Radiology Roundup: New Research for HD-MRI, Color Mapping CT, and More


Radiology Images on Dual Screen MonitorNew advances in the science of clinical imaging seem to come hand-in-hand with new challenges for the radiology department to prove its value. In the best-case scenario, evolving methods for treatment will enable radiologists to contribute even more meaningfully to overall patient care, as well as demonstrate how our existing efforts help keep patients healthy.

This month’s roundup takes a look at both parts of this new equation. The first three articles explore promising new imaging methodologies. Then the final two address the challenges of proving radiology’s worth in a value-based paradigm, including tools to help radiologists deal with the MACRA rollout.

1. Color Mapping Boosts Vessel Interpretation in Stroke CT

At ECR 2017, researchers from Radboud University in the Netherlands presented results from an investigation into the effectiveness of color mapping CT scans in acute stroke patients.

The research was conducted to determine whether color mapping — a post-processing technique that color codes CT scans according to contrast arrival time in vessels — could increase speed and accuracy in identifying vessel occlusions.

Two neuroradiologists evaluated scans from patients with and without occlusions, with and without the color mapping. The results look promising: Time to detection was nearly halved, from 37 to 19.4 seconds. The researchers also noted a slight boost in accuracy with the color mapped scans.

The color mapping algorithm currently takes a little less than a minute run, which would mitigate the time savings. However, the research team is confident the time can be improved with further development.

 2. High-resolution MRI appropriate for diagnosing and characterizing ICAD

High-definition MRI (HD-MRI) produces superior results to digital subtraction angiography (DSA) for diagnosing intracranial artery disease (ICAD), a new study shows.

Researchers in South Korea performed a retrospective analysis on scans from 37 patients with ICAD. Neurologists who performed the studies agreed on diagnoses for 27 out of the 37 DSA scans, versus 32 out of 37 for HD-MRI.

The study notes that HD-MRI has shown superior performance to CTA or MRA, and its minimally invasive nature may make it the preferred diagnostic tool. Researchers concluded that HD-MRI should be seen as a comparable imaging method to DSA.

 3. Quantitative Imaging Biomarkers Show Promise for NASH

Nonalcoholic steatohepatitis (NASH) is traditionally diagnosed through liver biopsy. There are potential disadvantages to biopsy, up to excessive bleeding and death. As such, clinicians have sought a noninvasive alternative.

Quantitative Imaging Biomarkers (QIB) may be a solution. QIBs have been proven reliable in assessing liver parenchyma fat content, making it possible for clinicians to diagnose, assess severity of, and monitor NASH.

QIBs can be calculated and measured with MRI, MR spectroscopy, and MR elastography. While more clinical trials are needed to confirm QIBs’ effectiveness, it does appear to be a promising avenue for noninvasive detecting and treatment of NASH.

 4. Downstream Imaging Utilization After Emergency Department Ultrasound Interpreted by Radiologists Versus Nonradiologists

In a value-based ecosystem, radiology departments are challenged to prove the value of their expertise to patient outcomes. A study recently published in the Journal of the American College of Radiology seems to prove that radiologists can have a positive effect on patients’ future utilization of health resources.

The study examined over 200,000 ED ultrasound events from 2009 to 2014. 81.6% were interpreted by radiologists and 18.4% by nonradiologists. The study found that patients whose results were read by nonradiologists were more likely to require additional downstream imaging compared to those interpreted by radiologists.

Even as overall downstream imaging volume declined over the years, the difference between specialists and non-specialist remained significant.

5. MACRA, MIPS, and Radiology

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and Merit-Based Incentive Payment System (MIPS) both came into effect this year. Radiology departments will be challenged to report on and improve quality metrics, with penalizations and reward structures coming in January of 2019.

This brief article gives an overview of current and future obligations under MIPS and MACRA. It also includes a list of tools imaging clinicians can use to help smooth the transition without sacrificing efficiency to the larger reporting burden.

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