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In This Article

  • Radiologists from Massachusetts General Hospital are well represented at the Radiological Society of North America's 106th annual meeting, with more than a dozen on-demand and featured papers and nearly 50 poster presentations
  • In adolescents, the weight loss procedure sleeve gastrectomy can have deleterious effects on the patient's bone
  • Dense breasts and selection of breast-conserving surgery are associated with ipsilateral breast events after treatment for ductal carcinoma in situ
  • Accelerated progression of coronary artery disease may be linked to the adverse effect of risk factors in HIV-infected individuals

The 106th annual meeting of the Radiological Society of North America is underway. The live virtual meeting was held in the first week of December and education and science sessions will be available on demand through the end of April. As always, radiologists from Massachusetts General Hospital are well represented at the meeting, with more than a dozen on-demand and featured papers and nearly 50 poster presentations. Here, we highlight several of the many fascinating studies described in the latter.

Effect of Sleeve Gastrectomy on Marrow Adipose Tissue in Adolescents with Obesity

M Bredella, MD; V Singhal, MD, MBBS; NH Karzar, MD; A Animashaun, BS; A Bose, BS; M Misra, MD, MPH

Sleeve gastrectomy is a commonly performed surgery for weight loss in adolescents. However, while it has proved effective in helping adolescents lose weight, and thus in addressing potential health problems including heart disease and high blood pressure, the procedure can also have deleterious effects on the patient's bone.

In this study, Miriam Bredella, MD, radiologist and vice chair for Faculty Affairs at Mass General, and colleagues measured volumetric bone mineral density of the lumbar spine by quantitative CT and marrow adipose tissue (MAT) content of the lumbar spine and peripheral skeleton by proton MR spectroscopy in 52 adolescents with moderate to severe obesity. One group was evaluated before and one year after sleeve gastrectomy and the other group was followed without surgery.

The results showed that sleeve gastrectomy leads to decreases in bone mineral density with accompanying differential changes in MAT content: increases in lumbar (central) MAT and decreases in extremity (peripheral) MAT. This shows that MAT is a dynamic endocrine organ associated with nutrition that might serve as a novel biomarker for bone quality.

Risk Factors for Ipsilateral Recurrence in Women with Ductal Carcinoma In Situ

L Lamb, MD, MSc; G Kim, MD, PhD; S Mercaldo, PhD; T Oseni, MD; M Bahl, MD, MPH

Approximately 20% of all mammographically-detected breast cancers are ductal carcinoma in situ (DCIS), a noninvasive or preinvasive form of breast cancer. Yet the risk of developing ipsilateral breast events (IBEs) after treatment for DCIS—IBEs refer to local recurrence of DCIS or invasive carcinoma—are not well understood by patient, imaging or pathologic characteristics. In this study, Mass General radiologist Leslie Lamb, MD, MSc, and colleagues sought to determine the risk factors associated with IBEs in women after treatment for DCIS.

In a cohort of 650 women with DCIS who underwent either breast-conserving surgery or mastectomy with follow-up for at least five years, 5.5% experienced an IBE. With multivariable analysis, the features associated with IBE were dense breasts and selection of breast-conserving surgery. No pathologic features of DCIS, such as nuclear grade, were associated with risk of an IBE.

Understanding risk factors for IBEs in women after treatment for DCIS could advance patient care. Surgeons and other clinicians would be better equipped to counsel women with DCIS about their long-term risks after treatment. In addition, this information could guide treatment decisions and therefore contribute to the optimization of long-term outcomes in women with DCIS.

Cardiovascular Risk Factors and Illicit Drug Use May Have a More Profound Effect on Coronary Atherosclerosis Progression in People Living with HIV

M Kolossváry, MD, PhD; EK Fishman, MD; G Gerstenblith, MD; DA Bluemke, MD; RN Mandler, MD; D Celentano, ScD; TS Kickler, MD; S Bazr, BA; S Chen, MS; S Lai, MPH; H Lai, PhD

In this study, Marton Kolossváry, MD, PhD, research fellow in radiology, and colleagues sought to determine the role of HIV infection, whether direct or indirect, in promoting coronary artery disease (CAD) progression in African Americans.

Three hundred individuals with subclinical CAD, randomly selected from a pool of 1,429 participants from an earlier prospective epidemiological study with no cardiovascular symptoms, underwent two coronary CT angiography scans with a mean follow-up of 4.0±2.3 years. The researchers then quantified noncalcified (NCP), low-attenuation noncalcified (LA-NCP) and calcified (CP) plaque volumes and applied linear mixed models to evaluate the impact of HIV infection, atherosclerotic cardiovascular disease (ASCVD) risk and years of cocaine use on the plaque volumes.

Multivariable analysis showed that, while HIV infection alone was not associated with coronary plaque volume, each percentage of ASCVD and each year of cocaine use was significantly correlated with higher NCP and CP volumes in HIV-infected individuals. The researchers concluded that the accelerated progression of CAD in these cases may be linked to the more profound adverse effect of risk factors in HIV-infected individuals.

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