.).

Pulmonary hypertension (PH) is defined by a mean pulmonary artery pressure greater than 20 mm Hg and classified into five different groups sharing similar pathophysiologic mechanisms, hemodynamic characteristics, and therapeutic management. Radiologists play a key role in the multidisciplinary assessment and management of PH. A working group was formed from within the Fleischner Society based on expertise in the imaging and/or management of patients with PH, as well as experience with methodologies of systematic reviews. The working group identified key questions focusing on the utility of CT, MRI, and nuclear medicine in the evaluation of PH: Is noninvasive imaging capable of identifying PH? What is the role of imaging in establishing the cause of PH? How does imaging determine the severity and complications of PH? How should imaging be used to assess chronic thromboembolic PH before treatment? Should imaging be performed after treatment of PH? This systematic review and position paper highlights the key role of imaging in the recognition, work-up, treatment planning, and follow-up of PH. This article is a simultaneous joint publication in and . The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article. © 2021 RSNA and the European Respiratory Society.
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http://dx.doi.org/10.1148/radiol.2020203108DOI Listing
March 2021

Utility of Apical Lung Assessment on Computed Tomography Angiography as a COVID-19 Screen in Acute Stroke.

Stroke 2020 12 29;51(12):3765-3769. Epub 2020 Oct 29.

Department of Radiology (A.S., I.G., R.Z., K.H., L.B.H.), Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.

Background And Purpose: Evaluation of the lung apices using computed tomography angiography of the head and neck during acute ischemic stroke (AIS) can provide the first objective opportunity to screen for coronavirus disease 2019 (COVID-19).

Methods: We performed an analysis assessing the utility of apical lung exam on computed tomography angiography for COVID-19-specific lung findings in 57 patients presenting with AIS. We measured the diagnostic accuracy of apical lung assessment alone and in combination with patient-reported symptoms and incorporate both to propose a COVID-19 era AIS algorithm.

Results: Apical lung assessment when used in isolation, yielded a sensitivity of 0.67, specificity of 0.93, positive predictive value of 0.19, negative predictive value of 0.99, and accuracy of 0.92 for the diagnosis of COVID-19, in patients presenting to the hospital for AIS. When combined with self-reported clinical symptoms of cough or shortness of breath, sensitivity of apical lung assessment improved to 0.83.

Conclusions: Apical lung assessment on computed tomography angiography is an accurate screening tool for COVID-19 and can serve as part of a combined screening approach in AIS.
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http://dx.doi.org/10.1161/STROKEAHA.120.030959DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678646PMC
December 2020

Thoracic aortic dissection classification among radiologists and surgeons and management trends.

Emerg Radiol 2021 Apr 6;28(2):297-301. Epub 2020 Oct 6.

Department of Radiology, Montefiore Medical Center, Bronx, NY, USA.

Objective: To investigate the discrepancy rate in classification of newly diagnosed aortic dissection (AD) between radiologists and surgeons and explore patient management.

Methods: 3255 CTs performed for AD from June 2013 to June 2018 at our institution were retrospectively identified. CT reports and charts were reviewed to identify newly diagnosed AD or intramural hematoma (IMH). Radiology reports and electronic health records were reviewed for Stanford type A or B classification and surgical versus medical management.

Results: Newly diagnosed AD was diagnosed in 1.9% (62/3255) with one false positive, mean age 60 years. Discrepancy rate was 1.6% (1/61). Type A AD/IMH was treated surgically in 85% (23/27), medically in 15% (4/27). Type B AD/IMH was treated surgically in 56% (19/34) (endovascular 95% (18/19)), medically in 44% (15/34).

Conclusions: Discrepancy rate between radiologists and surgeons in Stanford classification of aortic dissection was low. Management of type B AD/IMH was predominantly endovascular, reflecting a shift in practice from the historical binary management strategy of type A dissections being treated surgically and type B dissections medically.
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http://dx.doi.org/10.1007/s10140-020-01861-7DOI Listing
April 2021

Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism.

Blood Adv 2020 09;4(18):4296-4311

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

Pulmonary embolism (PE) is a common, potentially life-threatening yet treatable condition. Prompt diagnosis and expeditious therapeutic intervention is of paramount importance for optimal patient management. Our objective was to systematically review the accuracy of D-dimer assay, compression ultrasonography (CUS), computed tomography pulmonary angiography (CTPA), and ventilation-perfusion (V/Q) scanning for the diagnosis of suspected first and recurrent PE. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. 2 investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 61 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.97 (95% confidence interval [CI], 0.96-0.98) and 0.41 (95% CI, 0.36-0.46) respectively, whereas CTPA sensitivity and specificity were 0.94 (95% CI, 0.89-0.97) and 0.98 (95% CI, 0.97-0.99), respectively, and CUS sensitivity and specificity were 0.49 (95% CI, 0.31-0.66) and 0.96 (95% CI, 0.95-0.98), respectively. Three variations of pooled estimates for sensitivity and specificity of V/Q scan were carried out, based on interpretation of test results. D-dimer had the highest sensitivity when compared with imaging. CTPA and V/Q scans (high probability scan as a positive and low/non-diagnostic/normal scan as negative) both had the highest specificity. This systematic review was registered on PROSPERO as CRD42018084669.
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http://dx.doi.org/10.1182/bloodadvances.2019001052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7509887PMC
September 2020

Overview of Common Surgical Procedures in CHD.

Semin Roentgenol 2020 07 26;55(3):264-278. Epub 2020 Jun 26.

Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.; Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

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http://dx.doi.org/10.1053/j.ro.2020.06.010DOI Listing
July 2020

Diagnostic Performance of Pulmonary Embolism Imaging in Patients with History of Asthma.

J Nucl Med 2021 Mar 17;62(3):399-404. Epub 2020 Jul 17.

Albert Einstein College of Medicine, Bronx, New York.

Asthma and pulmonary embolism (PE) can present with overlapping symptoms, and distinguishing between these 2 conditions can be challenging. Asthma may limit imaging for PE because of either worsened ventilation defects on ventilation-perfusion scanning (VQ) or increased motion artifacts on CT pulmonary angiography (CTPA). We identified adults evaluated for PE with VQ or CTPA from 2012 to 2016. Patients with chronic lung disease (other than asthma) were excluded. Studies were classified as negative, positive, or nondiagnostic. Follow-up of negative cases was reviewed to determine the rate of repeat exams (within 1 wk) and the false-negative rate (defined as diagnosis of venous thromboembolism within 90 d). We reviewed 19,412 adults (aged 52 ± 18 y, 70% women) evaluated for PE (60% with VQ, 40% with CTPA); 23% had a history of asthma. Nondiagnostic results were comparable for those with and without asthma for both VQ (asthma, 3.3%; nonasthma, 3.8%; = 0.223) and CTPA (asthma, 1.6%; nonasthma, 1.5%; = 0.891). A history of asthma was not associated with a higher rate of repeat exams after negative imaging for VQ (asthma, 1.9%; nonasthma, 2.1%; = 0.547) or CTPA (asthma, 0.6%; nonasthma, 0.6%; = 0.796), nor was a history of asthma associated with a higher false-negative rate for VQ (asthma, 0.4%; nonasthma, 0.9%; = 0.015) or CTPA (asthma, 1.9%; nonasthma 1.5%; = 0.347). A history of asthma in the preceding 10 y was not associated with impaired diagnostic performance of PE imaging for either VQ or CTPA.
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http://dx.doi.org/10.2967/jnumed.120.242776DOI Listing
March 2021

Reply: COVID-19 and Pulmonary Embolism: Diagnostic Imaging Trends.

J Nucl Med 2020 08 23;61(8):1102-1103. Epub 2020 Jun 23.

Montefiore Medical Center 1695A Eastchester Rd. Bronx, NY 10461 E-mail:

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http://dx.doi.org/10.2967/jnumed.120.250530DOI Listing
August 2020

Implementation of an aortic dissection CT protocol with clinical decision support aimed at decreasing radiation exposure by reducing routine abdominopelvic imaging.

Clin Imaging 2020 Nov 8;67:108-112. Epub 2020 Jun 8.

Department of Radiology, Montefiore Medical Center, Bronx, NY 10467, United States; Albert Einstein College of Medicine, Bronx, NY 10467, United States; Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States.

Patients suspected of having an acute aortic syndrome in the ED typically undergo CT of the chest/abdomen/pelvis. However, the overwhelming majority of these exams are negative. With the help of clinical decision support, we implemented a new radiologist monitored 'aortic dissection screening protocol' that forgoes routine abdominopelvic imaging in order to reduce radiation dose without compromising diagnostic accuracy. The purpose of the present study is to assess the performance of this protocol. A retrospective analysis was performed to study the effect of the dissection screening protocol on the diagnostic yield, radiation and contrast dose on a total of 835 ED patients who underwent CT scans for suspected aortic dissection over a 48-week study period immediately before and after implementation of the protocol. 3.4% (28/835) of examinations were positive for an acute aortic syndrome over the 48-week study period with no difference in positivity before and after implementation of the 'aortic dissection screening' protocol, 3.0% vs. 3.7%, respectively (p = 0.57). There was a 14.6% reduction in median radiation dose and a 16% decrease in contrast volume utilization for the total ED population who underwent CT for aortic dissection using any protocol in the period after implementation of the 'aortic dissection screening' protocol. Aortic dissection CT in the ED is negative in the overwhelming majority of cases. A monitored 'aortic dissection screening' protocol that initially images the chest only significantly reduced contrast and radiation dose without reducing diagnostic accuracy for ED patients who underwent CT for aortic dissection.
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http://dx.doi.org/10.1016/j.clinimag.2020.06.005DOI Listing
November 2020

Bovine Arch and Stroke Laterality.

J Am Heart Assoc 2020 07 17;9(13):e015390. Epub 2020 Jun 17.

Department of Radiology Montefiore Medical Center Albert Einstein College of Medicine Bronx NY.

Background Left-hemispheric strokes are more frequent and often have a worse outcome than their right-hemispheric counterparts. This study aimed to evaluate whether cardioembolic stroke laterality is affected by anatomical characteristics of the aortic arch. We hypothesized that laterality varies between patients with bovine versus standard arch. Methods and Results We retrospectively identified 1598 acute cardioembolic strokes in patients with atrial fibrillation from our institutional stroke database (2009-2017). Inclusion criteria were acute anterior circulation ischemic infarct and availability of both arch and brain imaging (magnetic resonance imaging or computed tomography). Alternative causes of stroke and anomalous arch were excluded. Imaging was reviewed for stroke characterization and laterality and arch branching pattern. Bovine arch denotes a common origin of the brachiocephalic trunk and left common carotid artery. Strokes were classified as bilateral (left or right). Univariate analysis was performed using chi-square tests. The final cohort comprised 615 patients, mean age 77 years (SD 11.8 years) with 376 women (61%) and 33% white, 30% black, and the remainder mixed/Hispanic. Standard arch (n=424) stroke distribution was left 43.6% (185), right 45.1% (191), and bilateral 11.3% (48). Bovine arch (n=191) stroke distribution was left 51.3% (98), right 35.6% (68), and bilateral 13.1% (25). Bovine arches were associated with more left-sided strokes compared with standard arches (=0.018). There was an association between black race and bovine arch (=0.0001). Conclusions Bovine aortic arch configuration is associated with left hemispheric laterality of cardioembolic stroke. This study enriches the understanding that arch anatomy influences stroke laterality and highlights the need for further research into the causative hemodynamic factors.
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http://dx.doi.org/10.1161/JAHA.119.015390DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7670536PMC
July 2020

Having a Primary Care Provider is the Strongest Predictor of Successful Follow-up of Participants in a Clinical Trial.

J Am Board Fam Med 2020 May-Jun;33(3):431-439

From Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (SHF, LBH, JML); Department of Family and Social Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (COC); Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (COC, LBH, JML); Department of Epidemiology & Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY (JL); Current Address: Department of Family Medicine, Overlook Medical Center, Summit, NJ (SHF).

Purpose: Ethnic minorities, women, and those of low socioeconomic status are widely underrepresented in clinical trials. Few studies have explored factors associated with successful follow-up in these historically difficult-to-reach patients. This study's objective was to identify patient characteristics and methods of contact that predict successful contact for follow-up in an urban, predominantly ethnic minority, majority-women, poor population to help devise strategies to improve retention.

Methods: We retrospectively reviewed records from a prospective randomized control trial of 400 hospitalized chest pain patients to determine which characteristics were associated with successful telephone follow-up at 1 year after enrollment. We assessed demographic variables, medical history, and social factors by using bivariate analyses. A multivariate analysis was performed using variables from the bivariate analysis with ≤ .2.

Results: The overall successful 1-year follow-up rate was 95% (381/400). Study participants who completed follow-up were significantly more likely to have a primary care physician (PCP) (88% [337/381] versus 68% [13/19]), speak English natively (52% [199/381] versus 26% [5/19]), have a higher Charlson comorbidity index score, and identify as women (64.0% [244/381] versus 42.1% [8/19]). Having a PCP and native English language remained significant at multivariate analysis. Socioeconomic status score, quantity of contact information recorded at recruitment, and insurance status were not significantly associated with successful follow-up.

Conclusions: Patients engaged with the health care system by having a PCP are significantly more likely to achieve follow-up. Successful follow-up is also associated with native English speaking. The potential of improving follow-up by facilitating connections with health care providers requires further study.
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http://dx.doi.org/10.3122/jabfm.2020.03.190018DOI Listing
January 2019

CT Scans Obtained for Nonpulmonary Indications: Associated Respiratory Findings of COVID-19.

Radiology 2020 09 11;296(3):E173-E179. Epub 2020 May 11.

From the Department of Radiology, School of Medicine, University of Maryland, 22 S Greene St, Baltimore, MD 21201 (R.H., F.D., V.M., C.S.W.); Department of Radiology, Montefiore Medical Center, Bronx, NY (M.S.L., J.A., B.Z., L.B.H.); Department of Radiology, Mount Sinai West Medical Center, New York, NY (A.R.); and Department of Radiology, Staten Island University Hospital, Staten Island, NY (B.L.).

Background Atypical manifestations of coronavirus disease 2019 (COVID-19) are being encountered as the pandemic unfolds, leading to non-chest CT scans that may uncover unsuspected pulmonary disease. Purpose To investigate patients with primary nonrespiratory symptoms who underwent CT of the abdomen or pelvis or CT of the cervical spine or neck with unsuspected findings highly suspicious for pulmonary COVID-19. Materials and Methods This retrospective study from March 10, 2020, to April 6, 2020, involved three institutions, two in a region considered a hot spot (area of high prevalence) for COVID-19. Patients without known COVID-19 were included who presented to the emergency department (ED) with primary nonrespiratory (gastrointestinal or neurologic) symptoms, had lung parenchymal findings suspicious for COVID-19 at non-chest CT but not concurrent chest CT, and underwent COVID-19 testing in the ED. Group 1 patients had reverse transcription polymerase chain reaction (RT-PCR) results obtained before CT scan reading (COVID-19 suspected on presentation); group 2 had RT-PCR results obtained after CT scans were read (COVID-19 not suspected). Presentation and imaging findings were compared, and outcomes were evaluated. Descriptive statistics and Fisher exact tests were used for analysis. Results Group 1 comprised 62 patients (31 men, 31 women; mean age, 67 years ±17 [standard deviation]), and group 2 comprised 57 patients (28 men, 29 women; mean age, 63 years ± 16). Cough and fever were more common in group 1 (37 of 62 [60%] and 29 of 62 [47%], respectively) than in group 2 (nine of 57 [16%] and 12 of 57 [21%], respectively), with no significant difference in the remaining symptoms. There were 101 CT scans of the abdomen or pelvis and 18 CT scans of the cervical spine or neck. In group 1, non-chest CT findings provided the initial evidence of COVID-19-related pneumonia in 32 of 62 (52%) patients. In group 2, the evidence was found in 44 of 57 (77%) patients. Overall, the most common CT findings were ground-glass opacity (114 of 119, 96%) and consolidation (47 of 119, 40%). Major interventions (vasopressor medication or intubation) were required for 29 of 119 (24%) patients, and 27 of 119 (23%) died. Patients who underwent CT of the cervical spine or neck had worse outcomes than those who underwent abdominal or pelvic CT ( = .01). Conclusion In a substantial percentage of patients with primary nonrespiratory symptoms who underwent non-chest CT, CT provided evidence of coronavirus disease 2019-related pneumonia. © RSNA, 2020.
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http://dx.doi.org/10.1148/radiol.2020201743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437495PMC
September 2020

Meeting ACR Dose Guidelines for CT Lung Cancer Screening in an Overweight and Obese Population.

Acad Radiol 2021 03 10;28(3):381-386. Epub 2020 Apr 10.

Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210 Street, Bronx, New York 10467.

Rationale And Objectives: Lung cancer screening adoption coincides with a growing obesity epidemic. Maintaining high-quality imaging at low radiation dose is challenging in obesity. We investigate the feasibility of meeting American College of Radiology (ACR) dose guidelines for lung cancer screening in a predominantly overweight and obese population.

Materials And Methods: Radiation dose (Volumetric CT dose index [CTDIvol], dose-length product), and body mass index (BMI) were collected for baseline screening CTs December, 2012-December, 2017. Dose metrics were analyzed according to BMI classification (normal <25, overweight 25-29, obese ≥30 kg/m), using k = 0.014 mSv/mGy*cm. Results were compared to ACR dose guidelines and mean national 2017 Lung Cancer Screening Registry dose metrics. Analysis used Kruskal-Wallis (SPSS, version 24.0.0, IBM corp, Armonk, NY).

Results: Study population comprised 1478 patients (49.2% [727] women: mean BMI 28.1 ± 6.5 kg/m, 26.9% [397] normal weight, 35.9% [530] overweight, 37.2% [551] obese). ACR dose requirements were met for both genders in all BMI classifications. Dose metrics were higher in men than in women; median effective dose and CTDIvol were 1.39 (0.8-1.58) mSv and 2.78 (1.41-2.80) mGy in men versus 1.16 (0.71-1.43) mSv and 2.70 (1.4-2.78) mGy in women. There were significant differences in dose metrics between men and women in the same BMI classification and between BMI classifications (p < 0.001). Mean dose metrics in our program were considerably lower than 2017 national average- mean CTDIvol and effective dose 2.45 ± 1.14 mGy and 1.26 ± 0.59 mSv versus 3.24 mGy and 1.35 mSv, respectively for our program and nationally. Mean dose metrics were also lower in our obese patients versus obese patients nationally.

Conclusion: ACR dose metrics for lung cancer screening were met and can be appropriately tailored in a predominantly overweight and obese population clinical program.
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http://dx.doi.org/10.1016/j.acra.2020.02.009DOI Listing
March 2021

The Role of Chest Imaging in Patient Management During the COVID-19 Pandemic: A Multinational Consensus Statement From the Fleischner Society.

Chest 2020 07 7;158(1):106-116. Epub 2020 Apr 7.

Department of Radiology, Stanford University School of Medicine, Stanford, CA.

With more than 900,000 confirmed cases worldwide and nearly 50,000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.
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http://dx.doi.org/10.1016/j.chest.2020.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138384PMC
July 2020

The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society.

Radiology 2020 07 7;296(1):172-180. Epub 2020 Apr 7.

From the Department of Radiology, Duke University School of Medicine, Box 3808, Durham, NC 27705 (G.D.R.); Department of Medicine, University of British Columbia, Vancouver, Canada (C.J.R.); Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (L.B.H.); Department of Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Parma, Italy (N.S.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Division of Pulmonary, Critical Care & Sleep Medicine, Lenox Hill Hospital, New York, NY (S.R.); Division of Pulmonary, Allergy and Critical Care Medicine, Columbia University Irving Medical Center, New York, NY (N.W.S.); 1st Anesthesia and Intensive Care Unit, University Hospital of Parma, Parma, Italy (A.V.); Division of Pulmonary and Critical Medicine, Seoul National University College of Medicine, Seoul, South Korea (J.J.Y.); Department of Emergency Medicine, The Medical College of Wisconsin School of Medicine, Milwaukee, Wis (I.B.K.M.); Director, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC (D.J.A.); Medical Director of Pathology and Clinical Laboratory Medicine, Stanford University Medical Center, Stanford, Calif (C.K.); Department of Radiology, University of Missouri, Columbia, Mo (T.A.); Department of Paediatrics and Paediatric Respirology, Royal Brompton Hospital, London, England (A.B.); Department of Radiology, Royal Brompton & Harefield NHS Foundation Trust, London, England (S.R.D.); National Heart and Lung Institute, Imperial College, London, England (S.R.D.); Department of Radiology, David Geffen School of Medline at University of California Los Angeles, Los Angeles, Calif (J.G.); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.G.); Department of Respiratory and Intensive Care Medicine, Université Paris-Saclay, Hôpital Bicêtre, Le Kremlin-Bicêtre, France (M.H.); Department of Pathology, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan (Y.I.); Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany (H.U.K.); Department of Pulmonary and Critical Care Medicine, West China Hospital, Sichuan University, Sichuan, China (F.L.); Respiratory Institute, Cleveland Clinic, Cleveland,Ohio (P.J.M.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (M.P.); Department of Thoracic Imaging-Hospital Calmette, University Centre of Lille, Lille, France (M.R.J.); Divisionof Pulmonary Medicine, Università Cattolica del Sacro Cuore, Rome, Italy (L.R.); Department of Radiology and Nuclear Medicine, Meander Medical Centre, Amersfoort, the Netherlands (C.M.S.P.); Department of Radiology, Osaka University Graduate School of Medicine, Osaka, Japan (N.T.); Department of Pulmonary Medicine, Royal Brompton Hospital, London, England (A.U.W.); and Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.N.L.).

With more than 900 000 confirmed cases worldwide and nearly 50 000 deaths during the first 3 months of 2020, the coronavirus disease 2019 (COVID-19) pandemic has emerged as an unprecedented health care crisis. The spread of COVID-19 has been heterogeneous, resulting in some regions having sporadic transmission and relatively few hospitalized patients with COVID-19 and others having community transmission that has led to overwhelming numbers of severe cases. For these regions, health care delivery has been disrupted and compromised by critical resource constraints in diagnostic testing, hospital beds, ventilators, and health care workers who have fallen ill to the virus exacerbated by shortages of personal protective equipment. Although mild cases mimic common upper respiratory viral infections, respiratory dysfunction becomes the principal source of morbidity and mortality as the disease advances. Thoracic imaging with chest radiography and CT are key tools for pulmonary disease diagnosis and management, but their role in the management of COVID-19 has not been considered within the multivariable context of the severity of respiratory disease, pretest probability, risk factors for disease progression, and critical resource constraints. To address this deficit, a multidisciplinary panel comprised principally of radiologists and pulmonologists from 10 countries with experience managing patients with COVID-19 across a spectrum of health care environments evaluated the utility of imaging within three scenarios representing varying risk factors, community conditions, and resource constraints. Fourteen key questions, corresponding to 11 decision points within the three scenarios and three additional clinical situations, were rated by the panel based on the anticipated value of the information that thoracic imaging would be expected to provide. The results were aggregated, resulting in five main and three additional recommendations intended to guide medical practitioners in the use of chest radiography and CT in the management of COVID-19.
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http://dx.doi.org/10.1148/radiol.2020201365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233395PMC
July 2020

Diagnostic Evaluation of Pulmonary Embolism During the COVID-19 Pandemic.

J Nucl Med 2020 05 1;61(5):630-631. Epub 2020 Apr 1.

Division of Nuclear Medicine, Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; and.

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http://dx.doi.org/10.2967/jnumed.120.245571DOI Listing
May 2020

Imaging of Chronic Thromboembolic Disease.

Lung 2020 04 12;198(2):245-255. Epub 2020 Mar 12.

Departments of Radiology and Internal Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, USA.

Acute pulmonary embolism (PE) is a leading cause of cardiovascular morbidity. The most common long-term complication of acute PE is chronic thromboembolic disease, a heterogenous entity which ranges from asymptomatic imaging sequelae to persistent symptoms. Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare disease that can develop in this population and represents the only treatable type of pulmonary hypertension. Recognition of the characteristic findings of chronic pulmonary embolism and CTEPH provides not only diagnostic information, but is also crucial for guiding therapy. The present state-of-the-art review focuses on the multimodality imaging features of chronic pulmonary embolism. Detailed description and illustrations of relevant imaging findings will be demonstrated for ventilation/perfusion (V/Q) scan, CT scan and Dual-Energy CT and MRI and features that distinguish chronic PE from common imaging mimics.
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http://dx.doi.org/10.1007/s00408-020-00344-3DOI Listing
April 2020

Cracking the Opium Den: Cardiothoracic Manifestations of Drug Abuse.

J Thorac Imaging 2021 Mar;36(2):W16-W31

Montefiore Medical Center, Bronx.

Recreational drug use is increasing worldwide, with emergency room visits and total deaths from drug overdose rising in recent years. Complications from prescription and recreational drug use may result from the biochemical effects of the drugs themselves, impurities mixed with substances, or from causes related to the method of drug administration. The presentation of drug overdose may be complex due to multisubstance abuse, including cigarette smoking and alcoholism, and can impact any organ system. Patients may present without history, and radiologists may be the first clinicians to suggest the diagnosis. We aim to explore the cardiothoracic manifestations of drug abuse and their multimodality imaging manifestations.
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http://dx.doi.org/10.1097/RTI.0000000000000488DOI Listing
March 2021

The relationship between adrenal incidentalomas and mortality risk.

Eur Radiol 2019 Nov 16;29(11):6245-6255. Epub 2019 Apr 16.

Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, 111 E 210th Street, Bronx, New York, NY, 10467, USA.

Objective: To determine all-cause mortality risk in patients with and without adrenal incidentaloma.

Methods: Retrospective cohort study of patients with CT abdomen performed within 24 h of emergency room presentation at an academic medical center from January 1, 2005, to December 31, 2009, without history of adrenal disease, adrenal lab testing, or cancer. Incidentaloma cohort identified by database query of imaging reports followed by manual review and matched to no-nodule controls at 3:1 on age ± 1 year and exam date ± 3 months. Mortality ascertained by in-hospital deaths and National Death Index query. Survival analysis performed with Kaplan-Meier curves and Cox proportional hazards models.

Results: Among 42,575 adults with abdominal CT exams, 969 adrenal incidentaloma patients and 2907 no-nodule controls were identified. All 3876 individuals entered survival analysis with 31,182 person-years at risk (median follow-up 8.9 years [IQR, 6.9-10.7]). All-cause mortality was significantly higher among those with adrenal incidentalomas (353/969, 36.4%) compared with those without (919/2907, 31.6%; mortality difference 7.6 per 1000 person-years; multivariable-adjusted hazard ratio [aHR] 1.14; 95% CI, 1.003-1.29). Exploratory analyses, limited by missing covariates, found that adrenal incidentalomas were associated with significantly increased incidence of malignancy (aHR 1.61; 95% CI, 1.22-2.12), diabetes (aHR 1.43; 95% CI, 1.18-1.71), heart failure (aHR 1.32; 95% CI, 1.07-1.63), peripheral vascular disease (aHR 1.28; 95% CI, 1.95-1.56), renal disease (aHR 1.21; 95% CI, 1.01-1.44), and chronic pulmonary disease (aHR 1.22; 95% CI, 1.01-1.46) compared with controls.

Conclusions: Adrenal incidentalomas are associated with increased mortality and may represent a clinically valuable biomarker.

Key Points: • Adrenal incidentalomas are associated with increased mortality. • Adrenal incidentaloma size is not predictive of mortality. • On exploratory analyses, adrenal incidentalomas are associated with chronic illnesses.
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http://dx.doi.org/10.1007/s00330-019-06202-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6801004PMC
November 2019

Vancouver Risk Calculator Compared with ACR Lung-RADS in Predicting Malignancy: Analysis of the National Lung Screening Trial.

Radiology 2019 04 22;291(1):205-211. Epub 2019 Jan 22.

From the Department of Diagnostic Radiology, University of Maryland, 22 S Greene St, Baltimore, Md 21136 (C.S.W., R.C.); Philips Healthcare, Highland Heights, Ohio (E.D.); Philips Research North America, Cambridge, Mass (S.D.); and Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (L.B.H.).

Purpose To compare the Vancouver risk calculator (VRC) with American College of Radiology (ACR) Lung Imaging Reporting and Data System (Lung-RADS) in predicting the risk of malignancy in the National Lung Screening Trial (NLST). Materials and Methods A total of 2813 patients with 4408 nodules (4078 solid, 330 subsolid) were available from the NLST for evaluation. Nodules were scored by using VRC with nine parameters (output was the percentage likelihood of malignancy; VRC threshold for malignancy likelihood set as greater than 5%) and Lung-RADS (output was category 2-4B; malignancy defined as category 4A or 4B; malignancy likelihood greater than 5%). Lung-RADS and VRC were compared for sensitivity, specificity, and accuracy for malignancy on a per-nodule and per-patient basis. Results Of 4408 total nodules, 100 of 4078 (2.5%) solid nodules were malignant and 10 of 330 (3%) subsolid nodules were malignant. On an overall per-nodule basis, the sensitivity, specificity, and accuracy for VRC and Lung-RADS were 93%, 90%, and 90% for VRC and 87%, 83%, and 83% for Lung-RADS, respectively (P = .077, P < .001, and P < .001, respectively). On a per-patient basis, the sensitivity, specificity, and accuracy for VRC and Lung-RADS were 93%, 85%, and 85% for VRC and 87%, 76%, and 76% for Lung-RADS, respectively (P = .077, P < .001, and P < .001, respectively). Conclusion The Vancouver risk calculator had superior overall accuracy than the Lung Imaging Reporting and Data System in predicting malignancy in the National Lung Screening Trial for total nodules, as well as on a per-patient basis. © RSNA, 2019 See also the editorial by Black in this issue.
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http://dx.doi.org/10.1148/radiol.2018181050DOI Listing
April 2019

American Society of Hematology 2018 guidelines for management of venous thromboembolism: diagnosis of venous thromboembolism.

Blood Adv 2018 11;2(22):3226-3256

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.

Background: Modern diagnostic strategies for venous thromboembolism (VTE) incorporate pretest probability (PTP; prevalence) assessment. The ability of diagnostic tests to correctly identify or exclude VTE is influenced by VTE prevalence and test accuracy characteristics.

Objective: These evidence-based guidelines are intended to support patients, clinicians, and health care professionals in VTE diagnosis. Diagnostic strategies were evaluated for pulmonary embolism (PE), deep vein thrombosis (DVT) of the lower and upper extremity, and recurrent VTE.

Methods: The American Society of Hematology (ASH) formed a multidisciplinary panel including patient representatives. The McMaster University GRADE Centre completed systematic reviews up to 1 October 2017. The panel prioritized questions and outcomes and used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess evidence and make recommendations. Test accuracy estimates and VTE population prevalence were used to model expected outcomes in diagnostic pathways. Where modeling was not feasible, management and accuracy studies were used to formulate recommendations.

Results: Ten recommendations are presented, by PTP for patients with suspected PE and lower extremity DVT, and for recurrent VTE and upper extremity DVT.

Conclusions: For patients at low (unlikely) VTE risk, using D-dimer as the initial test reduces the need for diagnostic imaging. For patients at high (likely) VTE risk, imaging is warranted. For PE diagnosis, ventilation-perfusion scanning and computed tomography pulmonary angiography are the most validated tests, whereas lower or upper extremity DVT diagnosis uses ultrasonography. Research is needed on new diagnostic modalities and to validate clinical decision rules for patients with suspected recurrent VTE.
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http://dx.doi.org/10.1182/bloodadvances.2018024828DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6258916PMC
November 2018

Navigating the Pulmonary Perfusion Map: Dual-Energy Computed Tomography in Acute Pulmonary Embolism.

J Comput Assist Tomogr 2018 Nov/Dec;42(6):840-849

From the Departments of Radiology and.

Pulmonary embolism is the third most common acute cardiovascular disease. Dual-energy computed tomography perfusion imaging is a promising adjunct in the detection of acute PE providing simultaneous functional assessment of pulmonary perfusion alongside the high-resolution morphological information from computed tomography pulmonary angiography. We review the evidence to date and common causes of perfusion defects including artifacts, parenchymal, and vascular causes, and discuss its potential in furthering our understanding of physiology and pathophysiology in acute pulmonary embolism.
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http://dx.doi.org/10.1097/RCT.0000000000000801DOI Listing
November 2018

Starfish in the heart: Congenital anomaly of the papillary muscles.

Echocardiography 2018 11 16;35(11):1872-1877. Epub 2018 Oct 16.

Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.

Most common congenital anatomical abnormalities of the subvalvular apparatus (papillary muscles and chordae tendineae) are parachute or parachute like mitral valve. This is more commonly reported among the pediatric population as they develop heart failure symptoms shortly after birth. Reports of adult cases are rare and incidental. Multimodality imaging has an important role in evaluating such anatomical abnormalities, and identification of possible related complications. We are describing a rare atypical variant of parachute like mitral valve.
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http://dx.doi.org/10.1111/echo.14164DOI Listing
November 2018

Are We Overdiagnosing Pulmonary Embolism? Yes!: Paradigm Shift in Pulmonary Embolism.

J Thorac Imaging 2018 Nov;33(6):346-347

Departments of Radiology and Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.

Pulmonary embolism (PE) is a relatively common and potentially fatal pathology. Fear of missing the diagnosis is pervasive for physicians, including radiologists. However, as computed tomography pulmonary angiography technology and utilization have evolved over the years, we have gained an understanding that not all PEs are equal. As such, our interpretations of PE imaging studies must be enriched by this understanding and adapted to patient circumstances. Herein, we shine the light on overdiagnosis of PE, exploring the evidence, impact, costs, and consequences of overdiagnosis on the care of our patients.
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http://dx.doi.org/10.1097/RTI.0000000000000365DOI Listing
November 2018

Effectiveness of Lung-RADS in Reducing False-Positive Results in a Diverse, Underserved, Urban Lung Cancer Screening Cohort.

J Am Coll Radiol 2019 Apr 23;16(4 Pt A):419-426. Epub 2018 Aug 23.

Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York; Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York.

Purpose: The Lung CT Screening Reporting and Data System (Lung-RADS) was created to standardize lung cancer screening CT reporting and recommendations but has not been well validated prospectively in clinical practice. The aim of this study was to determine the effectiveness of lung cancer screening using Lung-RADS in a diverse, underserved, academic clinical screening program, focusing on whether Lung-RADS would successfully reduce the 23.3% false-positive rate found in the National Lung Screening Trial.

Methods: Institutional review board approval was obtained to study the clinical lung cancer screening cohort. Low-dose CT results were prospectively assigned a Lung-RADS or equivalent score. The proportion of examinations in each Lung-RADS category and the corresponding lung cancer rate, subsequent imaging, interventions, mortality, and compliance were tracked. The National Death Index was queried for follow-up losses.

Results: The cohort comprised 1,181 patients with 2,270 person-years of follow-up from December 2012 to December 2016. The mean age was 64 ± 16.2 years, with 51% women, 63% nonwhite, 71% current smokers, 69% overweight and obese, and multiple comorbidities. The Lung-RADS false-positive rate was 10.4% (95% confidence interval, 8.8%-12.3%). Baseline CT results were negative in 87% (n = 1,031): for Lung-RADS 1, the lung cancer rate was 0.2%, and for Lung-RADS 2, the cancer rate was 0.5%. Positive baseline examinations were Lung-RADS 3 in 10% (n = 119), 4a in 1.2% (n = 14), and 4b in 1.5% (n = 18). Corresponding cancer rates were 3.4%, 43%, and 83%, respectively. Lung cancer prevalence was 2.1%. Mortality was 40% in patients with lung cancer versus 2.5% in the remaining cohort (P < .001). Fifty-four percent of patients were overdue for first annual examinations. Eighty-four percent of patients (n = 989) had follow-up verified via electronic records or personal contact, and the remainder had vital status ascertained via the National Death Index.

Conclusions: Lung cancer screening using Lung-RADS was effective in reducing the false-positive rate compared with the National Lung Screening Trial in a diverse and underserved urban population.
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http://dx.doi.org/10.1016/j.jacr.2018.07.011DOI Listing
April 2019

Ventricular Myocardial Fat: An Unexpected Biomarker for Long-term Survival?

Eur Radiol 2019 Jan 14;29(1):241-250. Epub 2018 Jun 14.

Department of Radiology, Montefiore Medical Center, 111 East 210th St, Bronx, NY, 10467, USA.

Purpose: To examine the association between myocardial fat, a poorly understood finding frequently observed on non-contrast CT, and all-cause mortality in patients with and without a history of prior MI.

Materials And Methods: A retrospective cohort from a diverse urban academic center was derived from chronic myocardial infarction (MI) patients (n = 265) and three age-matched patients without MI (n = 690) who underwent non-contrast chest CT between 1 January 2005-31 December 2008. CT images were reviewed for left and right ventricular fat. Electronic records identified clinical variables. Kaplan-Meier and Cox proportional hazard analyses assessed the association between myocardial fat and all-cause mortality. The net reclassification improvement assessed the utility of adding myocardial fat to traditional risk prediction models.

Results: Mortality was 40.1% for the no MI and 71.7% for the MI groups (median follow-up, 6.8 years; mean age, 73.7 ± 10.6 years). In the no MI group, 25.7% had LV and 49.9% RV fat. In the MI group, 32.8% had LV and 42.3% RV fat. LV and RV fat was highly associated (OR 5.3, p < 0.001). Ventricular fat was not associated with cardiovascular risk factors. Myocardial fat was associated with a reduction in the adjusted hazard of death for both the no MI (25%, p = 0.04) and the MI group (31%, p = 0.018). Myocardial fat resulted in the correct reclassification of 22% for the no MI group versus the Charlson score or calcium score (p = 0.004) and 47% for the MI group versus the Charlson score (p = 0.0006).

Conclusions: Patients with myocardial fat have better survival, regardless of MI status, suggesting that myocardial fat is a beneficial biomarker and may improve risk stratification.

Key Points: • Myocardial fat is commonly found on chest CT, yet is poorly understood • Myocardial fat is associated with better survival in patients with and without prior MI and is not associated with traditional cardiovascular risk factors • This finding may provide clinically meaningful prognostic value in the risk stratification of patients.
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http://dx.doi.org/10.1007/s00330-018-5546-4DOI Listing
January 2019