Radiological Society of North America (RSNA) 2009 Annual Meeting: Slideshow

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Fran Lowry
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Medscape

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TheHeart.org

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The Radiological Society of North America 95th Scientific Assembly and Annual Meeting took place November 29 through December 4, 2009, at McCormick Place in Chicago, Illinois. Highlights from the meeting discussed in this slideshow are:

elastography to reduce unnecessary breast biopsies,
use of MRI to detect placenta accreta,
debate on the new USPSTF guidelines on mammography for breast cancer screening,
use of ultrasound plus mammography to identify breast cancer,
percutaneous disc decompression for long-term relief of sciatica pain,
the connection between childhood lead exposure and permanent brain damage,
smart phones for the diagnosis of acute appendicitis,
the ability of elastography with high-frequency ultrasound to distinguish benign from malignant skin lesions,
use of MRI in determining disc disease in overweight and obese children,
and how an automated cardiac-CT reader can help diagnose chest-pain patients in the emergency department in off hours.

Despite a slow economy, attendance of the RSNA 95th Scientific Assembly and Annual Meeting set a new record. Organizers estimated overall attendance at approximately 60,000.

"We must focus on methods to extract quantitative data about whatever anatomical or biochemical properties our imaging systems signify are present," said Daniel C. Sullivan, MD, professor of radiology at Duke University Medical Center, Durham, North Carolina; coordinator of imaging facilities for the Duke Comprehensive Care Center; and director of the Imaging Core of the Duke Clinical and Translational Science Aware Program, during the Annual Oration in Diagnostic Radiology.

Elastography imaging performed during breast ultrasound is extremely helpful in evaluating breast lesions and selecting patients who need a biopsy, according to new research. "If it is a cancer, it will measure bigger on the elastogram because elastography measures stiff tissue - not just the tissue that is seen on ultrasound, but the stiffness around the mass - and cancers tend to be stiff," said Stamatia Destounis, MD, University of Rochester School of Medicine, New York. Healthy tissue and benign cysts are more compressible and therefore appear smaller on elastography.

Magnetic resonance imaging (MRI) is a useful and accurate adjunct to ultrasound for the diagnosis of placenta accreta, one of the top causes of maternal and fetal deaths in the United States, according to the results of a study presented at the RSNA meeting. "We found that MRI had a higher accuracy than ultrasound in detection of placenta accreta," said lead researcher Reena Malhotra, MD, University of California, San Diego. "Detection of placenta accreta prior to delivery is absolutely crucial."

New US Preventive Services Task Force (USPSTF) guidelines recommending routine screening mammograms for breast cancer biennially beginning at age 50 rather than annually beginning at age 40 has sparked a heated response from radiologists and other healthcare professionals. RSNA's position statement on screening mammography is starkly opposed to the USPSTF guidelines.

A variety of experts discussed with Medscape Radiology the new US Preventive Services Task Force (USPSTF) guidelines on breast cancer screening, which recommend mammography every other year in women 50 to 74 years old instead of starting at age 40 years. They warned that the new guidelines will result in an increased number of deaths from breast cancer.

Ultrasound plus mammography screening annually is significantly more efficient than mammography alone in detecting early-stage breast cancer in women who are at elevated risk for the disease, Wendie A. Berg, MD, PhD, American Radiology Services, Johns Hopkins at Green Spring Station, Lutherville, Maryland, told attendees of RSNA 2009.

Minimally invasive percutaneous disc decompression was superior to traditional, conservative treatment for herniated lumbar discs. Results were durable over 2 years of follow-up in this first-ever randomized controlled trial comparing the 2 therapies, Greek researchers announced.

Increased mean blood lead levels were associated with decreased circuit activity in posterior portions of the parietal cortex, including the bilateral precuneus and posterior cingulate, reported Kim Cecil, PhD, professor of radiology, pediatrics and neuroscience at the University of Cincinnati College of Medicine and Cincinnati Children's Hospital Medical Center. "Men's brains had greater decrements, greater loss of activity, according to their levels of blood lead. They also had greater amounts of compensation by recruiting additional areas in the brain."

Acute appendicitis can be accurately diagnosed remotely with a handheld device or mobile phone equipped with special software, according to a new study. Researchers took CT images of 25 patients suspected of having appendicitis and sent them via iPhone to 5 radiology residents. The residents were then asked to make a diagnosis based on what they could see on their phones. Only 1 reader failed to make the right diagnosis. In every other case, the residents correctly determined that 15 of the patients were suffering from appendicitis and that 10 of the patients did not have appendicitis and did not require treatment. Asim Choudhri, MD, a fellow in neuroradiology at Johns Hopkins who performed the study while at the University of Virginia in Charlottesville, presented the findings at the RSNA annual meeting.

"High-frequency ultrasound with elastography has the potential to improve the efficiency of skin cancer diagnosis," said lead author Eliot L. Siegel, MD, vice chairman of the Department of Radiology, University of Maryland School of Medicine, Baltimore. "It successfully delineated the extent of lesions and was able to provide measurable differentiation among a variety of benign and malignant lesions."

Overweight and obese adolescents who came to an emergency department for severe back pain had a high incidence of lumbar disc herniation, a team from Montefiore Medical Center, Bronx, New York, reported. MRI of the spine was abnormal in 66% of children with body mass indices above the 75th percentile, said Judah G. Burns, MD, a fellow in diagnostic neuroradiology at Montefiore. "Disc herniation and spinal disease are generally thought of as a problem of older people, but we're seeing it in obese youngsters, too."

Automated cardiac CT-analysis software has a high negative predictive value and may help move patients quickly through the emergency department, a small study at Beth Israel Deaconess Medical Center, Boston, Massachusetts, shows. "The automated analyzer could have a role as a second reader in the emergency-department setting as an aid to normal expert CCTA readers. It's available at all hours, it interprets raw data — there's no waiting for 3D reformats — and there are cost savings to be had from rapid triage of this group of patients," explained Girish Tyagi, MD, from Beth Israel Deaconess Medical Center in Boston, Massachusetts.