OBJECTIVE: To evaluate the performance of 1.5 T true fast imaging with steady state precession (TrueFISP) magnetic resonance imaging (MRI) sequences for the detection and characterization of pulmonary abnormalities caused by coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: In this retrospective single-center study, computed tomography (CT) and MRI scans of 20 patients with COVID-19 pneumonia were evaluated with regard to the distribution, opacity, and appearance of pulmonary lesions, as well as bronchial changes, pleural effusion, and thoracic lymphadenopathy. McNemar’s test was used in order to compare the COVID-19-associated alterations seen on CT with those seen on MRI. RESULTS: Ground-glass opacities were better visualized on CT than on MRI (p = 0.031). We found no statistically significant differences between CT and MRI regarding the visualization/characterization of the following: consolidations; interlobular/intralobular septal thickening; the distribution or appearance of pulmonary abnormalities; bronchial pathologies; pleural effusion; and thoracic lymphadenopathy. CONCLUSION: Pulmonary abnormalities caused by COVID-19 pneumonia can be detected on TrueFISP MRI sequences and correspond to the patterns known from CT. Especially during the current pandemic, the portions of the lungs imaged on cardiac or abdominal MRI should be carefully evaluated to promote the identification and isolation of unexpected cases of COVID-19, thereby curbing further spread of the disease.

Keywords: Thorax; Tomography, spiral computed; Magnetic resonance imaging; Pneumonia; Coronavirus infections.

Objective: To describe the safety and efficacy of prostatic artery embolization (PAE) in patients with a markedly enlarged prostate. Materials and Methods: This was a retrospective study including 18 consecutive patients (mean age, 74 years) with benign prostatic hyperplasia, all with a prostate volume ≥ 200 cm³, who were enrolled to receive PAE for the treatment of moderate-to-severe lower urinary tract symptoms. Results: The PAE procedure was technically successful in 17 patients (94.4%). During follow-up, clinical failure (defined as an International Prostate Symptom Score [IPSS] ≥ 8) was observed in two (11.1%) of those 18 patients. At 3 months of follow-up, there was significant improvement over baseline in all relevant outcome measures: total IPSS (from 15.7 to 2.9); IPSS quality of life score (from 5.2 to 1.0); prostate specific antigen (from 11.4 to 1.82 ng/mL); peak urinary flow rate (from 7.45 to 18.6 mL/s); prostate volume (from 252.4 to 151.6 cm³); and post-void residual volume (from 143.7 to 28.3 mL)—p < 0.05 for all. Of the 18 patients, one (5.6%) presented detachment of prostate tissue and self-limited hematuria, which did not require specific treatment. Conclusion: In patients with a markedly enlarged prostate, PAE proved to be safe and effective, resulting in significant improvements in clinical, imaging, and urodynamic parameters.

Keywords: Prostate/blood supply; Embolization, therapeutic; Prostatic hyperplasia/diagnostic imaging; Lower urinary tract symptoms; Severity of illness index; Quality of life.

OBJECTIVE: To establish the diagnostic performance of diffusion-weighted magnetic resonance imaging (DWI) in discriminating malignant from non-malignant thoracic lymph nodes. MATERIALS AND METHODS: This was a meta-analysis involving systematic searches of the MEDLINE, EMBASE, and Web of Science databases up through April 2020. Studies reporting thoracic DWI and lymph node evaluation were included. The pooled sensitivity, specificity, diagnostic odds ratio, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (AUC) were calculated. RESULTS: We evaluated six studies, involving a collective total of 356 mediastinal lymph nodes in 214 patients. Thoracic DWI had a pooled sensitivity and specificity of 92% (95% confidence interval [95% CI]: 71–98%) and 93% (95% CI: 79–98%), respectively. The positive and negative likelihood ratios were 13.2 (95% CI: 4.0–43.8) and 0.09 (95% CI: 0.02–0.36), respectively. The diagnostic odds ratio was 149 (95% CI: 18–1,243), and the AUC was 0.97 (95% CI: 0.95–0.98). CONCLUSION: DWI is a reproducible technique and has demonstrated high accuracy for differentiating between malignant and benign states in thoracic lymph nodes.

Keywords: Diffusion magnetic resonance imaging; Lymphadenopathy; Lymph nodes/diagnostic imaging; Thoracic neoplasms/diagnosis; Magnetic resonance imaging; Meta-analysis.

OBJECTIVE: To determine whether technetium-99m-labeled tropane derivative single-photon emission computed tomography (^99mTc-TRODAT-1 SPECT) provides results comparable to those of the less widely available, less accessible tool fluorine-18-labeled fluorodopa positron-emission tomography (¹⁸F-FDOPA PET) in the setting of a movement disorders clinic. MATERIALS AND METHODS: In this prospective pilot study, eight subjects with a clinical diagnosis of Parkinson’s disease were randomly selected from among patients under treatment at a movement disorders clinic and submitted to ^99mTc-TRODAT-1 SPECT and ¹⁸F-FDOPA PET. The results were read by two experienced observers, and a semiquantitative analysis was performed. RESULTS: The visual and semiquantitative analyses were concordant for all studies, showing that radiotracer uptake in the contralateral striatum on the most affected side was lower when ^99mTc-TRODAT-1 SPECT was employed. The semiquantitative analysis demonstrated a significant correlation between ¹⁸F-FDOPA PET and ^99mTc-TRODAT-1 SPECT (r = 0.73; p < 0.01). CONCLUSION: It appears that ^99mTc-TRODAT-1 SPECT is a valid option for the study of dopaminergic function in a clinical setting.

Keywords: Parkinson disease/diagnostic imaging; Parkinsonian disorders/diagnostic imaging; Tomography, emission-computed, single-photon/methods; Positron-emission tomography/methods; Tropanes/pharmacokinetics; Dihydroxyphenylalanine/analogs & derivatives.

OBJECTIVE: The objective of this study was to allow physicians with self-diagnosed gadolinium deposition disease symptoms to report their own experience. MATERIALS AND METHODS: Nine physicians (seven females), with a mean age of 50.5 ± 8.3 years, participated in this case series. Nationalities were American (n = 6), British, Portuguese, and Romanian. Medical practices included internal medicine (n = 2), trauma surgery, ophthalmology, gastroenterology, psychiatry, family medicine, obstetrics/gynecology, and general practice. RESULTS: Genetically, eight of the physicians were of central European origin. Underlying autoimmune conditions were present in four. Symptoms developed after a single injection in one physician and after multiple injections in eight. The precipitating agent was gadobenate dimeglumine in four physicians, gadobutrol in three, gadoterate meglumine in one, and gadopentetate dimeglumine in one. The most consistent symptoms were a burning sensation, brain fog, fatigue, distal paresthesia, fasciculations, headache, and insomnia. Eight of the physicians were compelled to change their practice of medicine. CONCLUSION: In the various physicians, gadolinium deposition disease showed common features and had a substantial impact on daily activity. Physicians are educated reporters on disease, so their personal descriptions should spark interest in further research.

Keywords: Gadolinium/adverse effects; Gadolinium DTPA/adverse effects; Physicians; Contrast media/adverse effects.

There is great optimism that artificial intelligence (AI), as it disrupts the medical world, will provide considerable improvements in all areas of health care, from diagnosis to treatment. In addition, there is considerable evidence that AI algorithms have surpassed human performance in various tasks, such as analyzing medical images, as well as correlating symptoms and biomarkers with the diagnosis and prognosis of diseases. However, the mismatch between the performance of AI-based software and its clinical usefulness is still a major obstacle to its widespread acceptance and use by the medical community. In this article, three fundamental concepts observed in the health technology industry are highlighted as possible causative factors for this gap and might serve as a starting point for further evaluation of the structure of AI companies and of the status quo.

Keywords: Artificial intelligence/supply & distribution; Industry/organization & administration; Software/trends; Delivery of health care/trends; Diagnosis, computer-assisted/trends.

Active surveillance (AS) is an important strategy to avoid overtreatment of prostate cancer (PCa) and has become the standard of care for low-risk patients. The role of magnetic resonance imaging (MRI) in AS has expanded due to its ability to risk stratify patients with suspected or known PCa, and MRI has become an integral part of the AS protocols at various institutions. A negative pre-biopsy MRI result is associated with a very high negative predictive value for a Gleason score ≥ 3+4. A positive MRI result in men who are otherwise eligible for AS has been shown to be associated with the presence of high-grade PCa and therefore with ineligibility. In addition, MRI can be used to guide and determine the timing of per-protocol biopsy during AS. However, there are several MRI-related issues that remain unresolved, including the lack of a consensus and guidelines; concerns about gadolinium deposition in various tissues; and increased demand for higher efficiency and productivity. Similarly, the need for the combined use of targeted and systematic sampling is still a matter of debate when lesions are visible on MRI. Here, we review the current AS guidelines, as well as the accepted roles of MRI in patient selection and monitoring, the potential uses of MRI that are still in question, and the limitations of the method.

Keywords: Prostatic neoplasms/diagnostic imaging; Watchful waiting/methods; Magnetic resonance imaging/methods; Neoplasms/diagnostic imaging.

The aim of this study was to compare virtual reality simulation with other methods of teaching interventional radiology. We searched multiple databases—Cochrane Library; Medline (PubMed); Embase; Trip Medical; Education Resources Information Center; Cumulative Index to Nursing and Allied Health Literature; Scientific Electronic Library Online; and Latin-American and Caribbean Health Sciences Literature—for studies comparing virtual reality simulation and other methods of teaching interventional radiology. This systematic review was performed in accordance with the criteria established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the Best Evidence Medical Education (BEME) Collaboration. Eligible studies were evaluated by using the quality indicators provided in the BEME Guide No. 11 and the Kirkpatrick model of training evaluation. After the eligibility and quality criteria had been applied, five randomized clinical trials were included in the review. The Kirkpatrick level of impact varied among the studies evaluated, three studies being classified as level 2B and two being classified as level 4B. Among the studies evaluated, there was a consensus that virtual reality aggregates concepts and is beneficial for the teaching of interventional radiology. Although the use of virtual reality has been shown to be effective for skill acquisition and learning in interventional radiology, there is still a lack of studies evaluating and standardizing the employment of this technology in relation to the numerous procedures that exist within the field of expertise.

Keywords: Radiology, interventional; Virtual reality; Education, medical; Simulation training.

Almost two decades ago, it became possible to use coronary computed tomography for the noninvasive assessment of the coronary arteries. That is an extremely accurate method for detecting or excluding coronary artery disease, even the subclinical forms. This pictorial essay aims to show the main imaging findings in 47 coronary computed tomography scans acquired at a general hospital between January 2014 and June 2018. The most common findings were atheromatous plaques (in 87%) and stents (in 34%). There were also incidental findings, not directly related to coronary artery disease, such as pulmonary nodules and aortic stenosis.

Keywords: Multidetector computed tomography; Coronary angiography/methods; Coronary artery disease/diagnostic imaging.

Radiotherapy plays a central role in the palliative and curative treatment of neoplasms of the chest wall or intrathoracic structures. However, despite technical advances, radiotherapy can alter previously normal organs and tissues, those alterations presenting as various types of imaging findings. Post-radiation alterations must be promptly recognized by radiologists, in order to avoid confusion between complications of radiotherapy and the recurrence of a tumor. This pictorial essay aims to illustrate different thoracic changes after radiotherapy.

Keywords: Radiotherapy; Tomography, X-ray computed; Magnetic resonance imaging; Diagnostic imaging; Thoracic neoplasms.

Pancreas transplantation is a well-established treatment for patients with complicated diabetes mellitus and advanced renal failure. The most common procedure is simultaneous pancreas-kidney transplantation, in which the pancreas graft is positioned in the right pelvic region and the kidney graft is positioned in the left iliac fossa. Various imaging methods are used for the post-transplantation evaluation of the graft parenchyma and vascular anatomy, as well as for the identification of possible complications. As the number of cases increases, it is fundamental that radiologists understand the surgical procedure and the postoperative anatomy, as well as to recognize the possible postoperative complications and their imaging aspects, with the aim of providing the best guidance in the postoperative management of transplant recipients.

Keywords: Pancreas transplantation; Kidney transplantation; Organ transplantation; Diabetes mellitus; Postoperative complications.