Parathyroid carcinoma is a rare form of cancer, which can be initially a diagnostic challenge and once diagnosed, there is lack of clinical evidence for its management. Its predominant manifestation is symptomatic hypercalcemia, but incidental diagnoses can also occur. Here, we report two cases but each with its own clinical nuances-one presents with asymptomatic hypercalcemia and the other presents with long-standing debilitating manifestations of hypercalcemia. We detail our extensive pre-operative evaluation and the perioperative management. Both are treated surgically, requiring radical excision, and both had unilateral level VI neck dissections. Radiological and biochemical surveillance is performed in both cases and in each case is essential in long-term management. Both patients remain disease free on one-year postoperative follow-up.

MR arthrography (MRA) has previously been the radiological gold standard for investigating labral and chondral lesions of the hip joint. In recent years, 3T MRI has demonstrated comparable accuracy, being adopted as the first-line imaging investigation in many institutions. We compare the associated increased cost and radiation dose of the fluoroscopic component of the MRA compared to MRI. In this retrospective review over 2 years, 120 patients (mean age 27.3 years ± 13.2, range 8–67) underwent 3T MRA or non-contrast 3T MRI. Three musculoskeletal radiologists reported the data independently. Primary objectives included cost-comparison between each and radiation dose of the fluoroscopic component of the MRA. Secondary objectives included comparing detection of pathology involving the acetabular labrum, femoral cartilage, and acetabular cartilage. Then, 58 (48

Objectives To assess if brake response times are altered pre and post CT-guided cervical spine nerve root injections.Methods Brake response times were assessed before and after CT-guided cervical spine nerve root injections in a cohort of patients. The average of 3 brake response times was recorded before and 30 min after injection. Statistical analysis was performed using GraphPad. A paired Student t-test was used to compare the times before and after the injections.Results Forty patients were included in this study. The mean age was 55 years. There were 17 male and 23 female patients. There was no significant difference in the mean pre and post CT-guided cervical spine nerve root injection brake response times; 0.94 s (range 0.4-1.2 s) and 0.93 s (range 0.5-1.25 s), respectively (P = .77).Conclusions Brake response time did not significantly differ pre and 30 min post CT-guided cervical spine nerve root injections.Advances in knowledge To the authors' best knowledge, there are no current studies assessing brake response times post CT-guided cervical spine nerve root injections. While driving safety cannot be proven by a single metric, it is a useful study in demonstrating that this is not inhibited in a cohort of patients.

Chronic exertional compartment syndrome is well documented in the distal extremities, but is rare in the thighs. We present the case of a 19-year-old male who presented with chronic, recurrent bilateral thigh pain induced by physical activity, which settled with rest but recurred on immediate return to exercise. Postexercise MRI of both thighs demonstrated changes of symmetrical edema in the proximal quadriceps muscles, reflecting exercise-induce compartment syndrome. The patient underwent selective fasciotomies of each anterior thigh with improvement of symptoms. The patient is now doing well, with some residual milder symptoms and appearances on follow-up MR imaging are not as pronounced. This case describes the clinical presentation and imaging appearance of a rare case of chronic compartment syndrome in the quadriceps femoris.

Objectives To assess the most common lower limb acute muscle injuries on MRI imaging in a national specialist centre for orthopaedics and sports medicine and to explore potential gender differences. Methods Over a 3-year time period, all MRI lower limb studies with acute muscle injury (AMI) were reviewed. A British Athletics muscle injury classification (BAMIC) was given and a statistical analysis was performed. Results A total of 195 AMIs were diagnosed: 177 (91%) male and 18 (9%) female injuries (M to F = 9.8:1). The most common lower limb AMIs were BAMIC grade 1a injuries ( n = 48, 25%). The most commonly injured muscle was biceps femoris ( n = 87, 45%), specifically grade 1b and grade 2b injuries. There was no significant difference in age between men and women with acute lower limb muscle injuries ( p = 0.19). Females were 1.5 times more likely to have a lower grade AMI than males, although this did not reach statistical significance ( p = 0.7) owing to a striking lower number of female patients. There was no significant difference between genders in the likelihood of sustaining a hamstring or quadricep AMI (hamstrings OR = 2.47, p = 0.14 and quadriceps OR = 0.926, p 0.99). Conclusions Grade 1a is the most common lower limb AMI grade in our institution, accounting for 25%. Biceps femoris is the most commonly injured muscle (45%) with grade 1b and grade 2b being the most frequently encountered grades of biceps femoris injuries. Lower-grade injuries are more common in females compared to males, although not significantly so. Further studies are required to explore possible reasons for this gender gap.

Puprose: The purpose of this study was to evaluate a combined autologous blood-patch (ABP)-immediate patient rollover (IPR) technique compared with the IPR technique alone on the incidence of pneumothorax and chest drainage following CT-guided lung biopsy. Methods: In this interventional cohort study of both prospectively and retrospectively acquired data, 652 patients underwent CT-guided lung biopsy. Patient demographics, lesion characteristics and technical biopsy variables including the combined ABP-IPR versus IPR alone were evaluated as predictors of pneumothorax and chest drain rates using regression analysis. Results: The combined ABP-IPR technique was performed in 259 (39.7 %) patients whilst 393 (60.3 %) underwent IPR alone. There was no significant difference in pneumothorax rate or chest drains required between the combined ABP-IPR vs IPR groups (p =.08, p =.60 respectively). Predictors of pneumothorax adjusted for the combined ABP-IPR and IPR alone groups included age (p =.02), lesion size (p =.01), location (p =.005), patient position (p =.008), emphysema along the needle track (p =.005) and lesion distance from the pleura (p =.02). Adjusted predictors of chest drain insertion included lesion location (p =.09), patient position (p =.002), bullae crossed (p =.02) and lesion distance from the pleura (p =.02). Conclusion: The combined ABP-IPR technique does not reduce the pneumothorax or chest drain rate compared to the IPR technique alone. Utilising IPR without an ABP following CT-guided lung biopsy results in similar pneumothorax and chest drain rates while minimising the potential risk of systemic air embolism.

We report the case of a 50-year old woman with a known history of lipodystrophy. A pelvic radiograph was taken for the investigation of right hip pain. The image shown demonstrates an indeterminate artefact projected over the right iliac fossa. A previous CT renal study was reviewed, demonstrating the same device in the subcutaneous tissues of the contralateral left lower quadrant which on close inspection was consistent with a continuous glucose monitoring device. Features of lipodystrophy were also noted on review of the CT imaging. Although many devices such as vagal stimulators and prosthetic valves are easily recognized by radiologists on radiographic images, they may be less familiar with devices such as continuous glucose monitors. The aim of this case report is to familiarize radiologists with the appearances of continuous glucose monitors to allow for effective reporting.

Background: Myocardial fibrosis leads to diastolic dysfunction in patients with hypertrophic cardiomyopathy (HCM). Objectives: To evaluate a manual method of measuring mitral annular relaxation velocity (termed cardiac MRI e') as a measure of diastolic dysfunction on routine cardiac MRI and its relationship with myocardial late-gadolinium enhancement (LGE) and feature tracking measures of diastolic dysfunction in patients with HCM. Methods: CMR e', feature tracking measures of diastolic function, left atrial, left ventricular (LV) parameters and LGE were retrospectively measured in 75 patients with HCM (mean age, 54.7 years +/- 15.3, 54 men). Multivariate regression and partial Spearman correlations were performed. Results: Cardiac MRI e' measures correlated with LGE (r = 0.49, P < 0.001) and multiple feature tracking measures of diastolic function, adjusted for patient demographics, left atrial and left ventricular parameters. Cardiac MRI e' measures were independently predictive of LGE >= 10% (mean total cardiac MRI e': LGE < 10% vs LGE >= 10% was 3.5 cm/s vs. 1.7 cm/s, P < 0.001). Superior CMR e' had an AUC of 0.79 [95%CI 0.66-0.92, P < 0.0001]) in predicting patients with LGE >= 10% and a cutoff of 1.7 cm/s resulted in a sensitivity and specificity of 81.0% and 78.0% respectively. Conclusion: Cardiac MRI e' is a manual measure of LV diastolic dysfunction acquired on routine cardiac MRI without specialized software and is an independent predictor of LGE >= 10% and diastolic dysfunction in HCM.

This review focuses on three key noninvasive cardiac imaging modalities-cardiac CT angiography (CTA), MRI, and PET/CT-and summarizes key publications in 2021 relevant to radiologists in clinical practice. Although this review focuses primarily on articles published in Radiology, important studies from other major journals are included to highlight "must-know" articles in the field of cardiovascular imaging. Cardiac CTA has been established as the first-line test for patients with stable chest pain and no known coronary artery disease, and its value remains central to the assessment of surgical or transcatheter aortic valve replacement. Artificial intelligence continues to evolve in a number of applications in cardiovascular disease. In cardiac MRI studies, 2021 has seen an emphasis on nonischemic cardiomyopathies, valvular heart disease, and COVID-19 disease cardiac manifestations and the authors highlight the key articles on these topics. A section featuring the increasing role of cardiac PET/CT in the assessment of cardiac sarcoidosis and prosthetic valves is also provided.

AIM:To describe the clinical characteristics and treatments associated with antibody positive optic neuropathies including anti-myelin oligodendrocyte glycoprotein (MOG) and anti-aquaporin 4 (AQP4), alongside diagnostic modalities, investigations, and outcomes. METHODS:A cross-sectional single-centre retrospective case series consisting of 16 patients including 12 anti-MOG positive patients and 4 anti-AQP4 positive patients. Each of these patients had clinical signs and symptoms of optic neuritis and consisted of all patients who had a positive blood antibody result in our centre. Clinical findings including presence of a relative afferent pupillary defect, colour vision and disc assessment were recorded. Structured clinical exam and multimodal imaging was undertaken sequentially on each. Optical coherence tomography (OCT) scanning was preformed to examine the correlation between ganglion cell layer (GCL) thickness and visual acuity (VA) at presentation and as a determinant of final visual outcome in both groups. Initial and long-term treatment is also summarised. RESULTS:A total of 16 patients were included in the study consisting of 12 anti-MOG and 4 anti-AQP4 positive patients. Nine of the 16 patients were female and the average age of onset was 29.2y in the MOG group and 42y in the AQP4 group. There was no statistically significant correlation (Pearson correlation) between GCL thickness and presenting and final VA [r(10)=0.081, P=0.08 and r(10)=0.089, P=0.34 respectively]. The same statistical analysis was performed for the correlation between retinal nerve fibre layer (RNFL) and VA and similar outcomes were observed [r(10)=0.04, P=0.22 and r(10)=0.09, P=0.04]. No correlation was seen for initial RNFL thickness and final visual outcome in this group either [r(2)=0.19, P=0.38]. Visual field testing and radiological findings for each group are described. CONCLUSION:No correlation between initial VA or RNFL and final visual outcome is identified. A broad range of visual field and radiographic findings are identified, a consensus on treatment of neuromyelitis optica spectrum disorders and anti-MOG positive optic neuropathies has yet to be accepted but initial high dose immunosuppression followed by low dose maintenance therapy is favoured.

In patients with unclassifiable interstitial lung disease, HRCT can show a characteristic pattern of bilateral patchy ground glass and consolidative infiltrates in a peribronchovascular distribution with striking macrocystic lung destruction. There is typically no prior history of antigen exposures or connective tissue disorder. Without treatment, the pattern may progress aggressively leading eventually to lung transplantation.

An 18-year-old lady presented with progressive cellulitis of her left orbit. Over the course of several weeks, she had noticed increasing swelling of her eyelid, reduced eye opening, and eventual pain on extraocular movements, all of which were present on clinical examination. Visual field tests and visual acuity were both unaffected, and there was no focal neurology. CT (Figure 1-A) revealed multiple ground glass osseous lesions within the left skull suggestive of polyostotic FD with a more aggressive appearing expansile lesion within the roof of the left orbit and frontal bone. MRI (Figure 1-B) demonstrated fluid-fluid levels within this lesion and surrounding enhancement. Tissue analysis eventually confirmed fibrous dysplasia (FD) with a secondary aneurysmal bone cyst (ABC). Follow-up MRI showed stability of these lesions, and the patient is currently being managed conservatively. FDs and ABCs are relatively common, but there are only a handful of cases of craniofacial FD with secondary ABC formation.1 Secondary ABCs may present a diagnostic challenge and can occur in a variety of primary bone lesions such as giant cell tumors, chondroblastomas, or FD.2 While not pathognomonic, a fluid-fluid level on MRI within a primary lesion may suggest the diagnosis.

In resectable pancreatic ductal adenocarcinoma (PDAC), few pre-operative prognostic biomarkers are available. Radiomics has demonstrated potential but lacks external validation. We aimed to develop and externally validate a pre-operative clinical-radiomic prognostic model. Retrospective international, multi-center study in resectable PDAC. The training cohort included 352 patients (pre-operative CTs from five Canadian hospitals). Cox models incorporated (a) pre-operative clinical variables (clinical), (b) clinical plus CT-radiomics, and (c) post-operative TNM model, which served as the reference. Outcomes were overall (OS)/disease-free survival (DFS). Models were assessed in the validation cohort from Ireland (n = 215, CTs from 34 hospitals), using C-statistic, calibration, and decision curve analyses. The radiomic signature was predictive of OS/DFS in the validation cohort, with adjusted hazard ratios (HR) 2.87 (95% CI: 1.40–5.87, p < 0.001)/5.28 (95% CI 2.35–11.86, p < 0.001), respectively, along with age 1.02 (1.01–1.04, p = 0.01)/1.02 (1.00–1.04, p = 0.03). In the validation cohort, median OS was 22.9/37 months (p = 0.0092) and DFS 14.2/29.8 (p = 0.0023) for high-/low-risk groups and calibration was moderate (mean absolute errors 7%/13% for OS at 3/5 years). The clinical-radiomic model discrimination (C = 0.545, 95%: 0.543–0.546) was higher than the clinical model alone (C = 0.497, 95% CI 0.496–0.499, p < 0.001) or TNM (C = 0.525, 95% CI: 0.524–0.526, p < 0.001). Despite superior net benefit compared to the clinical model, the clinical-radiomic model was not clinically useful for most threshold probabilities. A multi-institutional pre-operative clinical-radiomic model for resectable PDAC prognostication demonstrated superior net benefit compared to a clinical model but limited clinical utility at external validation. This reflects inherent limitations of radiomics for PDAC prognostication, when deployed in real-world settings. • At external validation, a pre-operative clinical-radiomics prognostic model for pancreatic ductal adenocarcinoma (PDAC) outperformed pre-operative clinical variables alone or pathological TNM staging. • Discrimination and clinical utility of the clinical-radiomic model for treatment decisions remained low, likely due to heterogeneity of CT acquisition parameters. • Despite small improvements, prognosis in PDAC using state-of-the-art radiomics methodology remains challenging, mostly owing to its low discriminative ability. Future research should focus on standardization of CT protocols and acquisition parameters.

HomeRadiologyVol. 302, No. 2 PreviousNext Reviews and CommentaryFree AccessEditorialThe Lung-to-Tumor Interface for the Evaluation of Tumor HypoxiaDavid J. Murphy , David T. RyanDavid J. Murphy , David T. RyanAuthor AffiliationsFrom the Department of Radiology, St Vincent’s University Hospital, Dublin, Ireland.Address correspondence to D.J.M. (e-mail: [email protected]).David J. Murphy David T. RyanPublished Online:Nov 16 2021https://doi.org/10.1148/radiol.2021211926MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In See also the article by Dewaguet et al in this issue.Dr David J. Murphy is a consultant radiologist specializing in cardiothoracic and PET imaging in the Department of Radiology, St Vincent’s University Hospital and an associate clinical professor of radiology in University College Dublin in Dublin, Ireland. His main research interests are in quantitative CT and MRI evaluation of thoracic malignancies, interstitial lung disease, diffuse cystic lung disease, inflammatory cardiomyopathies, and nonmalignant cardiothoracic applications of PET.Download as PowerPointOpen in Image Viewer Dr David T. Ryan is a 4th-year radiology resident in the Department of Radiology, St Vincent’s University Hospital, Dublin, Ireland. His main areas of interest include musculoskeletal and cardiothoracic imaging, with a special focus on interventional techniques along with research in cardiac MRI and radiomics.Download as PowerPointOpen in Image Viewer The treatment of non–small cell lung cancer (NSCLC) is on the basis of combinations of surgery, chemotherapy, radiation therapy, and targeted therapies. Treatment failure is a major problem in NSCLC, and tumor hypoxia is one of the driving forces of treatment failure. The rapid and uncontrolled growth of solid tumors leads to imbalances between oxygen supply and consumption, which often exhibits substantial temporal variability (intermittent/cycling hypoxia). The resulting hypoxia promotes an alternate means of energy production via anaerobic glycolysis.Hypoxia has an aggressive effect on the tumor microenvironment, promoting genomic instability, further abnormal proliferation, enhanced local invasion, and new blood vessel formation (1). This environment of altered gene expression can ultimately promote metastatic spread and confer therapy resistance (2). Hypoxia is also an attractive therapeutic target if successfully exploited because it is almost only found in cancer cells, giving it a favorable therapeutic ratio. Identifying hypoxic tumors allows recognition of more aggressive lung cancers and may eventually inform therapeutic decision making. Accurate identification of hypoxic tumors with noninvasive imaging is currently difficult because of the complexity of the tumor microenvironment.In this issue of Radiology, Dewaguet et al (3) reported on the use of dual-energy CT (DECT) perfusion to assess for tumor hypoxia in NSCLC, with a particular emphasis on the perfusion profile of the invading tumor front. This is the outer layer of the tumor at the interface with surrounding lung parenchyma and is a part of the tumor that demonstrates active endothelial proliferation. This prospective study examined tumor perfusion in 49 patients with NSCLC (37 adenocarcinomas, 12 squamous cell carcinomas) before surgical resection by using a dual-phase DECT protocol. Resected pathologic specimens were examined for expression of a marker of tumor hypoxia, membranous carbonic anhydrase (mCA) IX. Tumor perfusion was evaluated at DECT by measuring iodine concentration and normalized iodine uptake at both first pass and on delayed-phase acquisitions throughout the tumor as a whole and in three 2-mm-thick peripheral layers that were automatically segmented by proprietary software. These three layers encompassed the rim of the lung parenchyma surrounding the tumor, the intermediate rim at the frontier between the tumor and the lung parenchyma (the invading tumor front), and the most peripheral rim of the tumor. Comparisons of iodine concentration between the two DECT phases were used to profile tumor neovascularization as either functional or nonfunctional. If the iodine concentration value on the delayed phase was greater than that at the first pass, the neovascularization was classified as nonfunctional (ie, composed of porous vessels), and the converse pattern was deemed functional neovascularization.Thirty-three tumors (67%) were positive for mCA IX (hypoxic), with no differences between adenocarcinomas and squamous cell carcinomas. At the DECT perfusion analysis, at the level of the invading tumor front, the iodine concentration and normalized iodine uptake were higher on the first-pass acquisitions of mCA IX–positive NSCLCs compared with mCA IX–negative tumors (0.53 vs 0.21 mg/mL and 0.04 vs 0.02 mg/mL, respectively; P = .03 for both). Delayed iodine concentration in the central part of the tumors was higher in mCA IX–negative tumors (1.68 vs 1.28 mg/mL; P = .02). Otherwise, there were no differences in iodine concentration and normalized iodine uptake between hypoxic and nonhypoxic NSCLCs in the tumor as a whole or in the outer or inner peripheral layers. Twenty-nine tumors (59%) exhibited a profile of functional neovascularization at the invasive tumor front. These tumors had a higher median mCA IX score than NSCLCs with a nonfunctional neovascularization profile (P = .03). 70% of hypoxic tumors exhibited a functional neovascularization profile at this intermediate rim, compared with 40% of nonhypoxic tumors (P = .05). These findings suggest that hypoxic NSCLCs have a greater proliferation of new blood vessels at the level of the invading tumor front than nonhypoxic tumors and that this neovascularization tends to be composed of well-formed capillaries.Perfusion-based imaging, in the form of dynamic contrast-enhanced (DCE) CT, has been previously assessed as a noninvasive indirect marker of tumor hypoxia. DCE CT tumor perfusion studies have shown that increases in regional tumor blood volume and permeability surface area occur as the tumor adapts to a hypoxic microenvironment. Therefore, comparisons of regional tumor blood flow and blood volume measurements may serve as a surrogate marker of tumor hypoxia (4). However, DCE CT perfusion has generally failed to transition from trials to routine clinical use. The reasons behind this are likely related to several factors, including a lack of standardization of techniques across different vendors and relatively high radiation dose and breathing-related artifacts because of the multiple sequential CT acquisitions required. The method used by Dewaguet et al (3) is on the basis of a similar principle to DCE CT, with tumor perfusion as an indirect marker of hypoxia. This technique measures perfusion by quantifying tumor iodine concentration at two points from iodine maps generated with DECT by using the material decomposition principle. This two-phase DECT protocol is straightforward to perform and does not have the same radiation dose penalty as earlier DCE CT techniques. The first-pass CT acquisition measures maximal tumor arterial perfusion and the 50-second delayed-phase measures contrast agent leak from tumor neovasculature into the interstitium. Of the measurements performed, normalized iodine uptake standardizes the iodine concentration measured within a volume to the iodine concentration in the aorta. This makes it the more robust and reproducible measurement of iodine content because it helps correct for differences in scan timing, cardiovascular status, and administered contrast agent dose.Previous DECT perfusion studies in NSCLC have shown usefulness in assessing tumor grade (5) and local tumor invasion (6). Li et al (7) found a correlation between lung cancer microvessel density, a marker of neoangiogenesis, and both iodine concentration and normalized iodine concentration at DECT perfusion, with a significant association between iodine concentration on the venous phase and both tumor grade and necrosis. Interestingly, these parameters were not associated with nodal metastasis or TNM stage at the time of diagnosis. DECT perfusion has also been evaluated in NSCLC treatment response assessment; Baxa et al (8) measured whole-tumor vascularity in patients with NSCLC on anti–epidermal growth factor receptor–targeted therapy by using DECT perfusion, demonstrating that treatment responders showed a reduction in overall tumor vascularity. These lung cancer DECT perfusion studies evaluated perfusion by considering the tumor as a whole single homogenous entity, but we know that this does not often reflect tumor biology. NSCLCs are complex, heterogeneous biologic environments. Therefore, the approach taken in the study by Dewaguet et al (3) to subdivide tumors into distinct central and distinct peripheral zones enables an evaluation of regional tumor perfusion that is likely to be more representative of underlying tumor biology. Their results demonstrate differences in tumor perfusion and profile of neoangiogenesis at the invading tumor front between hypoxic and nonhypoxic NSCLCs. This is an important advance in our knowledge because it begins to provide an insight into the biology of probably the most active portion of the invading lung cancer.There are a number of unanswered questions that merit further exploration. The authors performed DECT with a dual-source DECT system from a single vendor. Validation of this technique would therefore need to be performed with other available DECT systems from different vendors. As an exploratory study, Dewaguet et al (3) only included patients with operable NSCLC. However, the type of tumor perfusion and hypoxia evaluation discussed in the study is most likely to be beneficial in treatment decisions for patients with inoperable disease. Therefore, any future studies should focus on patients with inoperable NSCLC, preferentially by encompassing different centers and including all NSCLC histologic subtypes. We also do not know the prognostic significance of characteristics at the invading tumor front because this was not evaluated with DECT perfusion, which would be of interest in future projects. CT is not the only noninvasive imaging technique that may depict tumor hypoxia. Oxygen-enhanced MRI techniques (9) and hypoxia-specific PET tracers, such as nitroimidazole-based fluorine 18–labeled radiotracers (10), have shown efficacy in depicting tumor hypoxia. However, widespread use of both of these modalities for tumor hypoxia evaluation is currently limited by cost, availability, and the level of expertise required. It would be interesting to evaluate how DECT perfusion performs relative to MRI or PET as a noninvasive marker of lung tumor hypoxia. However, given its widespread availability, any CT technique that provides clinically relevant information regarding tumor biology should be explored. Nearly every patient with lung cancer who chooses to be treated will undergo CT at some point in their clinical course. Advancing the assessment that radiologists can offer beyond morphologic structure into tumor biology will hopefully advance patient care.Disclosures of Conflicts of Interest: D.J.M. No relevant relationships. D.T.R. No relevant relationships.References1. Salem A, Asselin MC, Reymen B, et al. Targeting Hypoxia to Improve Non-Small Cell Lung Cancer Outcome. J Natl Cancer Inst 2018;110(1)14–30. Crossref, Google Scholar2. Ziółkowska-Suchanek I. Mimicking Tumor Hypoxia in Non-Small Cell Lung Cancer Employing Three-Dimensional In Vitro Models. Cells 2021;10(1):141. Crossref, Medline, Google Scholar3. Dewaguet J, Copin MC, Duhamel A, et al. Dual-Energy CT Perfusion of Invasive Tumor Front in Non–Small Cell Lung Cancers. Radiology 2021. https://doi.org/10.1148/radiol.2021210600. Published online November 16, 2021. Link, Google Scholar4. Miles KA, Lee TY, Goh V, et al. Current status and guidelines for the assessment of tumour vascular support with dynamic contrast-enhanced computed tomography. Eur Radiol 2012;22(7):1430–1441. Crossref, Medline, Google Scholar5. Iwano S, Ito R, Umakoshi H, Ito S, Naganawa S. Evaluation of lung cancer by enhanced dual-energy CT: association between three-dimensional iodine concentration and tumour differentiation. Br J Radiol 2015;88(1055):20150224. Crossref, Medline, Google Scholar6. Shimamoto H, Iwano S, Umakoshi H, Kawaguchi K, Naganawa S. Evaluation of locoregional invasiveness of small-sized non-small cell lung cancers by enhanced dual-energy computed tomography. Cancer Imaging 2016;16(1):18. Crossref, Medline, Google Scholar7. Li Q, Li X, Li XY, Huo JW, Lv FJ, Luo TY. Spectral CT in Lung Cancer: Usefulness of Iodine Concentration for Evaluation of Tumor Angiogenesis and Prognosis. AJR Am J Roentgenol 2020;215(3):595–602. Crossref, Medline, Google Scholar8. Baxa J, Matouskova T, Krakorova G, et al. Dual-Phase Dual-Energy CT in Patients Treated with Erlotinib for Advanced Non-Small Cell Lung Cancer: Possible Benefits of Iodine Quantification in Response Assessment. Eur Radiol 2016;26(8):2828–2836. Crossref, Medline, Google Scholar9. O’Connor JPB, Robinson SP, Waterton JC. Imaging tumour hypoxia with oxygen-enhanced MRI and BOLD MRI. Br J Radiol 2019;92(1095):20180642. Crossref, Medline, Google Scholar10. Peeters SGJA, Zegers CML, Lieuwes NG, et al. A comparative study of the hypoxia PET tracers [18F]HX4, [18F]FAZA, and [18F]FMISO in a preclinical tumor model. Int J Radiat Oncol Biol Phys 2015;91(2):351–359. Crossref, Medline, Google ScholarArticle HistoryReceived: July 29 2021Revision requested: Aug 11 2021Revision received: Aug 13 2021Accepted: Aug 16 2021Published online: Nov 16 2021Published in print: Feb 2022 FiguresReferencesRelatedDetailsAccompanying This ArticleDual-Energy CT Perfusion of Invasive Tumor Front in Non–Small Cell Lung CancersNov 16 2021RadiologyRecommended Articles Dual-Energy CT Perfusion of Invasive Tumor Front in Non–Small Cell Lung CancersRadiology2021Volume: 302Issue: 2pp. 448-456Pseudoprogression during Immune Checkpoint Inhibitor Therapy for Solid Tumors: Clarity Amidst Rapid EvolutionRadiology2020Volume: 297Issue: 1pp. 97-98Pulmonary Functional Imaging: Part 2—State-of-the-Art Clinical Applications and Opportunities for Improved Patient CareRadiology2021Volume: 299Issue: 3pp. 524-538Advances in Thoracic Imaging: Key Developments in the Past Decade and Future DirectionsRadiology2023Volume: 306Issue: 2Is the Cyst-Airway Communicating Index a Possible Tool to Differentiate Cystic Lung Diseases?Radiology: Cardiothoracic Imaging2020Volume: 2Issue: 2See More RSNA Education Exhibits Pitfalls in Interpreting FDG PET Findings Related to Lung Cancer Except StagingDigital Posters2020Spectral CT in Cardiothoracic Imaging: Potential Applications that Radiologists Should KnowDigital Posters2022Wait, You Can See Motion on Chest Radiographs?! 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The aim of this study was to identify and analyse all articles published by Irish radiology departments in the medical literature since the year 2000. The PubMed database was searched to identify and review all articles published by radiologists based in the Republic of Ireland or Northern Ireland. Citation counts were then obtained and the top ten most cited articles were identified. There were 781 articles published during the study period. Of these, 558 (71%) were published in radiology journals and the remaining 223 (29%) were published in general medical journals. Abdominal radiology was the most represented sub-specialty (33% of all articles). There was a general trend of increased publications per year. Only 75 (9.6%) of articles were collaborative efforts by more than one radiology department. Irish radiology departments have a considerable research output and this has increased since the year 2000. More collaborative research between Irish radiology departments is encouraged.