Radiologists have the unique opportunity to use imaging to look inside their patients to make a diagnosis. Some of the things they find are unexpected.
Diagnostic radiologists Margarita Revzin, MD, and Nadia Solomon, MD, teamed up to study and write about their profession’s vital role in identifying eating disorders for the RSNA journal RadioGraphics. They found that while such disorders are common, they are often underdiagnosed and undertreated because social stigma makes patients less likely to seek medical attention and less compliant with treatment.
“A lot of patients are not forthcoming when describing their problems,” Dr. Revzin said. “They may not even understand that they have a problem, or they may be in denial and don’t come to the physician and say, ‘I have anorexia … I have bulimia.’”
Drs. Revzin and Solomon are colleagues at the Yale School of Medicine. Dr. Revzin is an associate professor of radiology and biomedical imaging, and Dr. Solomon is a fourth-year diagnostic radiology resident and senior chief resident. In addition to being on the Holman Research Pathway, Dr. Solomon is enrolled in the Investigative Medicine PhD Program with the Yale Graduate School of Arts and Sciences. Dr. Solomon also is a member of the ABR’s Diagnostic Radiology Initial Certification Advisory Committee.
Dr. Revzin was the inspiration for the two to begin collaborating on material for medical journals.
“We worked together in the emergency department one day and she mentioned that she had projects, and I was interested in getting involved,” Dr. Solomon said. “We just bonded as two very enthusiastic people who like learning and teaching.”
Their work found that eating disorders impact between 0.3% and 1% of Americans, with women being 10 times more likely to develop one. The most recognized eating disorders are anorexia nervosa and bulimia nervosa.
Eating disorders are a substantial health threat because they can affect any organ system and are associated with the highest mortality rates of any psychiatric disorder. Anorexia nervosa has a 5% to 10% mortality rate within 10 years of diagnosis.
“You have to be vigilant to recognize these abnormalities because you may be saving patients’ lives,” Dr. Revzin said. “As a radiologist, you are the first one to put things together and figure out that the patient suffers from an eating disorder. The mortality and morbidity for eating disorders is relatively high, and a lot of the times they link to psychiatric disorders.”
The subject was a good fit for Dr. Solomon, who has a master’s in forensic psychology from the John Jay College of Criminal Justice. Her initial goal was to pursue a different type of medicine.
“I went to med school to be a psychiatrist,” she said. “I studied psychology and particularly forensic psychology in undergrad and in graduate school prior to medicine. This was an awesome opportunity to explore a topic that is very deeply linked to psychology. I think understanding why certain things appear the way they do or why patients demonstrate certain imaging findings related to these diseases is deeply ingrained in what’s going on with these diseases.”
Dr. Revzin said there are many signs that a radiologist can find through imaging that strongly suggest eating disorders. Their work centered on cardiac, gastrointestinal, and urologic issues.
“One of the major ones that we usually think of is when we see a small heart shadow,” she said. “A small heart shadow is something that right away you can detect on a regular X-ray.”
She said CT scans can reveal a lack of subcutaneous fat. In addition, osteoporosis in a younger patient is a concerning sign as is an underdeveloped uterus or swollen parotid glands.
“Imaging is fascinating (in this clinical context) because your patient may tell you one thing, but what we see is what we see,” Dr. Solomon said. “If we see something there, it’s there. The next step is to figure out what the finding might mean.”
Both physicians agree that society’s expectations often cause people – especially those who are young and impressionable – to develop body image issues. Watching others experiencing their best days on social media – sometimes with the help of photo manipulation – can send a message that nothing short of a “perfect” look is acceptable.
“Society puts a lot of pressure on what is supposed to be normal and what is supposed to be attractive,” Dr. Revzin said. “This is really affecting people in a negative way because they all want to adhere to those expectations.”
Radiologists regularly consult with physicians from outside their field. Dr. Solomon said that it’s crucial to take a big-picture approach when helping patients, and she wants to continue research work that involves other areas of medicine.
“It’s important to dig into what other people are doing outside of your specialty,” she said. “If you really want to be an expert and best serve a patient who is struggling with a certain problem or disease, it’s vital to take an interdisciplinary, multispecialty approach.”
