Radiology (RADIOLOGY)

Publications in this journal

• Article: MR Imaging Predictors of Molecular Profile and Survival: Multi-institutional Study of the TCGA Glioblastoma Data Set.

  Cooper LA, Hwang SN, Holder CA, Gao J, Aurora TD, Dunn WD Jr, Scarpace L, Mikkelsen T, Jain R, Wintermark M, [......], Freymann J, Kirby J, Zinn PO, Moreno C, Jaffe C, Colen R, Rubin DL, Saltz J, Flanders A, Brat DJ
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  ABSTRACT: Purpose:To conduct a comprehensive analysis of radiologist-made assessments of glioblastoma (GBM) tumor size and composition by using a community-developed controlled terminology of magnetic resonance (MR) imaging visual features as they relate to genetic alterations, gene expression class, and patient survival.Materials and Methods:Because all study patients had been previously deidentified by the Cancer Genome Atlas (TCGA), a publicly available data set that contains no linkage to patient identifiers and that is HIPAA compliant, no institutional review board approval was required. Presurgical MR images of 75 patients with GBM with genetic data in the TCGA portal were rated by three neuroradiologists for size, location, and tumor morphology by using a standardized feature set. Interrater agreements were analyzed by using the Krippendorff α statistic and intraclass correlation coefficient. Associations between survival, tumor size, and morphology were determined by using multivariate Cox regression models; associations between imaging features and genomics were studied by using the Fisher exact test.Results:Interrater analysis showed significant agreement in terms of contrast material enhancement, nonenhancement, necrosis, edema, and size variables. Contrast-enhanced tumor volume and longest axis length of tumor were strongly associated with poor survival (respectively, hazard ratio: 8.84, P = .0253, and hazard ratio: 1.02, P = .00973), even after adjusting for Karnofsky performance score (P = .0208). Proneural class GBM had significantly lower levels of contrast enhancement (P = .02) than other subtypes, while mesenchymal GBM showed lower levels of nonenhanced tumor (P < .01).Conclusion:This analysis demonstrates a method for consistent image feature annotation capable of reproducibly characterizing brain tumors; this study shows that radiologists' estimations of macroscopic imaging features can be combined with genetic alterations and gene expression subtypes to provide deeper insight to the underlying biologic properties of GBM subsets
  Radiology 02/2013; Radiology. 2013 Feb 7. [Epub ahead of print].
• Article: Pulmonary Emphysema Diagnosis with a Preclinical Small-Animal X-ray Dark-Field Scatter-Contrast Scanner

  A. Yaroshenko, F. G. Meinel, M. Bech, A. Tapfer, A. Velroyen, S. Schleede, S. Auweter, A. Bohla, A. O. Yildirim, K. Nikolaou, F. Bamberg, O. Eickelberg, M. F. Reiser, F. Pfeiffer
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  ABSTRACT: Purpose:To test the hypothesis that the joint distribution of x-ray transmission and dark-field signals obtained with a compact cone-beam preclinical scanner with a polychromatic source can be used to diagnose pulmonary emphysema in ex vivo murine lungs.Materials and Methods:The animal care committee approved this study. Three excised murine lungs with pulmonary emphysema and three excised murine control lungs were imaged ex vivo by using a grating-based micro-computed tomographic (CT) scanner. To evaluate the diagnostic value, the natural logarithm of relative transmission and the natural logarithm of dark-field scatter signal were plotted on a per-pixel basis on a scatterplot. Probability density function was fit to the joint distribution by using principle component analysis. An emphysema map was calculated based on the fitted probability density function.Results:The two-dimensional scatterplot showed a characteristic difference between control and emphysematous lungs. Control lungs had lower average median logarithmic transmission (-0.29 vs -0.18, P = .1) and lower average dark-field signal (-0.54 vs -0.37, P = .1) than emphysematous lungs. The angle to the vertical axis of the fitted regions also varied significantly (7.8 degrees for control lungs vs 15.9 degrees for emphysematous lungs). The calculated emphysema distribution map showed good agreement with histologic findings.Conclusion:X-ray dark-field scatter images of murine lungs obtained with a preclinical scanner can be used in the diagnosis of pulmonary emphysema.(c) RSNA, 2013Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.13122413/-/DC1.
  Radiology 01/2013;
• Article: Nonmalignant Breast Lesions: ADCs of Benign and High-Risk Subtypes Assessed as False-Positive at Dynamic Enhanced MR Imaging

  Parsian S, Rahbar H, Allison KH, Demartini WB, Olson ML, Lehman CD, Partridge SC
  Radiology 10/2012;
• Article: Detection of coronary artery anomalies in infants and young children with congenital heart disease by using MR imaging

  T. Tangcharoen, A. Bell, S. Hegde, T. Hussain, P. Beerbaum, T. Schaeffter, R. Razavi, R. M. Botnar, G. F. Greil
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  ABSTRACT: PURPOSE: To evaluate the feasibility and accuracy of magnetic resonance (MR) coronary angiography for the detection of coronary artery anomalies in infants and children by using surgical findings as a reference. MATERIALS AND METHODS: The data analysis was approved by the institutional review board. One hundred children with congenital heart disease underwent MR coronary angiography while under general anesthesia (mean age +/- standard deviation, 3.9 years +/- 3; age range, 0.2-11 years). A navigator-gated, T2-prepared, three-dimensional steady-state free precession whole-heart protocol (isotropic voxel size, 1.0-1.3 mm(3); mean imaging time, 4.6 minutes +/- 1.2; mean navigator efficiency, 70%; 3-mm gating window) was used after injection of gadopentetate dimeglumine. The cardiac rest period (end systole or middiastole) and acquisition window were prospectively assessed for each patient. Coronary artery image quality (score of 0 [nondiagnostic] to 4 [excellent]), vessel sharpness, and coronary artery anomalies were assessed by two observers. Surgery was performed in 58 patients, and those findings were used to define accuracy. Variables were assessed between age groups by using either analysis of variance or Kruskal-Wallis tests. RESULTS: Diagnostic image quality (score, >/=1 for all coronary artery segments) was obtained in 46 of the 58 patients (79%) who underwent surgery. The origin and course of the coronary artery anatomy depicted with MR imaging was confirmed at surgery in all 46 patients-including the four (9%) with substantial coronary artery anomalies. Diagnostic-quality images were obtained in 84 of the 100 patients. The rate of success improved significantly when patients were older than 4 months (88% for patients >4 months vs 17% for patients </=4 months, P < .001). CONCLUSION: Improved whole-heart MR coronary angiography enables accurate detection of abnormal origin and course of the coronary artery system even in very young patients with congenital heart disease.
  Radiology 01/2011; 259(1):240-7.
• Article: Baseline, Interim and Post Treatment PET/CT versus CECT Evaluation in Pediatric Non-Lymphoblastic Non-Hodgkin Lymphoma: a Prospective Study

  Sameer Bakhshi, Venkatraman Radhakrishnan, Punit Sharma, Rakesh Kumar, Sanjay Thulkar, Sreenivas Vishnubhatla, Deepa Dhawan, Arun Malhotra
  Radiology 01/2011;
• Article: Case 162: Scapulothoracic Dissociation

  MC Kreeger, P Bhargava
  Radiology 10/2010; 257:290-293.
• Article: Detection of epidermal thickening in GJB2 carriers with epidermal US.

  Pierpaolo Guastalla, Veronica Ileana Guerci, Antonella Fabretto, Flavio Faletra, Domenico Leonardo Grasso, Elisabetta Zocconi, Despina Stefanidou, Pio D'Adamo, Luca Ronfani, Marcella Montico, Marcello Morgutti, Paolo Gasparini
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  ABSTRACT: To measure epidermal thickness by using skin ultrasonography (US) in a series of healthy control subjects and obligate carriers for the worldwide most frequent form of congenital hearing loss owing to the mutated alleles of the connexin 26 gene (GJB2).
  Radiology 01/2009; 251(1):280-6.
• Article: Is it possible to quantify fluorescence during optical endoscopy?

  Peter L Choyke
  Radiology 12/2007; 245(2):307-8.
• Article: MR angiography versus CT angiography in the evaluation of neurovascular disease.

  Brian C Bowen
  Radiology 12/2007; 245(2):357-60; discussion 60-1.
• Article: Liver fibrosis: noninvasive assessment with MR elastography versus aspartate aminotransferase-to-platelet ratio index.

  Laurent Huwart, Christine Sempoux, Najat Salameh, Jacques Jamart, Laurence Annet, Ralph Sinkus, Frank Peeters, Leon C ter Beek, Yves Horsmans, Bernard E Van Beers
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  ABSTRACT: To prospectively compare the sensitivity and specificity of magnetic resonance (MR) elastography with those of the routinely available aspartate aminotransferase-to-platelet ratio index (APRI) test for staging hepatic fibrosis in patients who have undergone liver biopsy for suspicion of chronic liver disease, with histopathologic examination as the reference standard. The study was approved by the ethics committee. All patients gave written informed consent. Eighty-eight patients (37 men, 51 women; mean age, 54.0 years +/- 13.1 [standard deviation]) who underwent liver biopsy for suspicion of chronic liver disease underwent MR elastography and APRI testing within 2 days after liver biopsy. At histopathologic examination, the fibrosis stage was assessed according to METAVIR scores (fibrosis scores F0 [no fibrosis] to F4 [cirrhosis]). MR elastography was performed by transmitting mechanical waves within the liver and measuring the small cyclic displacement of the liver spins with a phase-contrast spin-echo sequence. The performances of MR elastography and APRI testing were assessed, and the optimal cutoff values for fibrosis stage were determined with receiver operating characteristic (ROC) curve analysis. At MR elastography, areas under the ROC curves (A(z)) for elasticity and viscosity, respectively, were 0.999 and 0.863 at fibrosis scores greater than or equal to F2, 0.997 and 0.962 at scores greater than or equal to F3, and 1.000 and 0.986 at score F4. A(z) values for elasticity at MR were significantly larger than those for the APRI (0.854 at scores > or = F2, P < .001; 0.886 at scores > or = F3, P = .003; and 0.851 at score F4, P = .004). Optimal cutoff values of elasticity were 2.5 kPa for fibrosis scores greater than or equal to F2, 3.1 kPa for scores greater than or equal to F3, and 4.3 kPa for score F4. Large A(z) values for elasticity (>0.990 for scores > or = F2, > or = F3, and F4) show that MR elastography was accurate in liver fibrosis staging and superior to biochemical testing with APRIs.
  Radiology 12/2007; 245(2):458-66.
• Article: Molecular imaging techniques in body imaging.

  Daniel J A Margolis, John M Hoffman, Robert J Herfkens, R Brooke Jeffrey, Andrew Quon, Sanjiv S Gambhir
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  ABSTRACT: Molecular imaging of the body involves new techniques to image cellular biochemical processes, which results in studies with high sensitivity, specificity, and signal-to-background. The most prevalently used molecular imaging technique in body imaging is currently fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET). FDG PET has become the method of choice for the staging and restaging of many of the most common cancers, including lymphoma, lung cancer, breast cancer, and colorectal cancer. FDG PET has also become extremely valuable in monitoring the response to therapeutic drugs in many cancers. New PET agents, such as fluorothymidine and acetate, have also shown promise in the evaluation of response to therapy and in the staging of prostate cancer. Magnetic resonance (MR) spectroscopy has shown promise in the evaluation of prostate cancer. Breast cancer evaluation benefits from advances in spectroscopic imaging and contrast-enhanced kinetic evaluation of vascular permeability, which is altered in neoplastic processes because of release of angiogenic factors. Superparamagnetic iron oxide (SPIO) particles represent the first of an expanding line of MR contrast agents that target specific cellular processes. SPIO particles have also been used in the evaluation of the cirrhotic liver and at MR lymphangiography.
  Radiology 12/2007; 245(2):333-56.
• Article: A true screening environment for review of interval breast cancers: pilot study to reduce bias.

  Paula B Gordon, Marilyn J Borugian, Linda J Warren Burhenne
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  ABSTRACT: To retrospectively assess the feasibility of an uninformed review process to evaluate interval breast cancers and to compare the number of false-negative cancers detected at uninformed review with the number detected at standard informed review. Institutional review board approval was obtained for this retrospective study, and informed consent was waived. Mammograms showing interval cancer were included in the daily work of radiologists in a high-volume screening center. Each of three experienced radiologists read studies in the normal screening environment, without knowledge that identifiers had been changed to conceal the fact that studies were not current (ie, uninformed review). Results were compared with the standard review procedure, in which mammograms showing interval cancers were mixed with normal mammograms and read in a panel of 17-20 interval cancers per 80 normal studies by radiologists who were aware that they were participating in a review process (ie, informed review). Of 21 interval cancers, six (29%) were interpreted as positive more often by the informed radiologists than by the uninformed radiologists. For 14 (67%) cancers, there was no difference in detection rate between the two groups, and one cancer (5%) was seen by one of the uninformed radiologists but by none of the informed radiologists. The screening environment review process was found to be feasible at the low volumes tested. The number of false-negative cancers was higher in the informed review than in the uninformed review. This result suggests that bias exists with the informed review process.
  Radiology 12/2007; 245(2):411-5.
• Article: Are we really practicing medicine today?

  Eric M Wilner
  Radiology 12/2007; 245(2):330.
• Article: Ectopic pregnancy.

  Deborah Levine
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  ABSTRACT: The differential diagnosis in a pregnant patient who presents with pain and bleeding in the first trimester includes normal early pregnancy, spontaneous abortion, molar pregnancy, and ectopic pregnancy. Knowledge of the sonographic appearance of these entities is helpful at arriving at the correct diagnosis. When no intrauterine pregnancy is visualized, careful attention to the adnexa is crucial for finding an extraovarian mass, since the fallopian tube is the most common location for ectopic pregnancy. This review describes and illustrates the sonographic findings of ectopic pregnancy.
  Radiology 12/2007; 245(2):385-97.
• Article: Contrast-enhanced 64-section coronary multidetector CT angiography versus conventional coronary angiography for stent assessment.

  K M Das, Ayman A El-Menyar, Amar M Salam, Rajvir Singh, Wafer Amin K Dabdoob, Hajar A Albinali, Jassim Al Suwaidi
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  ABSTRACT: To prospectively evaluate the accuracy of 64-section computed tomography (CT) for diagnosis of stent restenosis, by using conventional coronary angiography as the reference standard. The ethics committee granted permission for the study; patients gave written consent. Contrast material-enhanced coronary CT angiography was performed in 53 patients (45 men, eight women; mean age, 54 years +/- 9 [standard deviation]) suspected of having stent restenosis. Coronary CT angiographic findings were compared with conventional coronary angiographic findings. Two physicians analyzed coronary CT angiographic data sets with multiplanar reformatted images and three-dimensional reformations by using a volume-rendering technique and looked for stent detectability, low-attenuation in-stent filling defects, and grades of restenosis. Conventional coronary angiographic results were interpreted by one of several observers in consensus for stent restenosis; they were blinded to coronary CT angiographic data. Statistical software and general estimating equations were used for data analysis. One hundred ten stents were identified in 53 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of coronary CT angiography in detection of in-stent restenosis were 96.9%, 88.0%, 77.5%, 98.5%, and 91%, respectively. Coronary CT angiography depicted in-stent low-attenuation filling defects with an accuracy of 91% and negative predictive value of 98.5% (95% confidence interval: 90.9, 99.9). Coronary CT angiography depicted the status of 97 of 107 stents. There was no significant difference between in-stent lumen visibility and stent diameter (P = .104). Coronary CT angiography helped diagnose 15 of 18 stent restenoses with less than 50% narrowing, five of five stent restenoses with 50%-74% narrowing, and nine of nine (100%) stent restenoses with 75% or greater narrowing or total occlusion of the stent lumen. Coronary CT angiography can depict in-stent low-attenuation filling defects, which appear to be a reliable sign of stent restenosis, and 64-section CT depicts such defects with a high degree of accuracy.
  Radiology 12/2007; 245(2):424-32.
• Article: Breast cancers: noninvasive method of preoperative localization with three-dimensional US and surface contour mapping.

  Charlotte J C Cash, Charlotte E Coles, Graham M Treece, Anand D Purushotham, Peter Britton, Ruchi Sinnatamby, Andrew H Gee, Richard W Prager
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  ABSTRACT: Formal ethical approval was granted by the local research ethics committee; all participants gave written consent. The purpose of the study was to prospectively evaluate the feasibility of a noninvasive method of breast tumor localization in 25 participants, based on the coregistration of three-dimensional (3D) ultrasonographic (US) data with surface contour data obtained by using a 3D laser camera. The tumor is segmented from the US data, and a surface-rendered 3D image of the tumor, in relation to the breast surface contour, is produced. From a personal computer in the operating room, the surgeon can dynamically view a 3D image of the tumor within the breast. This noninvasive method was equivalent to conventional techniques in 18 of 25 patients but was less successful in larger-breasted patients. In selected patients, this localization method could provide an alternative to conventional invasive techniques and can offer both spatial localization and tumor morphology.
  Radiology 12/2007; 245(2):556-66.
• Article: Quantitative real-time catheter-based fluorescence molecular imaging in mice.

  Rabi Upadhyay, Rahul A Sheth, Ralph Weissleder, Umar Mahmood
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  ABSTRACT: To prospectively evaluate an optical imaging system designed to perform quantitative, intravital catheter-based imaging of fluorescent molecular probes. This study was performed according to a protocol approved by the institutional animal care committee. A fiberoptic catheter imaging system was developed to implement a normalization algorithm for real-time quantitative near-infrared (NIR) imaging. The system was validated with in vitro imaging of fluorochrome phantoms and in vivo fluorescence measurements obtained in tumors implanted in murine abdomens (n = 7) after administration of an enzyme-activatable NIR probe. Standard analysis of variance tests were used to determine significant dissimilarities in signal from distinct fluorochrome concentrations. The clinical utility of the system was further evaluated by imaging orthotopically implanted murine colonic adenocarcinomas (n = 4). Raw NIR fluorescence intensities, which were measured with a fiberoptic catheter placed above wells of varying NIR fluorochrome concentration, varied markedly (>100%) with catheter position, while the corrected NIR signal was confined to a range of values within 10% of their mean for each individual fluorochrome concentration and were significantly distinct (P < .001) between relevant concentration ranges. Similar results were observed for the in vivo measurements from the abdominally implanted tumors, with raw NIR signal varying 20% from the mean and corrected NIR signal varying only 1% from the mean. The colonic studies revealed that the correction method was robust enough for use during minimally invasive imaging procedures. The authors have developed and implemented a method for quantitative real-time catheter-based fluorescence imaging that resolves NIR signal dependence on changes in catheter position.
  Radiology 12/2007; 245(2):523-31.
• Article: Differentiating benign from malignant solid breast masses with US strain imaging.

  Elizabeth S Burnside, Timothy J Hall, Amy M Sommer, Gina K Hesley, Gale A Sisney, William E Svensson, Jason P Fine, Jinfeng Jiang, Nicholas J Hangiandreou
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  ABSTRACT: To prospectively evaluate the sensitivity and specificity of ultrasonographic (US) strain imaging for distinguishing between benign and malignant solid breast masses, with biopsy results as the reference standard. The study was institutional review board approved and HIPAA compliant. Informed consent was obtained from all participating patients. US strain imaging of 403 breast masses was performed. The 50 malignant and 48 benign lesions (in patients aged 19-83 years; mean age, 49 years +/- 17 [standard deviation]) with the highest quality were selected for the reader study. Three observers blinded to the pathologic outcomes first described the B-mode image findings by using US Breast Imaging Reporting and Data System descriptors and derived a probability of malignancy. They then updated the probability by assessing strain images. Receiver operating characteristic (ROC) curves were constructed by using these probabilities. Areas under the ROC curve, sensitivities, and specificities were calculated and compared. Interobserver variability and the correlation between automated and subjective image quality assessment were analyzed. The average area under the ROC curve for all three readers after US strain imaging (0.903) was greater than that after B-mode US alone (0.876, P = .014). With use of a 2% probability of malignancy threshold, strain imaging-as compared with B-mode US alone-had improved average specificity (0.257 vs 0.132, P < .001) and high sensitivity (0.993 vs 0.987, P > .99). Significant interobserver variability was observed (P < .001). The ability to assess strain image quality appeared to correlate with the highest observer performance. US strain imaging can facilitate improved classification of benign and malignant breast masses. However, interobserver variability and image quality influence observer performance.
  Radiology 12/2007; 245(2):401-10.
• Article: Management of suspected acute pulmonary embolism in the era of CT angiography: a statement from the Fleischner Society.

  Martine Remy-Jardin, Massimo Pistolesi, Lawrence R Goodman, Warren B Gefter, Alexander Gottschalk, John R Mayo, H Dirk Sostman
  Radiology 12/2007; 245(2):315-29.
• Article: Commentary on "are we really practicing medicine today?".

  James H Thrall
  Radiology 12/2007; 245(2):331-2.