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This podcast was originally published on Diagnostic Imaging's sister publication, NeurologyLive.

In an exclusive interview, Scott D. Newsome, D.O., president of the Consortium of Multiple Sclerosis Centers (CMSC), director of Neurosciences Consultation and Infusion Center at Green Spring Station, and associate professor of neurology at Johns Hopkins Medicine, and David Li M.D., FRCPC, professor of radiology, associate member of neurology, and director of Multiple Sclerosis/MRI Research Group at the University of British Columbia, discussed the recent consensus MRI guidelines for multiple sclerosis.

These guidelines were published by the Magnetic Resonance Imaging in Multiple Sclerosis study group, the CMSC working group, and the North America Imaging in Multiple Sclerosis Guidelines working group.

New MRI Guidelines for Multiple Sclerosis Show Global Agreement

In particular, these guidelines provided recommendations on using standardized MRI protocols for both diagnostic and prognostic purposes. Previous guidelines were released in 2015 and 2016. They supported using axial single T2-weighted sequences, dual-echo T2-weighted spin-echo sequences, axial and sagittal T2-weighted fluid-attenuated inversion recovery (FLAIR), and contrast-enhanced axial T1-weighted sequences, preferably at 3T.

An interview with two experts to discuss newly released guidance for using standardized MRI protocols for patients with this condition.

MindMoments: Consensus MRI Guidelines for Multiple Sclerosis

When it comes to brain imaging, functional MRI – commonly called fMRI – is considered the gold standard. However, it can be costly, time consuming, and come with several restrictions that can prohibit use with certain patients. 

In recent years, investigators have been searching for a different brain imaging method that can side-step these problems and potentially provide better quality scans at the same time. Researchers from the University of Southern California Keck School of Medicine and California Institute of Technology recently succeeded. They’ve developed functional photoacoustic computed tomography (fPACT) – a technique that works by emitting a laser beam of light into the area being imaged. 

Drs. Charles Liu and Jonathan Russin join me to discuss the differences and benefits with fPACT.

Drs. Charles Liu and Jonathan Russin discuss the benefits and potential of fPACT, the alternative to functional MRI.

The Reading Room: Potential fMRI Alternative -- fPACT

For patients with mild cognitive impairment (MCI), early changes with respect to decreased intra-network connectivity involving the default mode network or salience network may aid in differentiating between the development of Alzheimer’s disease and Parkinson’s disease, according to new MRI research.

MRI Study Reveals Early Differences in Mild Cognitive Impairment Preceding Alzheimer’s Disease and Parkinson’s Disease

The CDM Insights software, which can be utilized with scans from 1.5T and 3T MRI, reportedly provides new measurements of cortical thickness and brain microstructure.

FDA Clears Brain MRI-Based Software for Assessing Cortical Disarray Measurement

InkSpace Imaging’s 24-channel MRI coil, which will be included in Magnetom 1.5T scanners from Siemens Healthineers, reportedly facilitates quicker set-ups for technologists and enhanced spatial resolution.

FDA Clears New 1.5T MRI Coil

Survey results revealed that 71 percent of clinicians preferred adjunctive AI in facilitating triage of brain MRI scans and 58 percent were comfortable utilizing AI triage without input from radiologists.

New Survey Explores Radiologist and Neurologist Comfort Level with AI Triage for Brain MRI

Convolutional neural network-enabled segmentation of brain MRI offered a 25.7 percent higher specificity than a radiomic model for differentiating radionecrosis and metastatic progression in patients treated with stereotactic radiosurgery for brain metastases.

Brain MRI Study Assesses Impact of AI in Differentiating Radionecrosis from Neoplastic Progression of Metastasis

Long Covid may affect up to 41 percent of non-hospitalized adults who have had COVID-19, according to the Centers for Disease Control and Prevention (CDC).

However, diffusion microstructural imaging, a novel magnetic resonance imaging (MRI) technique, may provide improved insight into associations between microstructural changes in the brain and common Long Covid effects such as neurocognitive deficits, fatigue, and olfactory dysfunction, according to new research presented at the recent 

Radiological Society of North America (RSNA) conference

In a recent interview, Alexander Rau, M.D., one of the lead authors of the study, discussed key findings from the prospective research that compared 89 patients with long Covid, 38 patients who had a COVID-19 infection but didn’t have long Covid, and 46 patients with no history of COVID-19.

By utilizing diffusion microstructural imaging, Dr. Rau and his colleagues discovered patterns of microstructural gray matter alterations that differed between those with long Covid and those who didn’t have long Covid after having a COVID-19 infection, particularly in basal brain structures.

“There is an impact of COVID-19 on the brain’s microstructure that we could measure with advanced diffusion imaging that was undetectable on conventional (MRI) imaging,” noted Dr. Rau, a resident in the Departments of Neuroradiology and Diagnostic and Interventional Radiology at University Hospital Freiburg in Freiburg, Germany. “Those alterations were associated with post-COVID condition associated symptoms such as fatigue, impaired olfaction, and cognitive decline. Thus, there is evidence that those alterations contribute to the pathophysiology of the post-COVID condition.”

(Editor’s note: For related content, see “

MRI Study: People with Past Hospitalization for COVID-19 Have Nearly Triple the Risk of Multiorgan Abnormalities

New Meta-Analysis Details Most Common Brain MRI Findings with COVID-19

Seven Takeaways from New Consensus Recommendations for Cardiac MRI Assessment of COVID-19

For more insights from Dr. Rau, watch the video below.

Alexander Rau, M.D., discusses how diffusion microstructural imaging can differentiate gray matter shifts associated with long COVID symptomatology.

Can Diffusion Microstructural Imaging Provide Insights into Long Covid Beyond Conventional MRI?

In a recent interview, Alexander Rau, M.D., discussed emerging research, presented at the recent RSNA conference, that shows the capability of diffusion microstructural imaging to differentiate subtle shifts in microstructural gray matter associated with common symptomatology of long Covid.

Can Diffusion Microstructural Imaging Provide Insights Into Long Covid Beyond Conventional MRI?

A higher amount of visceral abdominal fat in one’s midlife years may be an early warning sign for the development of Alzheimer’s disease, according to magnetic resonance imaging (MRI) and positron emission tomography (PET) findings recently presented at the Radiological Society of North America (RSNA) conference.

In a cohort of 54 cognitively healthy people with an average body mass index (BMI) of 32, researchers found that a higher amyloid PET tracer uptake in the precuneus cortex, a brain region known to show early pathological sings of Alzheimer’s disease, was associated with a higher ratio of visceral abdominal fat to subcutaneous fat.

“Showing this association in midlife in individuals with obesity highlights that we are observing early amyloid pathology in the Alzheimer’s (disease) signature areas 20 years before the onset of Alzheimer’s disease,” noted Mahsa Dolatshahi, M.D., M.P.H., the lead author of the study and a postdoctoral research scholar affiliated with the Mallinckrodt Institute of Radiology at Washington University, in a recent video interview.

Emerging Neuroradiology Concepts: Could Tau-PET be a New Standard in Assessing Possible Alzheimer’s Disease?

FDA Clears AI-Powered MRI Software for Brain Atrophy

Brain PET Study Suggests Link Between Early Amyloid Accumulation and Repetitive Subconcussive Trauma

Cyrus A. Raji, M.D., Ph.D, said the long relied upon body mass index (BMI) is an “imperfect measure” for characterizing body fat. In taking a closer look at the anatomically specific distribution of visceral fat and subcutaneous fat and its relationship to the risk of developing Alzheimer’s disease, Dr. Raji noted the preliminary research findings have many potential implications for early intervention.

“By characterizing the actual distribution of fat and the biophysical profiles, we can really start building an idea of who needs a more aggressive form of lifestyle intervention or related drug therapies,” explained Dr. Raji, an associate professor of radiology and neurology at the Mallinckrodt Institute of Radiology at Washington University. 

“This will not only decrease the risk for Alzheimer’s disease for people at midlife, but it will also improve the potential for people to be more successful on any Alzheimer’s drug they may have to take later in life since individuals who take those drugs are less likely to benefit from those drugs if their underlying brain health is already impaired.”

For additional insights from Drs. Dolatshahi and Raji, watch the video below.

Researchers discuss new MRI and PET study findings that show a link between higher visceral abdominal fat and early development of Alzheimer's disease.

Emerging MRI and PET Research Reveals Link Between Visceral Abdominal Fat and Early Signs of Alzheimer’s Disease

In a recent interview, Mahsa Dolatshahi, M.D., M.P.H., and Cyrus A. Raji, M.D., Ph.D., discussed MRI and PET study findings, presented at the Radiological Society of North America (RSNA) conference, that showed an association between higher amyloid PET tracer uptake in the precuneus cortex and a higher visceral to subcutaneous fat ratio.

Emerging MRI and PET Research Reveals Link Between Visceral Abdominal Fat and Early Signs of Alzheimer's Disease

The recent Radiology Partners (RP) publication 

Neuroradiology and Stroke Clinical Pathway 

offers a practical best practice guidance for radiologists and technologists on the use and reporting of neuroimaging, including head and neck computed tomography angiography (CTA), cerebral perfusion CT and brain magnetic resonance imaging (MRI), for stroke patients.

In a recent interview, Vivek Bansal, M.D., makes it clear that the publication is geared toward achieving a consistent baseline standard for providing a high level of stroke imaging and care regardless of the size or resources of the given facility.

“We’re not rewriting the guidelines but (trying to) take some of these other hospitals or smaller practices, (facilities) with limited resources, or maybe don’t have neuroradiology specialty coverage, and bring everybody up to some baseline level to where we can say we’re giving optimal stroke care no matter where you go at any RP facility,” noted Dr. Bansal, a Houston-based neuroradiologist who serves as the national subspeciality lead for neuroradiology for Radiology Partners.

Emphasizing the constantly evolving nature and urgency of stroke care, Dr. Bansal said radiologists need to be active members of the stroke care team.

“In particular with stroke, we can’t be radiologists locked in our little reading rooms separate from everybody else and just putting out reports,” maintained Dr. Bansal. “We have to be part of the team … We have pushed to get really granular data and really help find the trouble points and fix them. That’s the key. When you do that, you get a lot of trust from your hospital system, and you can actually make processes better, and do better for the patients.”

(Editor’s note: To download the Neuroradiology and Stroke Clinical Pathway guidance, 

For more insights from Dr. Bansal, watch the video below.

In a recent video interview, Vivek Bansal, M.D., discussed a recent Radiology Partners publication that offers practical tips and best practice guidance on CT and MRI neuroimaging for stroke patients.

Practical Insights on CT and MRI Neuroimaging and Reporting for Stroke Patients

The purchase of new and cutting-edge imaging equipment comes with a lot of excitement—and a learning curve. That's where Canon Medical Education comes in, providing a host of education solutions for clients that include both in-person and virtual training and continuing education opportunities.

The education arm of Canon Medical Systems USA provides a customizable plan to ensure that all imaging associates are well-trained and comfortable operating advanced equipment including MR and CT, as well as vascular and cath applications, among others. 

Understanding that every learner is different, Canon offers educational opportunities that include in-person, at their Institute of Advanced Imaging in Irvine, California; on-site training at a client facility; online and instructor-led courses in their Canon Learning Center; as well as CE and non-CE webinars and special programs.

To learn more about Canon's educational offerings, 

Canon Medical Systems offer a range of in-person and virtual educational opportunities for their clients. 

Education in Radiology: Canon's Customized Approach

Morris Panner didn’t want to call the familiar PACS system outdated or antiquated. However, he did suggest that radiology is on the cusp of a revolution with medical image and data management that parallels the ongoing emergence of the radiologist from the reading room to being a key member of the interdisciplinary team in facilitating optimal patient outcomes.

“The PACS system is no longer a new invention. It is important and you can always improve it but what people are really looking for now is how to free that data, take that pixel information, share it, use it with other types of data and advance the liquidity and flexibility in data management. That was the revolution that came out of the SIIM (Society for Imaging Informatics in Medicine) meeting this year,” noted Panner, the president of Intelerad Medical Systems, in a recent video interview.

recent survey research showing an increasing patient acceptance of artificial intelligence (AI)

, and the more gradual “try it” phase for many radiologists as they discern the most optimal fit for AI in their current workflows. To that end, Panner also reviewed key aspects of Intelerad’s Enterprise Imaging and Informatics Suite. It is Panner’s hope that by emphasizing improved efficiency and quality in radiology workflows, the system can “free up brain space for great diagnostics.”

For more insights from Morris Panner, watch the video below.

In a video interview, Morris Panner, the president of Intelerad Medical Systems, discussed key observations from the recent Society for Imaging Informatics in Medicine (SIIM) conference, recent research about artificial intelligence (AI) adoption and emerging goals for enhancing the efficiency of radiology workflows.

What's Next in Medical Image and Data Management in Radiology?

In a new study presented recently at the 8th European Academy of Neurology (EAN) Congress in Vienna, Austria, researchers from Denmark found that patients who tested positive for COVID-19 were 3.5 times more likely to be diagnosed with Alzheimer’s disease and 2.6 times more likely to have Parkinson’s disease in comparison to patients without COVID-19. 

(Editor's note: For a related article, see "New Study Shows Link Between COVID-19 and Elevated Risks for Neurological Disorders.")

In a recent video interview, neurologist Pardis Zarifkar, MD discussed the findings of the exploratory observational study.

The study authors also found that patients with COVID-19 had a 2.7 times higher risk of ischemic stroke and a 4.8 times higher risk for intracerebral hemorrhage. While the higher prevalence of cerebrovascular disorders was expected given the previously reported association between these disorders and COVID-19, the “extent of the increase (with neurodegenerative disorders) was quite surprising,” noted Dr. Zarifkar, who is affiliated with the Department of Neurology at Rigshospitalet in Copenhagen, Denmark.

That said, Dr. Zarifkar emphasized that “neurodegenerative disorders are a long time in the making” and it is “highly unlikely” that a COVID-19 infection could cause the development of a neurodegenerative disorder at one year.

While maintaining that more research is needed to evaluate potential long-term neurological complications with COVID-19, Dr. Zarifkar is also hopeful that future studies will examine the phenomenon of cognitive and mental health issues after critical illness.

For more insights from Dr. Zarifkar, watch the video below:

In a recent video interview, neurologist Pardis Zarifkar, MD discussed a new study that found significantly elevated risks for Alzheimer’s disease and Parkinson’s disease among patients who tested positive for COVID-19. 

Video Interview: Is There an Increased Incidence of Neurodegenerative Diseases in Patients with COVID-19?

The temporary shortage of iodinated contrast media (ICM) has been a huge issue in the radiology community, not to mention the overarching impact on the health-care field. While there is proverbial light at the end of the tunnel with the 

recent announcement from GE Healthcare about resuming full production of Omnipaque products

, Sean Bryant, M.D. said there are key takeaways that radiologists can utilize in the next couple of weeks as contrast supply begins to be restored and moving forward.

In a recent video interview, Dr. Bryant, the owner and president of Diversified Radiology, discussed the impact of the ICM shortage in the neuroradiology space. In addition to appropriate use of alternative imaging, such as substituting magnetic resonance imaging (MRI) or non-contrast computed tomography (CT) for contrast-enhanced CT scans, Dr. Bryant said the guidelines from the American College of Radiology (ACR) and the American Society of Health-System Pharmacists (ASHP) have been helpful in managing the ICM shortage.

Dr. Bryant said the ICM shortage also was an opportunity to reassess imaging protocols and educate patients as well as referring clinicians on alternatives to high contrast imaging. In emergency departments, oncology care and in-patient services in a hospital, Dr. Bryant noted that clinicians at times opt for high contrast without knowing the most optimal study to order for a given clinical scenario.

For additional insights from Dr. Bryant, watch the video below.

In a recent video interview on the current iodinated contrast media shortage, neuroradiologist Sean Bryant, MD discussed imaging alternatives, emphasized communication with referring physicians on optimal studies, and discussed the ongoing need to prevent “protocol creep” with timely updates of imaging protocols.

Lessons Learned from the Iodinated Contrast Media Shortage: A Neuroradiologist's Perspective

Despite the technological advances in transferring electronic health information, medical imaging data, to this day, is predominantly exchanged between instiutions via physical media (such as a CD or flash drive) that patients carry to an appointment at another facility.

Emphasizing the impact of this seemingly dated practice on workflow efficiencies within radiology and the broader field of health care, Arun Krishnaraj, MD, MPH and David Larson, MD, MBA, said the continued reliance on patients to transport medical images via physical media (such as a CD or flash drive) can lead to delays in patient care.

In their quest to change this dynamic, Drs. Krishnaraj and Larson recently co-authored a provocative article, “

Moving Toward Seamless Interinstitutional Electronic Image Transfer

ournal of the American College of Radiology (JACR)

. In the article and in a video interview with 

, Drs. Krishnaraj and Larson discussed the potential creation of a “linked multi-hub model” that would facilitate electronic transmission of medical images through image exchange companies that would connect different health-care facilities.

“Everyone in the imaging community should really see this as a call to arms to work with our imaging vendor exchange communities to solve this problem for the benefit of patients,” emphasized Dr. Krishnaraj, Chief of the Division of Body Imaging with the Department of Radiology and Medical Imaging at the University of Virginia School of Medicine.

For more insights from Drs. Krishnaraj and Larson, watch the video below:

In a recent video interview, Arun Krishnaraj, MD, MPH and David Larson, MD, MBA, discussed the continued use of physical media to transport medical images between different health-care facilities, resulting inefficiencies and delays with patient care, and the initiative to create a linked multi-hub model to end this dated practice once and for all.

'A Call to Arms' for Electronic Transfer of Medical Images Between Institutions

While magnetic resonance (MR) perfusion is not exactly new, Kevin J. Abrams, MD, says the potential of dynamic susceptibility contrast with MR perfusion is exciting as it “allows you to hopefully differentiate active spine disease versus treated spine disease in a patient who has metastatic cancer.”

This was just one of the takeaways Dr. Abrams had after attending the 25th Annual Symposium of the American Society of Spine Radiology (ASSR). In a recent video interview with 

, Dr. Abrams also praised discussions of imaging for spontaneous intracranial hypotension (SIH). In addition to learning more about the risk of superficial siderosis in patients with this condition, he noted strong lectures on the use of CT myelography and digital subtraction myelography to diagnose different types of cerebrospinal fluid (CSF) leaks associated with SIH.

Dr. Abrams said another highlight talk was a lecture on the use of dual-energy CT to differentiate between acute and chronic vertebral fractures. He added that he started to incorporate this modality more in his practice shortly after attending the ASSR conference. The combination of artificial intelligence and augmented reality, as discussed at the ASSR meeting, has the potential to supplant procedure videos in the training of radiologists as it “feels like you’re doing the procedure before you do the procedure,” noted Dr. Abrams, the chief of radiology at Baptist Hospital of Miami, and a clinical associate professor of radiology at the Herbert Wertheim School of Medicine at Florida International University.

For additional insights from Dr. Abrams about the ASSR conference, watch the video below:

In a recent video interview, Kevin J. Abrams, MD, discussed highlights from the recent 25th Annual Symposium of the American Society of Spine Radiology (ASSR), including lectures on imaging for spontaneous intracranial hypotension, the emergence of dynamic susceptibility contrast for MR perfusion and insights on the use of dual-energy computed tomography (CT) for diagnosing vertebral fractures.

Key Highlights From the Annual Symposium of the American Society of Spine Radiology

Welcome to Diagnostic Imaging’s Weekly Scan. I’m senior editor, Whitney Palmer.

Before we get to our featured interview with Linda Blount, MPH, president and chief executive officer for Black Women’s Health Imperative about the inequities of access to digital breast tomosynthesis, here are the top stories of the week.

Adding a radiomics-based machine learning algorithm to CT colonography allows for the differentiation between benign and pre-cancerous polyps picked up on colorectal cancer screening. To date, radiologists have not been able to make that determination using CT colonography, but thanks to work from German 

, it is possible to do so with high sensitivity and specificity. They built a machine algorithm that uses radiomics to extract quantitative image features that predict whether a polyp will develop into cancer. They trained the algorithm on 169 CT segmentations from 107 colorectal polyps from 63 patients and tested it on 118 segmentations from 77 polyps from 59 patients. Using random forest analysis, they determined their algorithm could accurately differentiate benign and pre-malignant polyps with 82-percent sensitivity and 85-percent specificity with an area under the curve of 0.91. Ultimately, the team said, incorporating a machine learning-derived algorithm into CT colonography can make it an even better colorectal cancer screening tool.

New brain MRI images have shown that COVID-19 can create leukoencephalopathy, a rare condition that affects white brain matter. Currently, the industry does not have defining criteria for COVID-19 disseminated leukoencephalopathy (CRDL), so researchers from the University of Pennsylvania investigated whether identifying signs was possible, and they published their findings in the 

. After examining 2,820 COVID-19-positive patients who were hospitalized between March 2020 and June 2020, they determined 59 patients underwent brain MRI. Those scans revealed six patients (10.2 percent) had findings that suggested CRDL, such as extensive confluent or multifocal white matter lesions, micro-hemorrhages, diffusion restriction, and enhancement. Other patients also had evidence of multiple sclerosis and small vessel ischemic disease white matter lesions; acute, subacute, and chronic infarcts; abnormal basal ganglia signal from hypoxemia; and micro-hemorrhage associated with acute, subacute, and chronic infarcts. The team did note that their findings could overlap with findings for other conditions, but they maintained that radiologists must remain alert to potential presentations of CRDL.

While CT is typically used in the angiography suite, new research published in 

 shows that using MRI instead can help providers determine whether to continue to thrombectomy, the place stents, or to administer anti-thrombotic medications with patients who have suffered acute ischemic stroke. In a retrospective study of patients who received endovascular intervention for acute ischemic stroke between July 2019 and May 2020, a team from the University of California at San Francisco determined that of 47 patients who underwent stroke intervention, 12 had X-ray angiography with MRI. Based on their analysis, including MRI directly impacted treatment decision for all 12, including whether to proceed with mechanical thrombectomy, to place intracranial stents, or whether to administer antithrombotic medication. But, while these advancements show promise, other experts said that streamlining workflow to reduce transfer time between the angiography unit and the MRI is critical because, with stroke, “time in brain.”

 spoke with Linda Blount, MPH, president and chief executive officer for Black Women’s Health Imperative about recent 

 that reveals black women do not have equal access to digital breast tomosynthesis despite better cancer detection and lower recall rates associated with the screening. She discussed what these inequities mean for this patient group and what can be done to alleviate the disparities. Here’s what she had to say.

For more coverage based on industry expert insights and research, subscribe to the Diagnostic Imaging e-Newsletter 

CT Colonography & Tumor Differentiation; COVID-19 & Leukoencephalopathy; MRI, the Angiography Suite, and Acute Ischemic Stroke; Plus, DBT, African American Women, & Decreased Access

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