Publications by authors named "Matthew F Covington"

41 Publications

PET-CT in Clinical Adult Oncology-IV. Gynecologic and Genitourinary Malignancies.

Cancers (Basel) 2022 Jun 18;14(12). Epub 2022 Jun 18.

Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA.

Concurrently acquired positron emission tomography and computed tomography (PET-CT) is an advanced imaging modality with diverse oncologic applications, including staging, therapeutic assessment, restaging and longitudinal surveillance. This series of six review articles focuses on providing practical information to providers and imaging professionals regarding the best use and interpretative strategies of PET-CT for oncologic indications in adult patients. In this fourth article of the series, the more common gynecological and adult genitourinary malignancies encountered in clinical practice are addressed, with an emphasis on Food and Drug Administration (FDA)-approved and clinically available radiopharmaceuticals. The advent of new FDA-approved radiopharmaceuticals for prostate cancer imaging has revolutionized PET-CT imaging in this important disease, and these are addressed in this report. However, [F]F-fluoro-2-deoxy-d-glucose (FDG) remains the mainstay for PET-CT imaging of gynecologic and many other genitourinary malignancies. This information will serve as a guide for the appropriate role of PET-CT in the clinical management of gynecologic and genitourinary cancer patients for health care professionals caring for adult cancer patients. It also addresses the nuances and provides guidance in the accurate interpretation of FDG PET-CT in gynecological and genitourinary malignancies for imaging providers, including radiologists, nuclear medicine physicians and their trainees.
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http://dx.doi.org/10.3390/cancers14123000DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9220973PMC
June 2022

PET-CT in Clinical Adult Oncology-VI. Primary Cutaneous Cancer, Sarcomas and Neuroendocrine Tumors.

Cancers (Basel) 2022 Jun 8;14(12). Epub 2022 Jun 8.

Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA.

PET-CT is an advanced imaging modality with many oncologic applications, including staging, therapeutic assessment, restaging and surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, the potential pitfalls and nuances that characterize these applications, and guidelines for image interpretation. Tumor-specific clinical information and representative PET-CT images are provided. The current, sixth article in this series addresses PET-CT in an evaluation of aggressive cutaneous malignancies, sarcomas and neuroendocrine tumors. A discussion of the role of FDG PET for all types of tumors in these categories is beyond the scope of this review. Rather, this article focuses on the most common malignancies in adult patients encountered in clinical practice. It also focuses on Food and Drug Agency (FDA)-approved and clinically available radiopharmaceuticals rather than research tracers or those requiring a local cyclotron. This information will serve as a guide to primary providers for the appropriate role of PET-CT in managing patients with cutaneous malignancies, sarcomas and neuroendocrine tumors. The nuances of PET-CT interpretation as a practical guide for imaging providers, including radiologists, nuclear medicine physicians and their trainees, are also addressed.
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http://dx.doi.org/10.3390/cancers14122835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9221374PMC
June 2022

PET-CT in Clinical Adult Oncology-V. Head and Neck and Neuro Oncology.

Cancers (Basel) 2022 May 31;14(11). Epub 2022 May 31.

Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA.

PET-CT is an advanced imaging modality with many oncologic applications, including staging, assessment of response to therapy, restaging, and longitudinal surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, and the potential pitfalls and nuances that characterize these applications. In addition, key tumor-specific clinical information and representative PET-CT images are provided to outline the role that PET-CT plays in the management of oncology patients. Hundreds of different types of tumors exist, both pediatric and adult. A discussion of the role of FDG PET for all of these is beyond the scope of this review. Rather, this series of articles focuses on the most common adult malignancies that may be encountered in clinical practice. It also focuses on FDA-approved and clinically available radiopharmaceuticals, rather than research tracers or those requiring a local cyclotron. The fifth review article in this series focuses on PET-CT imaging in head and neck tumors, as well as brain tumors. Common normal variants, key anatomic features, and benign mimics of these tumors are reviewed. The goal of this review article is to provide the imaging professional with guidance in the interpretation of PET-CT for the more common head and neck malignancies and neuro oncology, and to inform the referring providers so that they can have realistic expectations of the value and limitations of PET-CT for the specific type of tumor being addressed.
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http://dx.doi.org/10.3390/cancers14112726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9179458PMC
May 2022

PET-CT in Clinical Adult Oncology: II. Primary Thoracic and Breast Malignancies.

Cancers (Basel) 2022 May 29;14(11). Epub 2022 May 29.

Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA.

Positron emission tomography combined with x-ray computed tomography (PET-CT) is an advanced imaging modality with oncologic applications that include staging, therapy assessment, restaging, and surveillance. This six-part series of review articles provides practical information to providers and imaging professionals regarding the best use of PET-CT for the more common adult malignancies. The second article of this series addresses primary thoracic malignancy and breast cancer. For primary thoracic malignancy, the focus will be on lung cancer, malignant pleural mesothelioma, thymoma, and thymic carcinoma, with an emphasis on the use of FDG PET-CT. For breast cancer, the various histologic subtypes will be addressed, and will include F fluorodeoxyglucose (FDG), recently Food and Drug Administration (FDA)-approved F-fluoroestradiol (FES), and F sodium fluoride (NaF). The pitfalls and nuances of PET-CT in breast and primary thoracic malignancies and the imaging features that distinguish between subcategories of these tumors are addressed. This review will serve as a resource for the appropriate roles and limitations of PET-CT in the clinical management of patients with breast and primary thoracic malignancies for healthcare professionals caring for adult patients with these cancers. It also serves as a practical guide for imaging providers, including radiologists, nuclear medicine physicians, and their trainees.
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http://dx.doi.org/10.3390/cancers14112689DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9179296PMC
May 2022

PET-CT in Clinical Adult Oncology: III. Gastrointestinal Malignancies.

Cancers (Basel) 2022 May 27;14(11). Epub 2022 May 27.

Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA.

PET-CT is an advanced imaging modality with many oncologic applications, including staging, assessment of response to therapy, restaging and longitudinal surveillance for recurrence. The goal of this series of six review articles is to provide practical information to providers and imaging professionals regarding the best use of PET-CT for specific oncologic indications, and the potential pitfalls and nuances that characterize these applications. In the third of these review articles, key tumor-specific clinical information and representative PET-CT images are provided to outline the role that PET-CT plays in the management of patients with gastrointestinal malignancies. The focus is on the use of F fluorodeoxyglucose (FDG), rather than on research radiopharmaceuticals under development. Many different types of gastrointestinal tumors exist, both pediatric and adult. A discussion of the role of FDG PET-CT for all of these is beyond the scope of this review. Rather, this article focuses on the most common adult gastrointestinal malignancies that may be encountered in clinical practice. The information provided here will provide information outlining the appropriate role of PET-CT in the clinical management of patients with gastrointestinal malignancies for healthcare professionals caring for adult cancer patients. It also addresses the nuances and provides interpretive guidance related to PET-CT for imaging providers, including radiologists, nuclear medicine physicians and their trainees.
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http://dx.doi.org/10.3390/cancers14112668DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9179927PMC
May 2022

Utility of PET to Appropriately Select Patients for PSMA-Targeted Theranostics.

Clin Nucl Med 2022 Jun 5;47(6):488-495. Epub 2022 Apr 5.

Departments of Medical Imaging, Medicine, and Biomedical Engineering, University of Arizona, Tucson, AZ.

Abstract: The majority of aggressive prostate cancers overexpress the transmembrane protein prostate-specific membrane antigen (PSMA). PSMA is, therefore, an attractive target for drug development. Over the last decade, numerous PSMA-targeted radiopharmaceuticals for imaging and therapy have been developed and investigated in theranostic combination. PSMA-targeted radiopharmaceuticals for imaging have been primarily developed for PET. PSMA PET provides whole-body evaluation of the degree of PSMA expression on tumors and potentially provides a method to better select patients for PSMA-targeted therapy. Numerous PSMA-targeted therapeutic agents using β- or α-particle emitters are under study in clinical trials. In particular, the β-particle-emitting radioisotope 177Lu bound to PSMA-targeted small molecules have ongoing and completed late-stage clinical trials in metastatic castration-resistant prostate cancer. To define the most appropriate patient group for PSMA-targeted therapeutics, multiple studies have investigated PSMA and FDG PET/CT to establish PET parameters as predictive and prognostic biomarkers. This article discusses recent clinical trials that examine the optimal use of PET for the selection of patients for PSMA-targeted therapeutics and provides an integrative overview of choice of PET tracer(s), targeting molecule, therapeutic radioisotope, nonradioactive therapy, and cancer type (prostate or nonprostate).
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http://dx.doi.org/10.1097/RLU.0000000000004196DOI Listing
June 2022

Ultrasound Elastography May Better Characterize BI-RADS 3 and BI-RADS 4A Lesions to Decrease False-Positive Breast Biopsy Rates and Enable Earlier Detection of Breast Cancer.

J Am Coll Radiol 2022 05 19;19(5):635-636. Epub 2022 Mar 19.

Assistant Professor of Radiology, Breast Imaging and Nuclear Medicine Sections, Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah; and the Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, Utah. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2022.02.023DOI Listing
May 2022

Rethinking the ACR Appropriateness Criteria® Supplemental Breast Cancer Screening Based on Breast Density.

J Am Coll Radiol 2022 05 22;19(5):595. Epub 2022 Jan 22.

Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2021.11.011DOI Listing
May 2022

Advances and Future Directions in Molecular Breast Imaging.

J Nucl Med 2022 01 9;63(1):17-21. Epub 2021 Dec 9.

University of Wisconsin School of Medicine and Public Health, Departments of Radiology and Medical Physics and the University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.

Molecular breast imaging (MBI) using Tc-sestamibi has advanced rapidly over the past decade. Technical advances allow lower-dose, higher-resolution imaging and biopsy capability. MBI can be used for supplemental breast cancer screening with mammography for women with dense breasts, as well as to assess neoadjuvant therapy response, evaluate disease extent, and predict breast cancer risk. This article highlights the current state of the art and future directions in MBI.
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http://dx.doi.org/10.2967/jnumed.121.261988DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8717200PMC
January 2022

An Overview of Selected Rare B-Cell Lymphoproliferative Disorders: Imaging, Histopathologic, and Clinical Features.

Cancers (Basel) 2021 Nov 22;13(22). Epub 2021 Nov 22.

Department of Radiology and Imaging Sciences, Utah University School of Medicine, Salt Lake City, UT 84123, USA.

Lymphoproliferative disorders (LPD) are conditions characterized by the uncontrolled proliferation of B or T-cell lines. They encompass a wide spectrum of abnormalities, which may be broadly classified as reactive processes or malignant diseases, such as lymphoma, based on their cellular clonality and clinical behavior. While some of these disorders are rare, they may be encountered sporadically in clinical practice, causing diagnostic dilemmas owing to overlap in their clinical and imaging features with more common disorders. The updated 4th edition WHO classification of lymphoid neoplasms was released in 2016 to incorporate the rapid clinical, pathological, molecular biology and cytogenetic advances of some of these disorders. Despite these updates, very little information is presented in the literature from the radiology perspective. The aim of this article is to familiarize radiologists and other physicians with certain rare variants of B-cell lymphoproliferative disorders with a focus on imaging features of these disorders, as well as to provide an overview of some important updates contained within the new WHO classification of lymphoid neoplasms.
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http://dx.doi.org/10.3390/cancers13225853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8616256PMC
November 2021

Prospective assessment of adjunctive ultrasound-guided diffuse optical tomography in women undergoing breast biopsy: Impact on BI-RADS assessments.

Eur J Radiol 2021 Dec 13;145:110029. Epub 2021 Nov 13.

Washington University in St. Louis, Department of Biomedical Engineering, Washington University in St. Louis, 1 Brookings Dr, Mail Box 1097, St. Louis, MO 63130, United States. Electronic address:

Purpose: To assess the impact of adjunctive ultrasound guided diffuse optical tomography (US-guided DOT) on BI-RADS assessment in women undergoing US-guided breast biopsy.

Method: This prospective study enrolled women referred for US-guided breast biopsy between 3/5/2019 and 3/19/2020. Participants underwent US-guided DOT immediately before biopsy. The US-guided DOT acquisition generated average maximum total hemoglobin (HbT) spatial maps and quantitative HbT values. Four radiologists blinded to histopathology assessed conventional imaging (CI) to assign a CI BI-RADS assessment and then integrated DOT information in assigning a CI&DOT BI-RADS assessment. HbT was compared between benign and malignant lesions using an ANOVA test and Tukey's test. Benign biopsies were tabulated, deeming BI-RADS ≥ 4A as positive. Reader agreement was assessed.

Results: Among 61 included women (mean age 48 years), biopsy demonstrated 15 (24.6%) malignant and 46 (75.4%) benign lesions. Mean HbT was 55.3 ± 22.6 µM in benign lesions versus 85.4 ± 15.6 µM in cancers (p < .001). HbT threshold of 78.5 µM achieved sensitivity 80% (12/15) and specificity 89% (41/46) for malignancy. Across readers and patients, 197 pairs of CI BI-RADS and CI&DOT BI-RADS assessments were assigned. Adjunctive US-guided DOT achieved a net decrease in 23.5% (31/132) of suspicious (CI BI-RADS ≥ 4A) assessments of benign lesions (34 correct downgrades and 3 incorrect upgrades). 38.3% (31/81) of 4A assessments were appropriately downgraded. No cancer was downgraded to a non-actionable assessment. Interreader agreement analysis demonstrated kappa = 0.48-0.53 for CI BI-RADS and kappa = 0.28-0.44 for CI&DOT BI-RADS.

Conclusions: Integration of US-guided DOT information achieved a 23.5% reduction in suspicious BI-RADS assessments for benign lesions. Larger studies are warranted, with attention to improved reader agreement.
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http://dx.doi.org/10.1016/j.ejrad.2021.110029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9321946PMC
December 2021

Uncommon Variants of Mature T-Cell Lymphomas (MTCLs): Imaging and Histopathologic and Clinical Features with Updates from the Fourth Edition of the World Health Organization (WHO) Classification of Lymphoid Neoplasms.

Cancers (Basel) 2021 Oct 18;13(20). Epub 2021 Oct 18.

Department of Radiology and Imaging Sciences, Utah University School of Medicine, Salt Lake City, UT 84132, USA.

Understanding the pathogenesis and molecular biology of malignant lymphomas is challenging, given the complex nature and incongruity of these disorders. The classification of lymphoma is continually evolving to account for advances in clinical, pathological, molecular biology and cytogenetic aspects, which impact our understanding of these disorders. The latest fourth edition of the WHO classification of lymphoid malignancies was released in 2016 to account for these changes. Additionally, unlike B-cell lymphomas (BCL), T-cell lymphomas (TCL) are uncommon, and may be sporadically experienced in clinical practice. These disorders are rare, thus early diagnosis is challenging for both physicians and radiologists, owing to the overlap in clinical and imaging features with other, more common disorders. We aim to discuss some rare variants of T-cell lymphomas, including clinicopathologic and imaging features, as well as to give a glimpse of the updates contained within the new 2016 WHO classification.
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http://dx.doi.org/10.3390/cancers13205217DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8534015PMC
October 2021

Correlation between FDG-PET uptake and survival in patients with primary brain tumors.

Am J Nucl Med Mol Imaging 2021 15;11(3):196-206. Epub 2021 Jun 15.

Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, University of Utah Salt Lake, UT, USA.

This study evaluates F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) semi-quantitative analysis as biomarker of tumor aggressiveness and predictor of survival in patients with primary brain tumors. Semi-quantitative analyses (SUVmax, SUVmean) were derived from FDG PET images in 78 patients with suspected recurrence of primary brain tumors based on MRI. SUVmax and the ratio of lesion SUVmax to the SUVmean of contralateral white matter (SUVmax/WM) were measured. A one-way Analysis of Variance (ANOVA), Kaplan-Meier analyses and the log rank test for evaluating statistical significance were utilized. There was statistical significance for time between FDG-PET and patient death. There was a significant difference with respect to FDG-PET time to death between patients with glioblastoma and patients with anaplastic oligodendroglioma, oligodendroglioma, and other histological subtypes. There is significant correlation with SUVmax/WM and patient survival following FDG-PET when a cut-point ratio of 1.90 is used. A 1.90 cut-point ratio of SUVmax/WM was associated with a difference in survival. GBM was associated with a significant difference in terms of reduced survival following FDG PET compared to most other histological sub-types. These results may inform current treatment and counseling strategies for patients with primary brain tumors.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8255218PMC
June 2021

Early Assessment Window for Predicting Breast Cancer Neoadjuvant Therapy using Biomarkers, Ultrasound, and Diffuse Optical Tomography.

Breast Cancer Res Treat 2021 Aug 10;188(3):615-630. Epub 2021 May 10.

Washington University School of Medicine in St Louis, St. Louis, USA.

Purpose: The purpose of the study was to assess the utility of tumor biomarkers, ultrasound (US) and US-guided diffuse optical tomography (DOT) in early prediction of breast cancer response to neoadjuvant therapy (NAT).

Methods: This prospective HIPAA compliant study was approved by the institutional review board. Forty one patients were imaged with US and US-guided DOT prior to NAT, at completion of the first three treatment cycles, and prior to definitive surgery from February 2017 to January 2020. Miller-Payne grading was used to assess pathologic response. Receiver operating characteristic curves (ROCs) were derived from logistic regression using independent variables, including: tumor biomarkers, US maximum diameter, percentage reduction of the diameter (%US), pretreatment maximum total hemoglobin concentration (HbT) and percentage reduction in HbT (%HbT) at different treatment time points. Resulting ROCs were compared using area under the curve (AUC). Statistical significance was tested using two-sided two-sample student t-test with P < 0.05 considered statistically significant. Logistic regression was used for ROC analysis.

Results: Thirty-eight patients (mean age = 47, range 24-71 years) successfully completed the study, including 15 HER2 + of which 11 were ER + ; 12 ER + or PR + /HER2-, and 11 triple negative. The combination of HER2 and ER biomarkers, %HbT at the end of cycle 1 (EOC1) and %US (EOC1) provided the best early prediction, AUC = 0.941 (95% CI 0.869-1.0). Similarly an AUC of 0.910 (95% CI 0.810-1.0) with %US (EOC1) and %HbT (EOC1) can be achieved independent of HER2 and ER status. The most accurate prediction, AUC = 0.974 (95% CI 0.933-1.0), was achieved with %US at EOC1 and %HbT (EOC3) independent of biomarker status.

Conclusion: The combined use of tumor HER2 and ER status, US, and US-guided DOT may provide accurate prediction of NAT response as early as the completion of the first treatment cycle.

Clinical Trial Registration Number: NCT02891681. https://clinicaltrials.gov/ct2/show/NCT02891681 , Registration time: September 7, 2016.
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http://dx.doi.org/10.1007/s10549-021-06239-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8487763PMC
August 2021

Impact of Time Awake and Hours Slept at Night on Radiologists' Mammogram Interpretations: Why We Must Not Burn Out on Radiologist Burnout.

J Am Coll Radiol 2021 05 23;18(5):739-740. Epub 2021 Jan 23.

Breast Imaging and Nuclear Medicine Sections, Department of Radiology and Imaging Sciences, University of Utah, and Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, Salt Lake City, Utah. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2020.12.024DOI Listing
May 2021

Comparison of Country of Origin, Research Collaborations, and Funding for Original Scientific Publications in the Journal from 2009 and 2019.

Radiology 2021 Apr 26;299(1):E221-E222. Epub 2021 Jan 26.

Department of Radiology and Imaging Sciences, Breast Imaging and Nuclear Medicine Sections, University of Utah, Salt Lake City, Utah.

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http://dx.doi.org/10.1148/radiol.2021203836DOI Listing
April 2021

Contrast-Enhanced Mammography Implementation, Performance, and Use for Supplemental Breast Cancer Screening.

Radiol Clin North Am 2021 Jan 29;59(1):113-128. Epub 2020 Oct 29.

Department of Radiology and Imaging Sciences, University of Utah, Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112, USA. Electronic address:

Contrast-enhanced mammography (CEM) is an emerging breast imaging technology that provides recombined contrast-enhanced images of the breast in addition to low-energy images analogous to a 2-dimensional full-field digital mammogram. Because most breast imaging centers do not use CEM at this time, a detailed overview of CEM implementation and performance is presented. Thereafter, the potential use of CEM for supplemental screening is discussed in detail, given the importance of this topic for the future of the CEM community. Diagnostic performance, safety, and cost considerations of CEM for dense breast tissue supplemental screening are discussed.
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http://dx.doi.org/10.1016/j.rcl.2020.08.006DOI Listing
January 2021

Molecular Breast Imaging at Ultra-Low Radiation Dose.

AJR Am J Roentgenol 2020 08;215(2):W30

Northwest Radiology Network, Indianapolis, IN.

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http://dx.doi.org/10.2214/AJR.19.22746DOI Listing
August 2020

Molecular Breast Imaging Under Threat by the Protecting Access to Medicare Act and ACR Appropriate Use Criteria.

J Am Coll Radiol 2020 04 30;17(4):445. Epub 2019 Dec 30.

Breast Imaging and Nuclear Medicine Sections, Department of Radiology and Imaging Sciences University of Utah, Center for Quantitative Cancer Imaging, Huntsman Cancer Institute, 2000 Circle of Hope, Salt Lake City, UT 84112. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2019.11.024DOI Listing
April 2020

FDG PET/CT and Ultrasound Evaluation of Breast Implant-Associated Anaplastic Large Cell Lymphoma.

Clin Nucl Med 2020 Jan;45(1):68-73

From the Breast Imaging.

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare malignancy with isolated case reports of FDG uptake on FDG PET/CT. We present 4 cases of pathology-confirmed BIA-ALCL to illustrate varying presentations and imaging features of this disease process. Breast implant-associated anaplastic large cell lymphoma presents most commonly approximately 10 years after implantation of textured silicone or saline breast implants. Patients may present with breast enlargement, peri-implant effusion, a palpable breast or axillary mass, lymphadenopathy, breast skin erythema, or pain. Diagnosis of BIA-ALCL may be confirmed by sampling of peri-implant fluid or biopsy of peri-implant masses or regional lymph nodes.
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http://dx.doi.org/10.1097/RLU.0000000000002801DOI Listing
January 2020

Comparative Benefit-to-Radiation Risk Ratio of Molecular Breast Imaging, Two-Dimensional Full-Field Digital Mammography with and without Tomosynthesis, and Synthetic Mammography with Tomosynthesis.

Radiol Imaging Cancer 2019 09 27;1(1):e190005. Epub 2019 Sep 27.

Sections of Nuclear Medicine (M.B., M.F.C.) and Breast Imaging (M.F.C.), Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110.

Purpose: To apply previously published benefit-to-risk ratio methods for mammography and molecular breast imaging (MBI) risk estimates to an expanded range of mammographic screening techniques, compressed breast thicknesses, and screening views.

Materials And Methods: Only previously published estimates were used; therefore, this study was exempt from the requirement to obtain institutional review board approval. Benefit-to-risk ratios were calculated as the ratio of breast cancer deaths averted and lives lost to screening over 10-year intervals starting at age 40 years for MBI, two-dimensional (2D) full-field digital mammography (FFDM) alone, 2D FFDM with synthetic mammography, and 2D FFDM with tomosynthesis for two-, four-, and five-view screening mammography and compressed breast thicknesses of 20-29 mm, 50-59 mm, and 80-89 mm.

Results: Central estimates of the benefit-to-risk ratios ranged from 3 to 179 for screening mammography and from 5 to 9 for MBI. Benefit-to-risk ratios for MBI were inferior to those for mammography for most scenarios, but MBI may be performed at an equal or superior benefit-to-risk ratio for women aged 40-59 years with a compressed breast thickness of at least 80 mm and for those undergoing mammographic screening examinations with four or five views per breast. The benefit-to-risk ratios across all ages with use of tomosynthesis plus 2D FFDM as a screening examination were 45% lower than those for tomosynthesis plus synthetic mammography.

Conclusion: Benefit-to-risk ratios for MBI are within the lower range of those for mammography when accounting for variation in mammography technique, compressed breast thickness, and age. Benefit-to-risk ratios of synthetic mammography plus tomosynthesis are superior to those of tomosynthesis plus 2D FFDM. Breast, Mammography, Molecular Imaging, Molecular Imaging-Cancer, Radiation Safety, Radionuclide Studies, Screening, Tomosynthesis© RSNA, 2019See also the commentary by Hruska in this issue.
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http://dx.doi.org/10.1148/rycan.2019190005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983792PMC
September 2019

Incidental Uptake in Benign Gynecomastia on 68Ga-DOTATATE PET/CT.

Clin Nucl Med 2019 Oct;44(10):799-800

From the Breast Imaging.

A 54-year-old man with mesenteric carcinoid tumor metastatic to the liver completed staging Ga-DOTATATE PET/CT demonstrating uptake in multiple hepatic lesions consistent with liver metastases with additional asymmetric increased uptake in the right greater than the left breast. Subsequent bilateral diagnostic mammogram revealed benign right greater than left gynecomastia without suspicious underlying mass. With Food and Drug Administration approval of Ga-DOTATATE and the increased use of this analog in neuroendocrine tumor imaging, this case illustrates a relevant example of uptake that can potentially mimic malignancy.
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http://dx.doi.org/10.1097/RLU.0000000000002597DOI Listing
October 2019

Signs and Artifacts in Amyloid PET.

Radiographics 2018 Nov-Dec;38(7):2123-2133

From the Department of Medical Imaging, University of Arizona/Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5128 (T.F.L., N.E., P.H.K.); Institute for Neurodegenerative Disorders, New Haven, Conn (J.P.S.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (M.F.C.); and Departments of Medicine and Biomedical Engineering, University of Arizona, Tucson, Ariz (P.H.K.).

Establishing a diagnosis of Alzheimer dementia can be challenging, particularly early in the course of the disease. However, with disease-modifying therapies on the horizon, it is becoming increasingly important to achieve the correct diagnosis as soon as possible. In challenging presentations of dementia, such as patients with clinically atypical features or early-age onset of mild cognitive impairment, amyloid PET is a valuable tool in determining the diagnosis of Alzheimer dementia. Furthermore, preliminary data show that amyloid PET findings alter clinical management in patients who meet the appropriate use criteria. There are currently three U.S. Food and Drug Administration (FDA)-approved fluorine 18 (F)-labeled radiopharmaceuticals that allow in vivo detection of cerebral amyloid deposition, which is a hallmark pathologic feature of Alzheimer dementia. Knowledge of the common imaging features among these three F-labeled radiopharmaceuticals in the normal and abnormal brain will enable the radiologist to more accurately interpret amyloid PET studies. As in other subspecialties of radiology, imaging signs in amyloid PET are helpful to distinguish if a region is normal or abnormal. This article reviews appropriate use criteria for amyloid PET, introduces the properties of the radiopharmaceuticals, explains the algorithmic approach to interpretation with examples of normal and abnormal amyloid PET scans with MRI correlation, and provides an atlas of regional amyloid PET signs and common artifacts. RSNA, 2018.
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http://dx.doi.org/10.1148/rg.2018180160DOI Listing
September 2019

Tc-Sulfur Colloid Bone Marrow Scintigraphy in Diagnosis of Diffuse Pulmonary Extramedullary Hematopoiesis Secondary to Myelofibrosis.

J Nucl Med Technol 2018 Dec 8;46(4):368-372. Epub 2018 Jun 8.

Department of Radiology, Mayo Clinic in Arizona, Scottsdale, Arizona.

Our objective was to define the role of combined Tc-sulfur colloid bone marrow (SC BM) scintigraphy, SPECT or SPECT/CT, and chest CT in diagnosing diffuse pulmonary extramedullary hematopoiesis (PEMH) in patients with myelofibrosis. We retrospectively reviewed Tc-SC BM scintigraphy scans performed at our institution for the diagnosis of diffuse PEMH, as well as accompanying chest CT and SPECT/CT imaging findings. Relevant clinical information, including respiratory manifestations, pulmonary hypertension, and subjective response to whole-lung radiation therapy, was also summarized. Twenty-two myelofibrosis patients with 27 Tc-SC BM scintigraphy scans were diagnosed with diffuse PEMH. In 21 patients (95%) with accompanying chest CT and SPECT/CT scans, the most common CT findings were ground-glass opacity, interstitial infiltration, and pleural effusion. Of 20 patients (91%) who underwent 2-dimensional echocardiography studies, 12 (55%) were diagnosed with pulmonary hypertension. All 12 patients exhibited the aforementioned nonspecific CT imaging findings, with 8 (66%) of them presenting with respiratory symptoms, including dyspnea, shortness of breath, and cough. In the remaining 8 patients, without pulmonary hypertension, half had similar respiratory symptoms. Fourteen patients (64%) of this cohort received whole-lung radiation therapy, of whom 7 (50%) experienced symptom relief after therapy. Nonspecific respiratory symptoms should raise concern about pulmonary hypertension and diffuse PEMH in patients with advanced-stage myelofibrosis. Combined Tc-SC BM scintigraphy and SPECT/CT is a promising noninvasive imaging tool to diagnose this rare clinical entity. hematology; respiratory; SPECT/CT; pulmonary hematopoiesis; Tc-99m sulfur colloid scintigraphy; myelofibrosis.
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http://dx.doi.org/10.2967/jnmt.118.210534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6944180PMC
December 2018

American College of Radiology Accreditation, Performance Metrics, Reimbursement, and Economic Considerations in Breast MR Imaging.

Magn Reson Imaging Clin N Am 2018 May;26(2):303-314

Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, Saint Louis, MO 63110, USA. Electronic address:

Accreditation through the American College of Radiology (ACR) Breast Magnetic Resonance Imaging Accreditation Program is necessary to qualify for reimbursement from Medicare and many private insurers and provides facilities with peer review on image acquisition and clinical quality. Adherence to ACR quality control and technical practice parameter guidelines for breast MR imaging and performance of a medical outcomes audit program will maintain high-quality imaging and facilitate accreditation. Economic factors likely to influence the practice of breast MR imaging include cost-effectiveness, competition with lower-cost breast-imaging modalities, and price transparency, all of which may lower the cost of MR imaging and allow for greater utilization.
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http://dx.doi.org/10.1016/j.mric.2017.12.004DOI Listing
May 2018

The Future of Contrast-Enhanced Mammography.

AJR Am J Roentgenol 2018 Feb 24;210(2):292-300. Epub 2017 Oct 24.

1 Department of Radiology, Mayo Clinic, Scottsdale, AZ.

Objective: The purpose of this article is to discuss facilitators of and barriers to future implementation of contrast-enhanced mammography (CEM) in the United States.

Conclusion: CEM provides low-energy 2D mammographic images analogous to digital mammography and contrast-enhanced recombined images that allow assessment of neovascularity similar to that offered by MRI. The utilization of CEM in the United States is currently low but could increase rapidly given the many potential indications for its clinical use.
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http://dx.doi.org/10.2214/AJR.17.18749DOI Listing
February 2018

FDG-PET/CT for Monitoring Response of Melanoma to the Novel Oncolytic Viral Therapy Talimogene Laherparepvec.

Clin Nucl Med 2017 Feb;42(2):114-115

From the Departments of *Medical Imaging, †Dermatology, and ‡Oncology, University of Arizona College of Medicine, Banner University Medical Center Tucson; and §Departments of Medical Imaging, Medicine and Biomedical Engineering, University of Arizona College of Medicine, Tucson, AZ.

61-year-old woman with stage IIIa (T3a N1a M0) left lower leg melanoma with lesions suggestive of in-transit metastases 8 months following wide local excision and femoral nodal dissection. FDG-PET/CT demonstrated 5 FDG-avid in-transit nodal metastases in the distal left leg, confirmed on biopsy. Talimogene laherparepvec (T-VEC) oncolytic immunotherapy consisting of intralesional injections of modified herpes simplex virus-expressing granulocyte-macrophage colony-stimulating factor was completed over 6 months. Subsequent FDG-PET/CT demonstrated reduced or resolved FDG activity in the treated in-transit metastases and a new FDG-avid left thigh in-transit metastasis. FDG-PET/CT can monitor response to T-VEC and potentially other novel viral immunotherapies.
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http://dx.doi.org/10.1097/RLU.0000000000001456DOI Listing
February 2017

Molecular Breast Imaging and the 2016 Update to the ACR Appropriateness Criteria for Breast Cancer Screening.

J Am Coll Radiol 2016 Dec;13(12 Pt A):1408

Department of Radiology, Mayo Clinic, Scottsdale, Arizona.

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http://dx.doi.org/10.1016/j.jacr.2016.09.017DOI Listing
December 2016

Pitfalls in the Performance and Interpretation of Scintigraphic Imaging for Pleuroperitoneal Shunt.

Clin Nucl Med 2016 Nov;41(11):858-861

From the *Department of Medical Imaging, Banner University Medical Center Tucson; and Departments of †Medical Imaging, ‡Medicine, and §Biomedical Engineering, University of Arizona College of Medicine, Tucson, AZ.

Ascites can cause pleural effusions when the peritoneal fluid crosses the diaphragm through a pleuroperitoneal shunt in the setting of hepatic cirrhosis (hepatic hydrothorax) or malignant ascites. Scintigraphic imaging for pleuroperitoneal shunt requires intraperitoneal injection of Tc-SC or Tc-macroaggregated albumin followed by planar imaging of the chest and abdomen. Pleuroperitoneal shunt is confirmed by identifying radiotracer crossing the diaphragm from the peritoneal to pleural space. An atlas of pleuroperitoneal shunt imaging pitfalls is presented to facilitate optimal performance and interpretation of nuclear pleuroperitoneal shunt examinations. Examples include cases of nondiagnostic radiotracer injections, processing errors, and nontarget uptake.
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http://dx.doi.org/10.1097/RLU.0000000000001326DOI Listing
November 2016

Optimal Time Points for Scintigraphic Imaging of Pleuroperitoneal Shunts.

Clin Nucl Med 2016 Oct;41(10):766-8

From the *Department of Medical Imaging, Banner University Medical Center Tucson, University of Arizona College of Medicine, Tucson, AZ; †Department of Radiology & Imaging Sciences, Emory University, Atlanta, GA; and ‡Departments of Medical Imaging, Medicine and Biomedical Engineering, University of Arizona College of Medicine, Tucson, AZ.

Objective: Nuclear imaging can confirm pleuroperitoneal shunt as the cause of pleural effusion. No society guidelines exist for scintigraphic pleuroperitoneal shunt detection. Our institutional protocol was evaluated to determine optimal imaging time points for shunt detection.

Methods: Pleuroperitoneal shunt studies over 4 years were blindly reviewed by 2 nuclear radiologists. Data from blinded review included presence or absence of pleuroperitoneal shunt, laterality of shunt and time points for shunt detection.

Results: Chart review yielded 30 studies. Three cases were excluded because of improper injection. Imaging was positive for pleuroperitoneal shunt in 81% (22/27) of cases. In positive cases, activity was identified in the right hemithorax in 82% (18/22), left hemithorax in 9% (2/22), and bilaterally in 9% (2/22). One-hour imaging demonstrated 91% (20/22) of positive cases. The remaining 2 positive cases were negative at 1 hour but positive after 4 hours. No study was negative at 1 and 4 hours and positive at 24 hours. All negative cases (5/27) were confirmed on 24-hour imaging.

Conclusions: The majority of positive pleuroperitoneal shunt examinations will demonstrate activity in the right hemithorax on 1-hour imaging. Although no case was negative at 1 and 4 hours and positive at 24 hours, imaging at 24 hours may still be necessary to confirm absence of shunt. Therefore, optimal imaging time points consist of early 1-hour and delayed 24-hour images if the 1-hour time point was negative. The 4-hour time point may be considered optional, thereby potentially optimizing patient safety and resource utilization.
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http://dx.doi.org/10.1097/RLU.0000000000001336DOI Listing
October 2016
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