Science to Practice: Can Semiquantitative Contrast-enhanced CT Be Used to Evaluate Hepatic Fibrosis?Jacob Sosna
doi: 10.1148/radiol.12122095pmid: 23264521
Science to Practice: Can Semiquantitative Contrast-enhanced CT Be Used to Evaluate Hepatic Fibrosis? deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/1"; var callbackToken='50557D4A40D21CD'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In Science to Practice: Can Semiquantitative Contrast-enhanced CT Be Used to Evaluate Hepatic Fibrosis? Jacob Sosna , MD Department of Radiology, Hadassah-Hebrew University Medical Center, PO Box 12000, Jerusalem 91120, Israel, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass, [email protected] Summary: Contrast material–enhanced computed tomographic (CT) uptake of conventional and macromolecular iodine-based contrast agents may be used as a semiquantitative marker of liver fibrosis. The Setting Chronic liver disease, the progressive destruction and regeneration of liver parenchyma leading to fibrosis and cirrhosis, ranks among the leading causes of death in the United States, claiming over 30 000 lives annually ( 1 ). The declining clinical status observed during the long progression of cirrhosis from compensated to decompensated states is associated with fibrosis and hepatocyte dysfunction or destruction, as well as worsening hepatic microcirculatory derangement leading to hemodynamic abnormalities and increasing portal pressure. Perfusion imaging may thus be an invaluable asset in evaluating these changes. Over the past few years, the feasibility of assessing liver disease with perfusion imaging modalities such as ultrasonography (US), CT, and magnetic resonance (MR) imaging has been shown, and gross hemodynamic and microcirculatory parameters have been described and correlated clinically and pathologically. However, the clinical and pathologic importance of various perfusion parameters remains to be elucidated. The advancement of medical options in the treatment of hemodynamic complications of cirrhosis has created unexplored potential for new applications of perfusion imaging. Obstacles to the clinical application of hepatic perfusion imaging include lack of study standardization and inadequate understanding of the … (Full Text of this Article)
Changes for Changing TimesHerbert Y. Kressel
doi: 10.1148/radiol.12122201pmid: N/A
Changes for Changing Times deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/3"; var callbackToken='50534A1EE35AE66'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In Changes for Changing Times Herbert Y. Kressel , MD From the Radiology Editorial Office, 800 Boylston St, 15th Floor, Boston, MA 02119. Address correspondence to the author (e-mail: [email protected] ). January marks the beginning of my 5th year as editor of Radiology . It has been a pleasure working with our dedicated cadre of deputy editors, associate editors, reviewers, and authors to continue the fine tradition of scientific excellence established by my predecessors. Over the past 5 years, we have tried to take advantage of the opportunities afforded by evolving Internet communication technologies and the growth of mobile devices to further enrich the journal content and to make it more user friendly for readers and authors. Increasingly, more and more readers are using the online journal either at their computer workstations, or through their mobile devices. At the time of this writing, our mobile app has been downloaded and installed more than 33 500 times. We have also worked to enhance the opportunities for scientific discussion through the Controversies feature; the podcasts, which present discussions among the authors and editors; and enhanced publication of Letters to the Editor. We have also expanded continuing medical education (CME) and self-assessment module (SAM) opportunities for journal readers. We now offer CME with review articles (eg, Review, State of the Art) published each month. The recently inaugurated Radiology Select series, consisting of collections of outstanding articles published in Radiology on a topic of clinical interest, provides readers the opportunity to obtain a large number of CME and SAM credits in each volume. We have been pleased by the response to our Radiology Select publications to date. I would encourage those readers not already familiar with the series to sample one of the first two volumes that are now available. The response from readers and authors to these initiatives has been excellent, and I have been pleased by the ongoing support for our efforts from our readers and from the Radiological Society of North America … (Full Text of this Article)
Radiology Editorial Board 2013Herbert Y. Kressel
doi: 10.1148/radiol.12121881pmid: N/A
Radiology Editorial Board 2013 deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/6"; var callbackToken='5056FD008FEA3CC'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In Radiology Editorial Board 2013 Herbert Y. Kressel , MD , Editor The 2013 Editorial Board of Radiology appears on our masthead. All those whose names are listed are recognized for expertise in their respective area of interest. Moreover, these individuals provide a highly valued service for our Journal, one that helps ensure the quality of the science published in Radiology . Twenty-nine new Associate Editors have been appointed: Body Computed Tomography Vicky J. Goh, MBBChir, MRCP, FRCR, MD, London, England Daniele Marin, MD, Durham, NC Yves M. Menu, MD, Paris, France Breast Imaging Michael H. Fuchsjaeger, MD, Vienna, Austria Anne Tardivon, MD, Paris, France Cardiac Imaging Maythem Saeed, DVM, PhD San Francisco, Calif Emergency Radiology Robert A. Novelline, … (Full Text of this Article)
Editor’s Recognition AwardsHerbert Y. Kressel
doi: 10.1148/radiol.12121993pmid: N/A
Editor’s Recognition Awards deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/8"; var callbackToken='5059EABB7FC66DA'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In Editor’s Recognition Awards Herbert Y. Kressel , MD , Editor The publication of a major peer-reviewed journal such as Radiology requires substantial time and effort by numerous reviewers. Our skilled and dedicated Editorial Board members are recognized each month on the Radiology masthead. I am pleased to make special note of an additional group of individuals who are recognized for the high quality of their prompt, detailed, and scholarly reviews—the recipients of the 2012 Editor’s Recognition Award. Each awardee will receive a certificate and letter of congratulations. If desired by the awardee, the letter will be copied to the recipient’s department chair and, if from an academic center, to the medical school dean to underscore the importance of reviewing as an academic activity. Note that the individuals listed on the 2012 masthead for Radiology were not eligible for these awards. With Special Distinction Alex M. Aisen, MD Frederik Barkhof, MD Andrew M. Blamire, PhD Chris Boesch, MD, PhD Florian M. Buck, MD Harry J. Cloft, MD, PhD Jonathan … (Full Text of this Article)
2012 RSNA Outstanding ResearcherGeorge S. Bisset III
doi: 10.1148/radiol.12124047pmid: N/A
2012 RSNA Outstanding Researcher deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/10"; var callbackToken='505CD17DECE56DD'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In 2012 RSNA Outstanding Researcher George S. Bisset III , MD From the Radiological Society of North America, 820 Jorie Blvd, Oak Brook, IL 60523. Address correspondence to Marian Strassner (e-mail: [email protected] ). Inspired by a lifelong fascination with the central nervous system, world-renowned neuroradiologist A. James Barkovich, MD, has changed the landscape of pediatric neuroradiology through his visionary research in neonatology, metabolic disease, medical genetics, and epilepsy. Dr Barkovich is a professor of radiology and biomedical imaging, neurology, pediatrics and neurosurgery and is chief of pediatric neuroradiology at the University of California at San Francisco (UCSF), where he helped pioneer the use of magnetic resonance (MR) imaging to search for evidence of injury or abnormal development in the brains of newborns. His research greatly contributed to the decreased frequency of neonatal brain injury and the improved outcomes of injured neonates over the past 20 years. “I feel very fortunate to have spent my professional life practicing radiology and studying the development of the brain; I can’t imagine a more interesting and rewarding career,” Dr Barkovich said. “This recognition from RSNA is really a tribute to all of my students and colleagues who have been … (Full Text of this Article)
Sarah S. Donaldson, MD, President, Radiological Society of North America, 2013Richard T. Hoppe
doi: 10.1148/radiol.12124057pmid: N/A
Sarah S. Donaldson, MD, President, Radiological Society of North America, 2013 deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/12"; var callbackToken='5059FD2EB189534'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In Sarah S. Donaldson, MD, President, Radiological Society of North America, 2013 Richard T. Hoppe , MD It is my honor to introduce Sarah S. Donaldson, MD, a world-renowned expert in pediatric radiation oncology, an influential educator, and a leader in reinforcing relationships between radiation oncologists and radiologists, as the new president of the Radiological Society of North America (RSNA). Sarah is the Catharine and Howard Avery Professor in the Department of Radiation Oncology at the Stanford University School of Medicine (Stanford, Calif). She serves as associate residency program director of radiation oncology at Stanford Hospital and Clinics and is chief of the radiation oncology service at Lucile Salter Packard Children’s Hospital at Stanford. Sarah has blazed trails from the very beginning of her distinguished career. In an interview with the American Association for Women Radiologists (AAWR)—which bestowed on her its Marie Sklodowska-Curie Award in 1998—she recalled how the doctor who first hired her as a research nurse challenged her assumptions that she lacked the qualifications—she was a woman, too old, and did not have enough money—to go to medical school. In fact, not only was she accepted into medical school, but she excelled in her performance. Sarah S. Donaldson, MD “Having a supportive and successful mentor was my good fortune,” Dr Donaldson said of William S. Fletcher, MD, a surgical oncologist at Oregon Health Sciences University (Portland, Ore) and her first employer. “Recognizing that Dr Fletcher was behind my own successes every step of the way influenced … (Full Text of this Article)
A Statement about Authorship from Individual Members of the International Society for Strategic Studies in RadiologyGabriel P. Krestin
doi: 10.1148/radiol.12124052pmid: 23264522
A Statement about Authorship from Individual Members of the International Society for Strategic Studies in Radiology deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/14"; var callbackToken='5056425B2FBD0D1'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In A Statement about Authorship from Individual Members of the International Society for Strategic Studies in Radiology Hedvig Hricak , MD, PhD, Dr(hc) , Christian J. Herold , MD and Gabriel P. Krestin , MD, PhD From the International Society for Strategic Studies in Radiology, 1891 Preston White Dr, Reston, VA 20191. Address correspondence to H.H. (e-mail: [email protected] ). There has been much recent discussion ( 1 , 2 ) about what constitutes appropriate authorship for scientific articles. Indeed, recent exposés in the press and elsewhere about “gift,” “honorary,” and even “ghost” authorship have led to lawsuits, other forms of litigation, and the ruin of the careers of some dedicated health professionals. In many cases, improper assignment of authorship is due to naivety or oversight; but in some cases, it is undertaken knowingly and, at worst, for ultimate financial gain. The International Committee of Medical Journal Editors (ICMJE) has … (Full Text of this Article)
Perfusion Imaging in Acute Ischemic Stroke: Let Us Improve the Science before Changing Clinical PracticeColin P. Derdeyn
doi: 10.1148/radiol.12112134pmid: 23264523
Perfusion Imaging in Acute Ischemic Stroke: Let Us Improve the Science before Changing Clinical Practice deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/16"; var callbackToken='505D069B080125F'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In Perfusion Imaging in Acute Ischemic Stroke: Let Us Improve the Science before Changing Clinical Practice Mayank Goyal , MD, FRCPC , Bijoy K. Menon , MD, DM and Colin P. Derdeyn , MD From the Departments of Radiology and Clinical Neurosciences and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada (M.G., B.K.M.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (C.P.D.). Address correspondence to M.G., Department of Radiology, Foothills Medical Centre, 1403 29th St NW, Calgary, AB, Canada T2N 2T9 (e-mail: [email protected] ). Reperfusion is the only proved effective therapy for patients with acute ischemic stroke ( 1 ). There is an urgent need for improvement in acute stroke care, as only 15%–20% of patients, at best, are eligible for intravenous tissue plasminogen activator (tPA), and many patients so treated do not achieve good clinical outcome ( 2 , 3 ). This need has resulted in an enormous amount of research about developing better methods of revascularization and neuroprotection and designing better imaging paradigms for patient selection. A key element of these advanced imaging paradigms is perfusion imaging. We intend to bring focus on the extent of our current knowledge on the imaging triaging of acute ischemic stroke patients by using perfusion imaging and to make recommendations for practice and clinical research. Our position is that perfusion imaging should not be used outside of clinical studies seeking to establish the utility of these measurements. We do not intend to focus on the utility of perfusion imaging in other relevant clinical scenarios where this imaging modality has defined its role, and neither do we intend to go into detail on the mathematic constructs behind these techniques. Definitions of Core, Penumbra, and Benign Oligemia The core is tissue that is already dead at the time of imaging. For our purpose, we shall define penumbra as ischemic, nonfunctioning but living brain tissue that will die unless blood flow is restored. Benign oligemia is tissue that is underperfused but functioning normally and that will survive irrespective of improvement in blood supply ( 4 – 6 ). The first indication of the presence of penumbra in ischemic brain tissue came from electrophysiologic studies in animals. In a series of experiments in cats, Hossman et al ( 7 ) reported the restoration of electrical activity in individual neurons with the restoration of cerebral blood flow. They also found that the longer the duration … (Full Text of this Article)
Perfusion Imaging of Acute Stroke: Its Role in Current and Future Clinical PracticeMichael H. Lev
doi: 10.1148/radiol.12121355pmid: 23264524
Perfusion Imaging of Acute Stroke: Its Role in Current and Future Clinical Practice deepdyve.host = 'www.deepdyve.com'; // replace with an affiliateId that we provide deepdyve.affiliateId = "highwire-rsnajnls"; // the div to fill in with the rental link deepdyve.divId = 'rentalLink'; // this is the anchor text for the rental link deepdyve.rentText = "Rent Article for $0.99"; // document identifier and identifier type deepdyve.fieldName = 'journal_mjid'; deepdyve.docId = "radiology;266/1/22"; var callbackToken='5058EFED36286A4'; var subCode='rsnajnl_sub'; var subScriptionType = 'legacysubs'; GS_googleAddAdSenseService("ca-pub-3649609630781117"); GS_googleEnableAllServices(); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-homepage-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-leaderboard-728x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-nonarticlepages-upper_right-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-podcasts-upper_right-120x90"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_one-120x300"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_two-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_three-125x125"); GA_googleAddSlot("ca-pub-3649609630781117", "radiology-toc_ad_four-125x125"); GA_googleFetchAds(); var journalCode = 'radiology'; Skip to main page content HOME CURRENT ARCHIVE COLLECTIONS 中国 (ABSTRACTS) RADIOLOGY SELECT RADIOGRAPHICS RSNA.org Search GO Advanced Search Institution: DeepDyve Sign In as Member / Individual User Name Password Sign In Perfusion Imaging of Acute Stroke: Its Role in Current and Future Clinical Practice Michael H. Lev , MD From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2622. Address correspondence to the author. The role of advanced imaging in patient selection for intravenous thrombolytic and endovascular acute stroke treatment—and of computed tomographic (CT) perfusion imaging in particular—are currently being hotly debated ( 1 – 4 ). In their accompanying counterpoint article in this issue of Radiology, Goyal et al ( 5 ) argue that we do not as yet have a proven imaging method to identify salvageable brain tissue and that the use of perfusion CT and magnetic resonance (MR) imaging to guide patient treatment in clinical practice is not entirely supported by evidence. They conclude that “perfusion imaging should not be used outside of clinical studies seeking to establish the utility of these measurements.” I certainly agree that the “science” of perfusion imaging should be optimized before altering standards of care. Currently, perfusion imaging is a “tower of Babel”; standardization and validation of both MR and CT perfusion imaging are required so that published acquisition, postprocessing, and interpretation protocols can be confidently shared among different groups, using different vendor and software platforms. This is especially true with regard to accurate quantification of perfusion parameter threshold values and ischemic lesion volumes. I equally agree that unnecessary imaging must not slow acute stroke treatment, as “time is brain.” Because an average of roughly 2 million neurons are lost per minute of severe ischemia, definitive “clot busting” reperfusion treatments must never be delayed—not even for minutes—by diagnostic imaging that is not absolutely essential for safe and effective therapeutic triage ( 6 ). Indeed, the algorithm for patient selection at my institution (the topic of a recent review (3)) calls for immediate intravenous thrombolysis following unenhanced CT to rule out hemorrhage, and deferring perfusion imaging if it will slow definitive endovascular therapy. In this context, two points are worth noting: (a) There is huge variability in the actual rate at which neurons … (Full Text of this Article)