BACKGROUND AND PURPOSE:Carotid intraplaque hemorrhage is associated with stroke, plaque thickness, stenosis, ulceration, and adventitial inflammation. Conflicting data exist on whether calcification is a marker of plaque instability, and no data exist on adventitial calcification. Our goal was to determine whether adventitial calcification and soft plaque (a rim sign) help predict carotid intraplaque hemorrhage.
, "Quantifying the costs of interruption during diagnostic radiology interpretation using mobile eye-tracking glasses," J. Med. Imag. 5(3), 031406 (2018), doi: 10.1117/1.JMI.5.3.031406. Abstract. What are the costs and consequences of interruptions during diagnostic radiology? The cognitive psychology literature suggests that interruptions lead to an array of negative consequences that could hurt patient outcomes and lead to lower patient throughput. Meanwhile, observational studies have both noted a strikingly high rate of interruptions and rising number of interruptions faced by radiologists. There is some observational evidence that more interruptions could lead to worse patient outcomes: Balint et al. (2014) found that the shifts with more telephone calls received in the reading room were associated with more discrepant calls. The purpose of the current study was to use an experimental manipulation to precisely quantify the costs of two different types of interruption: telephone interruption and an interpersonal interruption. We found that the first telephone interruption led to a significant increase in time spent on the case, but there was no effect on diagnostic accuracy. Eye-tracking revealed that interruptions strongly influenced where the radiologists looked: they tended to spend more time looking at dictation screens and less on medical images immediately after interruption. Our results demonstrate that while radiologists' eye movements are reliably influenced by interruptions, the behavioral consequences were relatively mild, suggesting effective compensatory mechanisms. © The Authors.Published by SPIE under a Creative Commons Attribution 3.0 Unported License. Distribution or reproduction of this work in whole or in part requires full attribution of the original publication, including its DOI.
Purpose-Carotid artery imaging is important in the clinical management of patients at risk for stroke. Carotid intraplaque hemorrhage (IPH) presents an important diagnostic challenge. 3D magnetization prepared rapid acquisition gradient echo (MPRAGE) has been shown to accurately image carotid IPH; however, this sequence can be limited due to motion-and flow-related artifact. The purpose of this work was to develop and evaluate an improved 3D carotid MPRAGE sequence for IPH detection. We hypothesized that a radial-based k-space trajectory sequence such as "Stack of Stars" (SOS) incorporated with inversion recovery preparation would offer reduced motion sensitivity and more robust flow suppression by oversampling of central k-space.Materials and Methods-A total of 31 patients with carotid disease (62 carotid arteries) were imaged at 3T magnetic resonance imaging (MRI) with 3D IR-prep Cartesian and SOS sequences. Image quality was determined between SOS and Cartesian MPRAGE in 62 carotid arteries using t-tests and multivariable linear regression. Kappa analysis was used to determine interrater reliability.Results-In all, 25 among 62 carotid plaques had carotid IPH by consensus from the reviewers on SOS compared to 24 on Cartesian sequence. Image quality was significantly higher with SOS compared to Cartesian (mean 3.74 vs. 3.11, P < 0.001). SOS acquisition yielded sharper image features with less motion (19.4% vs. 45.2%, P < 0.002) and flow artifact (27.4% vs. 41.9%, P < 0.089). There was also excellent interrater reliability with SOS (kappa = 0.89), higher than that of Cartesian (kappa = 0.84). *Address reprint requests to: S.-E.K., Utah Center for Advanced Imaging Research, 729 Arapeen Dr., Salt Lake City, UT, 84108. sekim@ucair.med.utah.edu. The basic premise of the MPRAGE sequence is that tissue with long T 1 relaxation times (blood and muscle) can be differentiated from tissue with short T 1 relaxation times (hemorrhage and fat) using nonselective inversion recovery preparation. Hemorrhage can be further delineated from fat by the addition of fat saturation to the sequence. The inversion time is selected to minimize the signal from flowing blood and other tissues to allow for maximum hemorrhage contrast. HHS Public AccessAlthough promising, MPRAGE accuracy can be limited by patient motion and flow-related artifact. Higher-resolution 3D MPRAGE requires long scan times to compensate for reduced signal-to-noise ratio (SNR), increasing the likelihood of motion artifacts and nondiagnostic studies. A previous study found that over one-third of MPRAGE exams exhibit motion artifacts. 11 Elimination of motion artifact will improve IPH detection and better assess IPH location relative to surface disruption. A motion-robust 3D radial and Cartesian hybrid sequence such as 3D "Stack of Stars" (SOS) has been used to acquire volumetric k-space data, where radial sampling is performed in-plane (along ky and kx) and Cartesian sampling is used along the slice dimension (kz). 12 Compared with conventional Cartesian sampl...
BACKGROUND AND PURPOSE: MR imaging-detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans.
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