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This paper summarizes the 2020 Diversity in Radiology and Molecular Imaging: What We Need to Know Conference, a three-day virtual conference held September 9–11, 2020. The World Molecular Imaging Society (WMIS) and Stanford University jointly organized this event to provide a forum for WMIS members and affiliates worldwide to openly discuss issues pertaining to diversity in science, technology, engineering, and mathematics (STEM). The participants discussed three main conference themes, “racial diversity in STEM,” “women in STEM,” and “global health,” which were discussed through seven plenary lectures, twelve scientific presentations, and nine roundtable discussions, respectively. Breakout sessions were designed to flip the classroom and seek input from attendees on important topics such as increasing the representation of underrepresented minority (URM) members and women in STEM, generating pipeline programs in the fields of molecular imaging, supporting existing URM and women members in their career pursuits, developing mechanisms to effectively address microaggressions, providing leadership opportunities for URM and women STEM members, improving global health research, and developing strategies to advance culturally competent healthcare. Supplementary Information The online version contains supplementary material available at 10.1007/s11307-021-01610-3.

We aimed to evaluate the impact of collaborative discussion between diagnostic radiologists and radiation oncologists on radiation oncology management for thoracic oncology patients.We reviewed cases presented at multidisciplinary thoracic tumor boards (TTB) (n = 122) and diagnostic radiology/radiation oncology rounds (DR/ROR) (n = 45). Changes in planned radiation management following imaging discussion were categorized-no change, timing change, and treatment volume change. Phase of care was also classified. In DR/ROR, radiation oncologists were surveyed regarding (1) change in radiation oncology management and (2) change in confidence (both 5-point Likert scales).Discussion of imaging with a radiologist changed radiation oncology management in 31.1% of TTB cases and 68.9% of DR/ROR cases (P0.001). Changes to the timing of initiating radiation therapy occurred with similar frequency in the 2 settings (31.1% vs 46.7%, P = 0.063). Changes to target volume occurred more frequently in DR/ROR (35.6% vs1%), P0.001. Over half of imaging discussions in DR/ROR resulted in at least "moderate" change in radiation oncology management, and the level of confidence held by the radiation oncologists increased following discussion with radiologists in 95.6% of cases.Collaborative discussions between radiation oncologists and diagnostic radiologists in a multispecialty tumor board and in targeted 2-specialty rounds are not redundant, but result in different management changes and at different phases of care. Our study emphasizes the importance of consultation with physicians as an area where radiologists can add value, specifically the added benefit of smaller collaborative discussions.

Imaging, specifically computed tomography (CT), is a key component in the characterization, management, and follow-up of patients with connective tissue disease (CTD)-related diffuse lung disease. The main role of CT is to help direct treatment by determining the primary pattern of lung injury present. Other roles include follow-up of lung disease over time, evaluation of acute symptoms, and monitoring for treatment complications. Although diagnosis is typically made using clinical and serologic criteria, CT plays an important role when lung disease is the dominant presenting feature. This article delineates the roles of CT in patients with CTD-related lung disease.

Smoke from cigarettes and other sources may induce a variety of patterns of lung injury. While smoking related lung diseases, in general, have a better prognosis than many other diffuse lung diseases, they may be a cause of significant symptoms and, in some cases, may even require lung transplantation. On histology, the manifestations of these patterns range from reversible inflammation to irreversible emphysema or fibrosis. High-resolution chest CT plays a critical role in the diagnosis of smoking related lung diseases. It has several roles including (1) helping determine diagnosis, (2) assessing the pattern of injury that is present, (3) evaluating the extent and severity of disease, and (4) determining the response to treatment. The practicing radiologist must have a knowledge of the clinical, pathologic, and imaging features of the differnent patterns of lung injury associated with smoke inhalation.

The presentation and identification of cardiovascular disease in women pose unique diagnostic challenges compared to men, and underrecognized conditions in this patient population may lead to clinical mismanagement.This article reviews the sex differences in cardiovascular disease, explores the diagnostic and prognostic role of cardiovascular magnetic resonance (CMR) in the spectrum of cardiovascular disorders in women, and proposes the added value of CMR compared to other imaging modalities. In addition, this article specifically reviews the role of CMR in cardiovascular diseases occurring more frequently or exclusively in female patients, including Takotsubo cardiomyopathy, connective tissue disorders, primary pulmonary arterial hypertension and peripartum cardiomyopathy. Gaps in knowledge and opportunities for further investigation of sex-specific cardiovascular differences by CMR are also highlighted.

High-quality aortic imaging plays a central role in the management of patients with thoracic aortic aneurysm. Computed tomography angiography and magnetic resonance angiography are the most commonly used techniques for thoracic aortic aneurysm diagnosis and imaging surveillance, with each having unique strengths and limitations that should be weighed when deciding patient-specific applications. To ensure optimal patient care, imagers must be familiar with potential sources of artifact and measurement error, and dedicate effort to ensure high-quality and reproducible aortic measurements are generated. This review summarizes the imaging evaluation and underlying pathology relevant to the diagnosis of thoracic aortic aneurysm.

Gigantomastia is an abnormal and rare breast condition characterized by excessive breast tissue growth that can result in physical and psychosocial debilitation. While the etiology is not fully understood, it is postulated that abnormal endogenous hormone stimulation plays a contributory role and often requires mastectomy for definitive treatment. Proliferation of all elements is commonly observed, including glands, ducts, stroma, fat, vessels and skin. Pseudoangiomatous stromal hyperplasia (PASH) is an additional benign breast disease defined microscopically by proliferation of mammary stroma. PASH often clinically presents as an incidental finding while evaluating other benign or malignant lesions, or less commonly as a palpable, well-circumscribed breast mass. Uncommon cases have been reported in which PASH presents as a bilateral, diffuse process. In this case presentation, we report a rare case of a 20-year-old woman presenting with acute onset gigantomastia most likely due to diffuse PASH.

Both noncontrast and contrast-enhanced approaches to gated thoracic magnetic resonance angiography (MRA) for aortic root evaluation have been reported at 3T. We compare qualitative and quantitative image quality measures for the two approaches, and assess the reproducibility of standard aortic measurements. Respiratory and cardiac gated MRA of the chest was performed at 3T in 45 patients: 23 after administration of iron-based blood pool contrast, and 22 without contrast. Image quality was assessed with a 5-point Likert scale, vessel lumen-to-muscle contrast ratios, and vessel wall sharpness. Two reviewers measured the ascending aorta diameter and valve annulus area. Interrater agreement was assessed using Bland-Altman plots and coefficient of variation (CV). Qualitative image quality was better with blood pool contrast in all principal vessels of the chest (mean Likert of 4.20 ± 0.79 vs. 2.60 ± 0.77, p

PURPOSE Studies have shown a modest association between pericardial fat volume (PFV) and coronary artery disease (CAD), potentially mediated by local inflammation. We aimed to investigate the association between a new biomarker of pericardial fat inflammation, named pericardial fat enhancement (PFE), and the severity of CAD on coronary computed tomography angiography (CCTA). MATERIALS AND METHODS We evaluated 114 patients referred for CCTA from 2007 to 2011. PFV, presence of obstructive CAD, and the burden of CAD were determined. PFE was measured in 10 mm regions of interest, adjusted to aortic enhancement (aPFE). The population was divided into those with greater than median (G-PFE) versus less than median pericardial fat enhancement (L-PFE). Stratified adjusted logistic regressions were performed. A P-value

This article describes an approach to analyzing the distribution of intravenous contrast on chest computed tomography and illustrates the various pathologies and pitfalls that may be encountered by the imager, especially in the hospitalized patient. Understanding normal and abnormal distribution of intravenous contrast can be used as a clue to detect alterations in physiology and flow.

© 2016 The Association of University Radiologists Rationale and Objectives We aimed to evaluate whether implementation of a low-dose computed tomography (CT)-guided lung biopsy protocol, with the support of individual radiologists in the section, would lead to immediate and sustained decreases in radiation dose associated with CT-guided lung biopsies. Materials and Methods A low-dose CT-guided lung biopsy protocol was developed with modifications of kilovoltage peak, milliamperes, and scan coverage. Out of 413 CT-guided lung biopsies evaluated over a 3-year period beginning in 2009, 175 performed with a standard protocol before the development of a low-dose protocol, and 238 performed with a low-dose protocol. The dose-length product (DLP) was recorded for each lung biopsy and retrospectively compared between the two protocols. Individual radiologist level DLPs were also compared before and after the protocol change. Results The mean biopsy dose decreased by 64.4% with the low-dose protocol (113.8 milligray centimeters versus 319.7 milligray centimeters; P

© 2016, Springer Science+Business Media Dordrecht. To evaluate the association between aortic morphology and elasticity with aortic regurgitation in surgically corrected of tetralogy of Fallot (TOF) patients. We retrospectively identified 72 consecutive patients with surgically corrected TOF and 27 healthy controls who underwent cardiac MRI evaluation. Velocity-encoded cine MRI was used to quantify degree of aortic regurgitation (AR) in TOF patients. Ascending aorta diameters were measured at standard levels on MRA images. Aortic pulse-wave velocity (PWV) was quantified with MRI. Morphological and functional MRI variables were compared between groups of TOF patients with and without clinically relevant AR and controls. The association between aortic morphology and elasticity with the presence of AR was evaluated using univariate and multivariate logistic regression. The majority of TOF patients had only trace AR. Nine TOF patients (12 %) had an AR fraction higher than 15 %. Indexed aorta diameter at the sinotubular junction (p = 0.007), at the RPA level (p = 0.006), and low left ventricular ejection fraction (LVEF) (p = 0.015) showed the strongest associations with the presence of at least mild AR, which persisted after controlling for age and gender. Increased ascending aorta dimension is associated with AR in patients after repair of TOF. LVEF was also low in the group of patients with relevant AR compared to those without, suggesting even mild to moderate AR may contribute to LV dysfunction in these patients. Enlarged ascending aorta may be an indication for precise quantification of regurgitant fraction with MRI, since symptomatic patients may need aortic valve repair when moderate regurgitation is present.

ObjectiveTo evaluate the predictive value of Computed Tomography Angiography (CTA) measurements of the RVOT for transcatheter valve sizing.BackgroundTranscatheter pulmonary valve replacement (TPVR) provides an alternative to surgery in patients with right ventricular outflow tract (RVOT) dysfunction. We studied 18 patients who underwent catheterization for potential TPVR to determine whether CT imaging can be used to accurately predict implant size.MethodsCases were grouped by RVOT characteristics: native or transannular patch (n=8), conduit (n=5) or bioprosthetic valve (n=5). TPVR was undertaken in 14/18 cases, after balloon-sizing was used to confirm suitability and select implant size. Retrospective CT measurements of the RVOT (circumference-derived (Dcirc) and area-derived (Darea) diameters) were obtained at the level of the annulus, bioprosthesis or conduit. Using manufacturer sizing guidance, a valve size was generated and a predicted valve category assigned: (1) 29mm. Predicted and implanted valves were compared for inter-rater agreement using Cohen's kappa coefficient.ResultsThe median age of patients was 37years old (IQR: 30-49); 55% were male. Diagnoses included: Tetralogy of Fallot (12/18), d-Transposition repair (3/18), congenital pulmonary stenosis (2/18) and carcinoid heart disease (1/18). Measurements of Darea (κ=0.697, p&nbsp

The aim of this article is to review the role of imaging in pre-procedural assessment prior to transcatheter aortic valve replacement (TAVR)—with a focus on relevant anatomic findings apart from the size of the aortic annulus. Pre-procedure imaging prior to TAVR heavily emphasizes assessment of the aortic annulus for appropriate valve sizing, with computed tomography angiography (CTA) emerging as the test of choice due to its ability to assess not only the aortic annulus but also the thoracoabdominal aorta and peripheral vasculature. Some patients with underlying kidney disease may be at increased risk of renal dysfunction following contrast-enhanced CTA; however, alternate imaging techniques can be performed to mitigate this risk such as magnetic resonance imaging. Familiarity with underlying anatomic variability and pathology relevant to TAVR implantation in addition to annulus size, as well as imaging approaches in patients with renal dysfunction, will allow radiologists to better contribute to multidisciplinary discussion for potential TAVR candidates.

Due to recent advances in artificial intelligence, there is renewed interest in automating interpretation of imaging tests. Chest radiographs are particularly interesting due to many factors: relatively inexpensive equipment, importance to public health, commonly performed throughout the world, and deceptively complex taking years to master. This article presents a brief introduction to artificial intelligence, reviews the progress to date in chest radiograph interpretation, and provides a snapshot of the available datasets and algorithms available to chest radiograph researchers. Finally, the limitations of artificial intelligence with respect to interpretation of imaging studies are discussed.

Objective The aim of the study was to determine the relationship of various thoracic fat depots with the presence and extent of coronary artery plaque and circulating biomarkers. Methods In 342 patients (52 ± 11 years, 61% male, BMI 29.1 ± 5.9 kg/m2) with coronary computed tomography (CT), angiography, we measured the fat volume in four thoracic depots (pericoronary, epicardial, periaortic, extracardiac), assessed coronary plaque, and determined the circulating levels of C-reactive protein, tumor necrosis factor alpha, plasminogen activator inhibitor-1, monocyte chemoattractant protein-1, and adiponectin. The extent of coronary plaque was classified into three groups: 0, 1−3, and >3 segments. Results Patients with plaque (n =169, 49%) had higher volumes of all four fat depots as compared to patients without plaque (all P

The role of cardiac magnetic resonance (MR) imaging as a prognostic tool in patients with ischemic heart disease is well established. However, an increasing body of data now demonstrates that cardiac MR imaging can provide prognostic information in a variety of nonischemic and diffuse myocardial diseases including myocarditis, dilated and hypertrophic cardiomyopathies, sarcoidosis, amyloidosis, and arrhythmogenic right ventricular cardiomyopathy. Cardiac MR imaging can also supply incremental information above established prognostic indicators, providing an additional tool for use in the prediction of disease progression, response to treatment, and risk stratification.

The aims of this article are to discuss the role of cardiac computed tomography (CT) and magnetic resonance (MR) applications in cardiac electrophysiology and to review recent literature including emerging technologies. Applications of CT and MR are relevant to electrophysiology procedures in patients with both atrial and ventricular arrhythmias. CT and MR can identify anatomic landmarks and barriers to successful pulmonary vein ablation and left atrial appendage ligation. Further, the excellent tissue characterization provided by cardiac MR allows rapid identification of ventricular ablation targets without the use of ionizing radiation. The use of MR in patients with implanted cardiac devices has been an area of ongoing research as has the emerging technology of real-time interventional cardiac MR to guide electrophysiology procedures. Familiarity with these CT/MR techniques and applications will allow radiologists to further assist our colleagues in electrophysiology and to participate in this growing field.

Purpose: Integrated interventional radiology (IR) residencies recently underwent their second year in the match, the first year of which involved only a limited number of programs. Now that students can choose to enter IR directly, student perceptions of IR vs diagnostic radiology (DR) are of paramount importance. Methods: We surveyed first- through fourth-year medical students and radiology residents regarding interest in IR vs DR. Results: Students considering a radiological career expressed more interest in IR than DR. Conversely, residents expressed more interest in DR. Conclusions: Medical student advisors and IR programs should continue to anticipate a high number of applications for integrated IR positions.

OBJECTIVE: We aim to assess the technical feasibility of ferumoxytol MRA in vascular mapping prior to transcatheter aortic valve replacement (TAVR) in patients with renal impairment. METHODS: This is an IRB-approved and HIPAA-compliant study. FE-MRA was performed at 3.0T or 1.5T with an infusion of ferumoxytol. Non-contrast CT images were used to overlay vascular calcification on FE-MRA images as composite fused 3D data. Image quality of the subclavian and aortoiliofemoral arterial tree and confidence in the assessment of calcification were evaluated using a 4-point scale (4=excellent vascular definition or strong confidence, respectively). Signal nonuniformity as reflected by the heterogeneity index (ratio between the mean standard deviation of luminal SI and the mean luminal SI), SNR, and consistency of luminal diameter measurements were quantified. Findings on FE-MRA were compared with pelvic angiograms. RESULTS: Twenty-six patients underwent FE-MRA without adverse events. A total of 286 named vascular segments were scored. The image quality score was 4 for 99% (n=283) of the segments (k=0.9). There was moderate to strong confidence in the ability to assess vascular calcific morphology in all studies with complementary non-contrast CT. Steady state luminal heterogeneity index was low and SNR was high. Inter-observer luminal measurements were reliable (ICC=0.98, 95% CI 0.98 to 0.99). FE-MRA findings were consistent with correlative pelvic angiograms in all 16 patients. CONCLUSION: In patients with renal impairment undergoing TAVR, FE-MRA is technically feasible and offers reliable vascular mapping without exposure to iodinated or gadolinium contrast agents. Thus, the total cumulative dose of iodinated contrast is minimized and the risk of acute nephropathy is reduced.

High-resolution computed tomography (HRCT) of the lung is a key component of the multidisciplinary approach to diagnosis in diffuse lung disease (DLD). HRCT also plays an important role in the follow-up of patients with established DLD. In this respect, serial HRCT examinations may provide valuable information that cannot be determined from clinical history and other diagnostic tests, such as pulmonary function tests. Important roles of HRCT in this context include assisting in determining prognosis, monitoring for the efficacy of treatment, detecting progression of disease or complications, and evaluating patients with worsening or acute symptoms. Both clinicians and radiologists should be aware of the expected evolution of HRCT changes in a variety of DLDs. The goals of this paper are to discuss: 1) the expected evolution of HRCT findings over time in common DLDs; 2) the role of serial HRCT examinations in formulating an initial diagnosis; and 3) the role of HRCT in the follow-up of patients with known DLD.

Background Computed tomography angiography (CTA) is the test of choice for pre-procedure imaging of transcatheter aortic valve replacement (TAVR) candidates. The iodinated contrast required, however, increases the risk of renal dysfunction in patients with pre-existing renal failure. Ferumoxytol is a magnetic resonance imaging (MRI) contrast agent that can be used with renal failure. Its long vascular resonance time allows gated MRA sequences that approach CTA in image quality. We present respiratory and cardiac gated MRA enabled by ferumoxytol that can be post-processed in an analogous fashion to CTA. Methods Seven patients with renal failure presenting for TAVR were imaged with respiratory and cardiac gated MRA at 3T using ferumoxtyol for contrast. Aortic annulus, root and peripheral access dimensions were calculated in a fashion identical to that used for CTA. Of these, 6 patients underwent a TAVR procedure and 5 had intraoperative valve assessment with transesophageal echocardiograph (TEE) using standard clinical protocols that employed both two- and three-dimensional techniques. Results Good correlation between MRA aortic annulus measurements and those from TEE were shown in 5 patients with mean annulus area of 392.4mm 2 (290–470 range) versus 374.1mm 2 (285–440 range), with a pairwise correlation coefficient of 0.92, p=0.029. All patients received Sapien valve implants (one 20mm, three 23mm, and two 26mm valves). Access decisions were guided by MRA with no complications. Annulus sizing resulted in no greater than trace/mild aortic regurgitation in all patients. Conclusions Ferumoxytol MRA is a safe alternative to CTA in patients with renal failure for pre-TAVR analysis of the aortic root and peripheral access.

Background In end-stage liver disease, alterations in iron metabolism can lead to iron overload and development of iron overload cardiomyopathy. In liver transplant candidates, evaluation for cardiac iron overload and dysfunction can help to identify candidates at increased risk for peritransplant morbidity and mortality, though recommendations for pretransplant evaluation of cardiac iron overload are not standardized. Cardiac Magnetic Resonance Imaging T2* (CMRI-T2*) is a validated method to quantify cardiac iron deposition, with normal T2* value of 20 ms or greater. In this study, we sought to identify the incidence and predictors of iron overload by CMRI-T2* and to evaluate the impact of cardiac and iron overload on morbidity and mortality after liver transplantation. Methods In this retrospective single-center cohort study, all liver transplant candidates who underwent a pretransplant CMRI-T2* between January 1, 2008, and June 30, 2016, were included to analyze the association between clinical characteristics and low T2* using logistic regression. Results One hundred seventy-nine liver transplant candidates who received CMRI-T2* were included. Median age was 57 years, 73.2% were male, and 47.6% were white. 49.7% had hepatitis C and 2.8% had hemochromatosis. Median Model for End-Stage Liver Disease score was 25. 65.2% were Child-Pugh C. In multivariable logistic regression, T2* less than 20 ms (n = 35) was associated with Model for End-Stage Liver Disease score of 25 or greater (odds ratio [OR], 3.65; P = 0.007), Child-Pugh C (OR, 3.42; P = 0.03), and echocardiographic systolic ejection fraction less than 65% (OR, 2.24; P = 0.01). Posttransplant heart failure occurred exclusively in recipients with T2* less than 15 ms. Survival was worse in T2* 10 to 14.9 versus T2* of 20 ms or greater (hazard ratio, 3.85; P = 0.003), but not for 15 to 19.9 versus T2* of 20 ms or greater. Conclusions Severity of liver disease and systolic dysfunction is associated with T2* less than 20 ms, though there was no difference in posttransplant outcomes between T2* 15 to 19.9 and T2* 20 ms or greater, suggesting that individuals with T2* of 15 ms or greater may be suitable transplant candidates. CMRI-T2* is an additional diagnostic tool in evaluating transplant candidates at high risk for posttransplant cardiac complications.

Methods Patients (n=19) with a clinical diagnosis or imaging findings of pulmonary hypertension who underwent cardiac MR between 1/1/2009 and 9/30/2014 were identified. Controls (n=10) were referred for cardiac MR evaluation to rule out ARVD due to family history or palpitations, but with a normal cardiac MR examination. Both patients and controls underwent cardiac MR with delayed gadolinium enhancement. Post-contrast locklocker inversion recovery sequences were obtained approximately 15 minutes following administration of gadolinium. T1 values were measured in the ventricular septum by placing a region of interest (ROI) that was confined to the myocardium using a semiautomated method. Manual correction was used to adjust ROIs that included the blood-pool. Statistical analysis was performed using Kruskal-Wallis equality-of-populations rank test to compare the patient and control groups due to data skewness.

Stroke is the fourth leading cause of death and the leading cause of long-term serious disability in the United States [1]. Treatment and management advancements for ischemic injury have increased the demand for accurate and reliable imaging techniques to rapidly identify both intra- and extracranial carotid artery pathology [2, 3].

Coronary artery calcium measurements have emerged as a tool for risk stratification, as coronary artery calcification has been shown to be highly specific for atherosclerosis.1 Conversely, the absence of coronary artery calcification is associated with a very low risk of future cardiovascular events.2 A recent statement by the American College of Cardiology and the American Heart Association suggested that a zero calcium score (CS 0) in symptomatic patients could act as a filter prior to invasive coronary angiography. In this substudy of the CORE 64 (Coronary Evaluation Using Multi-Detector Spiral Computed Tomography Angiography Using 64 Detectors) trial, Gottlieb and colleagues3 evaluated whether the absence of coronary calcium could rule out significant stenosis, obstruction, or the need for revascularization in patients referred for conventional angiography. This multicenter (n = 9) international observational study enrolled 291 patients (mean age 59.3 ± 10 years, 26.8% women) between November 2005 and January 2007. All patients underwent calcium scanning with 64-multidetector row computed tomography (MDCT) scanners using standard tube currents of 300 mA and voltage of 120 kV followed by coronary angiography within 30 days. Endpoints were defined as ≥ 50% luminal narrowing by quantitative coronary angiography or the need for revascularization within 30 days. The authors evaluated patients according to calcium score (CS > 0 vs CS 0); those with CS 0 were further evaluated by acuity of presentation (emergency department vs outpatient referral) and pretest probability of coronary artery disease (CAD). In addition, they report the diagnostic accuracy of CS 0 for detecting the absence of ≥ 50% coronary stenosis. The authors found that the overall prevalence of ≥ 50% coronary stenosis by conventional angiography was 56% in this cohort. Of the 291 enrolled patients, 195 (67%) had CS > 10, 24 (8%) had CS 1–10, and 72 (25%) had CS 0. In patients with CS > 10, significant stenosis was present in 138 patients (71%) and revascularization was performed in 85 patients (44%). A subset of 11 patients (46%) with CS 1–10 were found to have ≥ 50% stenosis and 6 patients (25%) subsequently underwent revascularization. Similarly, 14 patients (19%) with CS 0 were found to have ≥ 50% stenosis and 9 (13%) underwent revascularization.

CardiacMR(CMR)imagingisusedfor a variety of indications, rangingfrom suspected cardiomyopathy toevaluationofcongenitalheartdefects[1-3].Atourinstitution,theseexam-inations are monitored and tailoredby physicians, with the potential tobecome lengthy and resource inten-sive. CMR examinations have comeunder particular scrutiny in the set-ting of rising health care costs [4,5].Although quality improvementinitiatives typically focus on care im-provement, waste reduction is an al-ternativequalitymeasure [6-9].Onaclinical CMR imaging service, wastetakestheformofaddedscantimeduetoextraneouspulsesequences,repeti-tion of sequences not necessary foraccurate diagnosis, or any extensionof the examination time withoutadded diagnostic value [7]. Waitingtime, whether time spent waiting fora scan to finish or for a radiologist’sassistance, and consequent “under-utilization” of the scanner are exam-plesofwasteonaclinicalservice [10].We observed low compliancewith allotted time slots for CMRexaminationsatourinstitution,de-spite allotted slot times of 90 min(the longest in the department). In2010, more than half of the 518CMR examinations performed ex-ceeded 90 min in length (Table 1).

Pericoronary adipose tissue (PCAT) may create a pro-inflammatory state, contributing to the development of coronary artery disease (CAD). We sought to evaluate the feasibility of a novel volumetric PCAT quantification method using a novel threshold based computed tomography approach. In addition we determined the relation between PCAT volumes and CAD.In 51 patients (49.5±5.1 years, 64.8% male) who underwent 64-slice MDCT, we measured threshold-based PCAT volumes using distance and anatomic-based methods. Using the most reproducible method, we performed the proximal 40-mm distance measurement in three groups as stratified by coronary plaque and high-sensitivity C-reactive protein (hs-CRP) levels: Group 1 (presence of coronary plaque, hs-CRP2.0 mg/L); an intermediate group (Group 2, no plaque, hs-CRP2.0 mg/L); and Group 3 (no plaque, hs-CRP1.0 mg/L). We compared PCAT volumes to the presence of coronary plaque on a patient (n=51) and vessel (n=153) basis. On a subsegment basis (n=1224), we compared PCAT volume to the presence of plaque as well as plaque morphology.Distance-based PCAT volume measurements yielded excellent reproducibility with intra-observer intraclass correlation (ICC) of 0.997 and inter-observer ICC of 0.951. On a both a per-patient and per-vessel analysis, adjusted PCAT volume was greater in patients with plaque (Group 1) than without plaque (Groups 2 and 3, p0.001). No difference in PCAT volume was seen between high and low hs-CRP groups without plaque (p=0.51). Adjusted PCAT volumes were higher in subsegments with plaque as compared without (p0.001). Additionally, adjusted PCAT volume was greatest in subsegments with mixed plaque followed by non-calcified plaque, calcified plaque, and the lowest volume in segments with no plaque (p0.001).In this proof-of-concept study, threshold based PCAT volume assessment is feasible and highly reproducible. PCAT volume is increased in patients and vessels with coronary plaques. Surrounding vessel subsegments with coronary plaque, particularly mixed plaques, have greatest PCAT volume and highlight the effect of local PCAT in the development of coronary atherosclerosis.