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Radiology's Latest Advances Recently On Display In Chicago
Every year during the week after Thanksgiving, the largest medical meeting in the world - the Radiological Society of North America (RSNA) - takes place at Chicago's McCormick Place. The 92nd annual RSNA meeting just concluded on December 1st, and a couple of the highlights which may impact diagnostic imaging at Northwest Community are summarized below.
Cardiac CT Takes Center Stage
With interest in cardiac CT continuing to increase, it should not be surprising that nearly 100 scientific papers specifically dedicated to this topic were presented at the RSNA.
New and emerging technologies always come with appropriate concerns regarding cost, and cardiac CT is no exception. Researchers from Germany performed a cost-effective analysis of tests commonly utilized to diagnose coronary artery disease (CAD). They found that when the pretest likelihood of CAD is less than 50%, coronary CT angiography (CTA) is more cost-effective than traditional catheter angiography. Only when the pretest likelihood of CAD was high (>60%) did traditional angiography perform better.
Researchers from South Carolina presented data on extracardiac findings identified on cardiac CT studies. Of all cardiac CT examinations performed at the authors' institution, 19.7% had extracardiac findings which warranted further evaluation. These findings were significantly more commonly encountered on coronary CTA studies than on calcium scoring examinations.
Northwest Community is waiting to offer coronary CTA to the general public until a new state-of-the-art multidetector CT scanner is installed next year. However, we currently are performing calcium scoring CT studies at both the Hospital and the Schaumburg Imaging Center, and we have encountered similar concerning extracardiac findings.
Calcium scoring CT study on a 45-year-old male. Extensive calcified and enlarged mediastinal lymph nodes (white areas) are present and suggestive of sarcoidosis.
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Calcium scoring CT study on a 55-year-old female. An unsuspected liver lesion (red arrows) is partially imaged.
Milk Potentially Useful As An Enteric CT Contrast Agent
The traditional oral contrast agents used for abdominal CT examinations contain barium and appear white on the CT images. While these products have been used successfully for decades and clearly delineate bowel, their increased density creates unwanted artifacts when CT is performed concurrently with PET and also when reformatted CT images are generated to highlight other high density structures such as bone (eg, 3D images to better define fractures) or opacified blood vessels (eg, abdominal CTA studies). Because of this, contrast manufacturers have recently developed products which create "negative" enteric contrast. These agents appear dark grey on the CT images and do not cause such artifacts. They also are better able to assess intrinsic bowel pathology than the traditional high density agents.
Cost has been a prohibitive factor in the widespread utilization of these negative contrast agents. Researchers from New York City compared milk (a negative contrast agent because of its fat content) to a commercially available product. They found image quality to be comparable, but with milk costing much less per patient, $1.39 vs. $18. The patients in their study also preferred the taste of milk, and this may be of particular use with pediatric abdominal CT.
Milk has shown promise as a less expensive - and tastier - alternative to the traditional enteric CT contrast agents.
For more information about Northwest Radiology Associates, the services we provide, and how to contact individual radiologists, please visit our web site: northwestradiologyassociates.com.
If you wish to be added to our distribution list, please contact: ckalbhen@northwestradiologyassociates.com . We also welcome your questions and comments.
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