Vaping in MRIs, Updated Pancreatic Screening Guidelines, and More Radiology News

USPSTF Updates Pancreatic Screening Recommendations

The United States Preventative Services Task Force (USPSTF) recently published an updated evidence report, with recommendations, regarding pancreatic cancer screening. The systematic review was published on August 6, 2019 in JAMA.

Pancreatic cancer is often referred to a as a death sentence. While survival rates have increased over the past decade, the American Cancer Society reports the 5-year relative survival rate for pancreatic adenocarcinoma, regardless of stage, is approximately 9%-and it remains the third most common cause of cancer death among both men and women in the United States. Given the mortality rates associated with this form of cancer, many have hoped that appropriate screenings could help physicians diagnose the disease earlier, ensuring that patients are treated in a timely fashion and, ultimately, increasing the odds of survival. But the current USPSTF recommendation, published in 2004, recommended against pancreatic cancer screening in adults who were not experiencing symptoms.

To investigate whether that recommendation should be revised, the USPSTF undertook a systematic review of more than 800 full-text articles, published between 2002 and 2019, investigating the benefits and harms of pancreatic screenings, including endoscopic ultrasound, MRI, and CT. Those papers included 13 unique studies, of more than 1300 individuals, who had an elevated familiar risk for the condition.

The Task Force researchers concluded there is limited evidence to suggest that pancreatic screening can improve morbidity or mortality-or, even, to accurately weigh the benefits versus harms of screening.

That said, they have updated their recommendations to say that image-based screening of patients with a high familial risk of disease, defined as two or more blood relatives affected by pancreatic cancer or as having specific mutations in certain genes, can be done without excess harm.

They do not recommend that asymptomatic adults be screened.

Audiovisual Reports May Improve Results Comprehension

A new study, published August 20, 2019 in the Journal of Digital Imaging, suggests the use of an audio-visual reporting tool may improve results comprehension, particularly of the referring physician, over traditional types of reports.

Traditionally, when orthopedic surgeons put in an imaging order for a patient with a musculoskeletal issue, they receive a narrative text report back that describes their findings. But, especially in complex cases, that text may leave out important information that could influence clinical decision-making.

Physicians can, of course, reach out to radiologists for an in-person consult-but, within the context of emergency medicine, where every second counts, there may not be ample time.

Researchers from Brazil’s Hospital do Coração and the Federal University of São Paulo decided to investigate whether an audio-visual reporting tool, with screen capture software, could help facilitate provider collaboration and engagement, as well as radiology results comprehension.

The researchers had seven radiologists prepare a total of 47 audiovisual reports, including two-minute videos that included screen captures from the hospital PACS system, for 9 attending orthopedic surgeons requesting musculoskeletal imaging from the emergency department. The team used surveys to asses whether the orthopedic surgeons benefitted from the enhanced reports. They found statistically significant positive responses to questions including:

• Was the clinical suspicion answered in the video?

• Are you willing to use such technology in other cases?

• Did it take less time to understand the audio-visual report?

• And, most importantly, did the audio-visual report make the imaging findings more understandable than traditional reports?

Just 18.2% of participants said they preferred the traditional reports and 72.8% reported that audio-visual reports might not be needed in simple cases. The authors concluded that the results support the idea that this technology could help provide more engaging and informative musculoskeletal radiology reports in the future-and could also be applied to other types of radiology studies in the future.

MRI Contrast Agent May Cause Problems for Pregnant Women

Many women may undergo an MRI screening before they even realize that they are pregnant. In doing so, they are exposing themselves-and their fetus-to the contrast agent gadolinium contrast media, used in 30-45% of MRI scans.

While gadolinium-based contrast agents (GBCAs) are commonly used in hospitals across America, there has been a lack of consistent evidence to determine whether fetal exposure is safe. A new study investigated GBCAs’ prevalence in pregnancies in the September 2019 issue of Radiology.

Researchers from the FDA Center for Drug Evaluation and Research and Harvard Medical School examined data from the FDA’s Sentinel Distributed Database, which allows secure access to electronic health records, insurance claims data, and other data partners to monitor the safety of drugs and other regulated medical products. The team was able to use the database to identify more 4,692,744 pregnancies that resulted in live births from 2006 and 2017, as well as nearly 7,000 women who underwent an MRI during her pregnancy, with or without GBCAs.

The researchers determined that, in 860 contrast-enhanced examinations, the majority of GBCA exposures occurred during the first trimester, far more than in the second or third stages of pregnancy.

Given fetal development during this critical period, the authors conclude that inadvertent exposure to GBCAs may occur before pregnancy is recognized. They therefore recommend that radiologists use effective pregnancy screening measures to help avoid unnecessary GBCA fetal exposure in the future.

Using MRI to Identify “Active” Lesions, Track MS Progression

Multiple sclerosis (MS) is a chronic, progressive neurodegenerative disorder that damages the myelin sheaths of nerve cells, ultimately leading to movement issues, speech impairments, and severe fatigue.

Unfortunately, one of the disease’s telltale pathologies, small spots on the brain referred to as “chronic active lesions,” are very difficult to detect-and often only seen after autopsy.

Now, researchers from the National Institute of Neurological Disorders and Stroke (NINDS) have demonstrated that they can detect chronic active lesions using 7T MRI, which can help clinicians better track the progression of the disease in patients as well as more effectively test novel treatments. The results were published August 12, 2019 in JAMA Neurology.

Nearly 6 years ago, using high-field, susceptibility-based 7T MRI, the researchers were able to identify chronic active lesions, or spots where the myelin had been depleted, by discernible darkened outer rims.

In this study, to confirm those results, the team scanned 192 patients who had been diagnosed with MS, discovering that 56% had at least one chronic active lesion, and 22% had at least four distinct lesions.

The patients who had more lesions were more likely to have more severe symptoms-and to have been diagnosed with the more progressive form of the disease. Those patients also exhibited less white matter and a smaller basal ganglia volume than those were fewer or no lesions.

The researchers concluded that chronic active lesions are not only common to MS patients, but associated with more severe and progressive disease. The MRI evidence shows that inflammation plays an integral role in disease progression-and could be tapped for future treatments.

Vaping’s Effects on Vascular Function Visible with MRI

The World Health Organization (WHO) recently reported that electronic cigarettes, or vapes, or “undoubtedly harmful” to users for a variety of reasons. They called for increased research on the effects of vaping on both teenager and adults. Those future studies could rely on MRI to help visualize effects on endothelial function now that researchers from the University of Pennsylvania Perelman School of Medicine have shown that 3T scanning can be effectively used to measure oxidative stress and inflammation.

In a paper published August 20, 2019 in Radiology, the researchers had 31 participants, who had never smoked tobacco products or used vapes before, undergo 3T MRI both before and after inhaling a nicotine-free electronic cigarette aerosol compound. After vaping the aerosol, the researchers discovered significant differences in:

• Higher resistivity index;

• Blunted luminal flow-mediated dilation;

• Reduced peak velocity;

• Hyperemic index;

• Delayed time to peak;

• Lower baseline SvO₂;

• And a small increase in the aortic pulse wave velocity.

Taken together, the authors concluded that even nicotine-free vaping can affect endothelial function in healthy “never smokers.” They, like the WHO, call for further studies to better understand vaping’s short-term and long-term effects on vascular health.