Jeff Vachon

PACS/VNA
Imaging data can be an asset in the fight against COVID-19
The current coronavirus pandemic is creating a new normal across all facets of daily life, and medical imaging is no exception. In a new article, Jeff Vachon of healthcare analytics firm Bialogics discusses how image data can be leveraged to fight COVID-19.
April 13, 2020
2020 03 30 23 32 9943 Virus Coronavirus Covid 19 400
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Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.
Ultrasound
Advanced ultrasound techniques improve soft tissue tumor evaluation
Both SWE and SMI can help distinguish benign from malignant soft tissue tumors.
Serial axial chest CT scans demonstrating the longitudinal evolution of small pure ground-glass nodules (pGGNs) incidentally detected during a routine wellness assessment. (A) Images in a 37-year-old woman with a family history of lung cancer show a nodule with the progressive growth pattern (box). The baseline CT scan, obtained in October 2017, demonstrates a pure ground-glass nodules in the right lower lobe. Consecutive CT scans obtained from 2017 to 2022 show the continuous enlargement of the nodule during active surveillance. The maximum diameter of the nodule increased from 5.6 mm in 2017 to 10.2 mm in 2022. (B) Images in a 45-year-old man show a nodule with the indolent growth pattern (box). The baseline CT scan, obtained in April 2018, demonstrates a pure ground-glass nodules in the left lower lobe. Consecutive CT scans obtained from 2019 to 2023 show that the nodule remained radiographically stable during CT surveillance. The maximum diameter of the nodule was 5.4 mm in 2018 and 6.1 mm at the final surveillance scan in 2023.
CT
CT reveals progressive growth pattern in incidental lung nodules
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Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.
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Serial axial chest CT scans demonstrating the longitudinal evolution of small pure ground-glass nodules (pGGNs) incidentally detected during a routine wellness assessment. (A) Images in a 37-year-old woman with a family history of lung cancer show a nodule with the progressive growth pattern (box). The baseline CT scan, obtained in October 2017, demonstrates a pure ground-glass nodules in the right lower lobe. Consecutive CT scans obtained from 2017 to 2022 show the continuous enlargement of the nodule during active surveillance. The maximum diameter of the nodule increased from 5.6 mm in 2017 to 10.2 mm in 2022. (B) Images in a 45-year-old man show a nodule with the indolent growth pattern (box). The baseline CT scan, obtained in April 2018, demonstrates a pure ground-glass nodules in the left lower lobe. Consecutive CT scans obtained from 2019 to 2023 show that the nodule remained radiographically stable during CT surveillance. The maximum diameter of the nodule was 5.4 mm in 2018 and 6.1 mm at the final surveillance scan in 2023.
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