Enhancement criteria rather than other size-based imaging guidelines can more accurately predict treatment response and long-term survival in patients with hepatocellular carcinoma (HCC) treated with chemoembolization. Using a modified version of Response Evaluation Criteria in Solid Tumors guidelines in a study of 332 patients with intermediate stage HCC and Child-Pugh A cirrhosis, Shim and colleagues found that enhancement criteria showed good intercriterion agreement with the European Association for the Study of the Liver guidelines than conventional size criteria for predicting survival after chemoembolization. These guidelines can be rapidly and effortlessly applied to clearly evaluate tumor responses to chemoembolization in clinical practice, the researchers concluded.

For small hepatocellular carcinomas (HCCs), transcatheter arterial chemoembolization (TACE) followed by radiofrequency (RF) ablation yields better survival rates than RF ablation alone. In a study of 139 patients with recurrent HCC, Peng and colleagues found that 1-, 3-, and 5-year overall survival rates were 94%, 69%, and 46%, respectively, for patients who underwent both treatments, compared with 82%, 47%, and 36% for patients who underwent RF ablation only. The researchers also found significant differences in recurrence-free survival rates. The efficacy of sequential TACE and RF ablation is better than that of RF ablation alone for recurrent HCC measuring 5 cm or smaller, the researchers concluded.

In patients with ileal Crohn disease (CD), two contrast-enhanced US parameters (maximum peak intensity [MPI] and wash-in slope coefficient [β]) can measure mural microvascularity and depict disease activity. De Franco and colleagues found that MPI and β coefficient were greater in 36 patients with clinically active CD than in 18 patients with inactive disease. The sensitivity for detecting active ileal CD was 97% for MPI and 86% for the β coefficient. Contrast-enhanced US of the ileal wall is a promising method for objective assessment of disease activity in patients with ileal CD, the researchers concluded.

A normative model based on the variability of growth rates measured in lung nodules enabled identification of lung cancer. Measuring the growth rates of 123 lung nodules using a 3D semiautomated computer-assisted volume method in 59 patients who had undergone lung cancer screening CT, Ko and colleagues determined that growth rates demonstrated decreased variability as time intervals between CT scans increased, ranging from 47.0% per year at an interval of 0.5 year to 19.6% per year at an interval of 2 years. By using 3D volumetry, growth rate–based diagnosis of malignancy was made at a mean of 183 days, compared with radiologic or clinical diagnosis at 344 days. The researchers concluded that the model can potentially be used for surveillance of lung nodules suspected of being malignant by differentiating normal from abnormal growth rates and may assist in monitoring solid and subsolid nodules for significant growth.

Digital subtraction CT angiography with a dual-source CT scanner has a high diagnostic accuracy in depicting intracranial aneurysms compared with 3D digital subtraction angiography, even for aneurysms of less than 3 mm in diameter. In a study of 513 patients, Lu and colleagues found that digital subtraction CT angiography had 97.8% sensitivity and 88.7% specificity in depicting intracranial aneurysms on a per-patient basis. Digital subtraction CT angiography should be the preferred noninvasive modality for evaluating intracranial aneurysms in patients with acute subarachnoid hemorrhage because of its high diagnostic accuracy and short scan time, the researchers concluded.

Current MR imaging is not sensitive or specific in diagnosis of acute whiplash injury. In a study of 100 patients involved in a motor vehicle accident, Anderson and colleagues found that in all but the most severe cases 1.5-T MR findings in patients with symptomatic injury were quite similar to those in age-matched control subjects without trauma. MR imaging at 1.5 T reveals only limited evidence of specific changes to the cervical spine and the surrounding tissues in patients with acute symptomatic whiplash injury, the researchers concluded.

Radiologists' recommendations account for only a small proportion of high-cost outpatient imaging. In a study of radiologic examinations (approximately 200 000) at one institution over a 6-month period, Lee and colleagues found that radiologists' recommendation accounted for only 5.3% (1558 of 29 232) of high-cost examinations overall. Chest CT for pulmonary nodules was the most common (878 of 9331, 9.4%) high-cost examination recommended, followed by abdominal CT (390 of 10 258, 3.8%) and brain MR imaging (222 of 6436, 3.4%). Altering radiologists' recommendation behavior is unlikely to result in a substantial decrease in high-cost imaging utilization, the researchers concluded.

On diffusion-weighted MR images, benign hepatocellular lesions often show findings that suggest restricted diffusion. In a study of 67 patients with 90 hepatocellular lesions, Agnello and colleagues found that the apparent water diffusion of focal nodular hyperplasias and hepatocellular adenomas was more restricted than that of the surrounding normal liver parenchyma, and signal intensity in most of those lesions (78 of 90) increased with increasing b values, mimicking malignant liver tumors. The researchers recommended that radiologists be aware of this finding and read diffusion-weighted MR images concurrently with all available MR images to avoid misinterpretation.

Implementation of evidence-based clinical decision support in the emergency department (ED) is associated with a significant decrease in use and increase in yield of CT pulmonary angiography for the evaluation of acute pulmonary embolism. In a study performed between 2003 and 2009 at one quaternary care institution with 60  000 annual ED visits, Raja and colleagues found that CT pulmonary angiography use decreased by 20.1% and diagnostic yield for pulmonary embolism increased 69.0% after evidence-based clinical decision support was implemented. Computerized decision support may help decrease the number of unnecessary CT pulmonary angiographic examinations performed to evaluate pulmonary embolism in the ED, the researchers concluded.

The addition of shear-wave (SW) elastography to conventional B-mode US increases the specificity of breast mass assessment. In a study of 958 women, Berg and colleagues found that SW elastography increased specificity from 61.1% to 78.5%. SW elastography showed utility for identifying circumscribed, oval malignant masses that would otherwise be assessed as probably benign at US and only followed up. The researchers concluded that masses with a low suspicion for malignancy, Breast Imaging Reporting and Data System category 4a, which appear as benign on an SW elastographic image, may be downgraded to category 3 and safely followed up.