Michael D. Hope

Article Abstract 4D flow imaging—state of the art Michael Markl, Michael D. Hope

Background: Abdominal aortic aneurysm (AAA) screening programs have been active in the United States since 2005, but are not the only way AAAs are detected. AAA management and outcomes have not been investigated broadly in the context of “implicit AAA screening,” whereby radiologic examinations not intended for focused screening can identify AAAs. Methods and Results: We examined the association between imaging‐based AAA screening, both explicit and implicit, and various outcomes for ≈1.6 million veterans in the Veterans Affairs health care system from 2005 to 2015. Screened‐positive, screened‐negative, and unscreened veterans were identified in the overall cohort and within a subgroup of veterans aged 65 years in 2005. The yearly composite screening rate increased over 10 years, from 11.7% to 18.3%, whereas the screened‐positive rate decreased from 7.3% to 4.9%. Only 12.9% of screening examinations were explicit AAA screening ultrasounds. The subgroup’s composite screening rate was 74% within its 10‐year eligibility window, with implicit screening accounting for 91.8% of examinations. In the 2005 subgroup, all‐cause mortality and Charlson comorbidity scores were higher for veterans who underwent screening compared with those unscreened (31.2% versus 23.1% and 0.47 versus 0.25, respectively; P <0.001). AAA rupture rates were similar between those unscreened and screened‐negative individuals. Conclusions: Accounting for both explicit and implicit screening, AAA screening in the Veterans Affairs population has moderate reach. Efforts to expand explicit AAA screening are not likely to impact either all‐cause mortality or AAA rupture on the population scale as significantly as a careful accounting for and use of implicit screening data.

This international evidence-based nomenclature and classification consensus on the congenital bicuspid aortic valve is intended to be universally used by clinicians, echocardiography sonographers a... This International Consensus Classification and Nomenclature for the congenital bicuspid aortic valve condition recognizes 3 types of bicuspid valves: 1. The fused type (right-left cusp fusion, rig...

This commentary discusses the findings of early studies that addressed the use of chest computed tomography for the detection of COVID-19. The authors urge caution in rushing science and overinterpreting preliminary or flawed data.

Objectives Several studies suggest the sensitivity of chest computed tomography (CT) is far greater than that of reverse transcription polymerase chain reaction (RT-PCR) in diagnosing COVID-19 patients, and therefore, CT should be included as a primary diagnostic tool. This systematic review aims to stratify studies as high or low risk of bias to determine the true sensitivity of CT for severe acute respiratory syndrome coronavirus-2 infection according to the unbiased (low risk) studies, a topic of particular importance given the insufficient quantity of RT-PCR kits in many countries. We focus on sensitivity as that is the chief advantage perceived of CT. Materials and Methods This systematic review involved searching the PubMed and Google Scholar databases for articles conducted and published between January 1 and April 15, 2020. The quality assessment tool QUADAS-2 was used to stratify studies according to their risk of bias, and exclusion criteria included not providing the information deemed relevant for such a stratification, such as not indicating if the patients were symptomatic or asymptomatic, or identifying the source of the specimen for the reference standard, RT-PCR (eg, nasal, oropharyngeal, etc). Sensitivity values were then extracted, and random effects meta-analyses were performed. Results Of 641 search results, 37 studies (n = 9610 patients) were included in the analysis. The mean sensitivity of RT-PCR for COVID-19 reported by the biased studies was 70% (n = 5409/7 studies; 95% confidence interval [CI], 43–97; I² = 99.1%), compared with 78% by unbiased studies (n = 534/4 studies; 95% CI, 69–87, I² = 89.9%). For chest CT, the mean sensitivity reported by biased studies was 94% (n = 3371 patients/24 studies; 95% CI, 92–96; I² = 93.1%), compared with 75% by unbiased studies (n = 957/10 studies; 95% CI, 67–83; I² = 89.5%). Conclusions The difference between the sensitivities of CT and RT-PCR for severe acute respiratory syndrome coronavirus-2 infection is lower than previously thought, as after stratifying the studies, the true sensitivity for CT based on the unbiased studies is limited.

Lung cancer is the leading cause of cancer-related death, accounting for approximately 25% of all estimated cancer deaths in 2019.¹ Age and cigarette smoking are the main risk factors for lung cancer.² Given the demographics of the population that receives care in the US Department of Veterans Affairs (VA) health system, specifically the high incidence of smoking, lung cancer is a significant issue for US veterans, accounting for nearly 20% of all cancers among veterans.³ It is estimated that 900 000 veterans in the VA health care system meet US Preventive Services Task Force criteria for lung cancer screening, which has led to efforts to implement and refine lung cancer screening and management throughout the VA.^4,5