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Mourato FA, Schmitt LG, Mariussi M, Torri G, Altmayer S, Giganti F, Abreu-Gomez J, Perlis N, Berlin A, Ghai S, Haider MA, Dias AB. Prostate Magnetic Resonance Imaging Using the Prostate Imaging for Recurrence Reporting (PI-RR) Scoring System to Detect Recurrent Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Oncol 2024:S2588-9311(24)00137-8. [PMID: 38824004 DOI: 10.1016/j.euo.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 04/23/2024] [Accepted: 05/16/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND AND OBJECTIVE Prostate Imaging for Recurrence Reporting (PI-RR) was introduced in 2021 to standardize the interpretation and reporting of multiparametric magnetic resonance imaging (MRI) for prostate cancer following whole-gland treatment. The system scores image on a scale from 1 to 5 and has shown promising results in single-center studies. The aim of our systematic review and meta-analysis was to assess the diagnostic performance of the PI-RR system in predicting the likelihood of local recurrence after whole-gland treatment. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for diagnostic test accuracy were followed. Relevant databases were searched up to December 2023. Primary studies met the eligibility criteria if they reported MRI diagnostic performance in prostate cancer recurrence using PI-RR. Diagnostic performance for MRI was assessed using two different cutoff points (≥3 or ≥4 for positivity according to the PI-RR system). A meta-analysis with a random-effects model was used to estimate pooled sensitivity and specificity values. KEY FINDINGS AND LIMITATIONS Sixteen articles were identified for full-text reading, of which six were considered eligible, involving a total of 467 patients. Using a cutoff of PI-RR ≥3 (4 studies) for recurrent disease, the sensitivity was 77.8% (95% confidence interval [CI] 69.9-84.1%) and the specificity was 80.2% (95% CI 58.2-92.2%). Using a cutoff of PI-RR ≥4 (4 studies), the sensitivity was 61.9% (95% CI 35.6-82.7%) and the specificity was 86.6% (95% CI 75.1-93.3%). Overall, the inter-rater agreement varied from fair to excellent. CONCLUSIONS AND CLINICAL IMPLICATIONS PI-RR is accurate in detecting local recurrence after whole-gland treatment for prostate cancer and shows fair-to-good to excellent inter-reader agreement. Overall, a PI-RR cutoff of ≥3 showed high sensitivity and specificity. PATIENT SUMMARY We reviewed studies that reported on how good MRI scans using a scoring system called PI-RR were in detecting recurrence of prostate cancer. We found that this system shows good performance, with fair to excellent agreement between different radiologists.
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Affiliation(s)
- Felipe A Mourato
- Unidade de Diagnóstico por Imagem, Empresa Brasileira de Serviços Hospitalares, Hospital das Clínicas da Universidade Federal de Pernambuco, Recife, Brazil.
| | - Luiza G Schmitt
- Department of Radiation Oncology, UT Southwestern, Dallas, TX, USA
| | - Miriana Mariussi
- Department of Diagnostic Radiology, Hospital Universitario Austral, Buenos Aires, Argentina
| | - Giovanni Torri
- Department of Radiology and Diagnostic Imaging, Hospital Universitário de Santa Maria, Universidade Federal de Santa Maria, Santa Maria, Brazil
| | - Stephan Altmayer
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, UCL, London, UK
| | - Jorge Abreu-Gomez
- University Medical Imaging Toronto; Joint Department of Medical Imaging; University Health Network-Sinai Health System-Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Nathan Perlis
- Division of Urology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Center, University Health Network and University of Toronto, Toronto, Canada
| | - Sangeet Ghai
- University Medical Imaging Toronto; Joint Department of Medical Imaging; University Health Network-Sinai Health System-Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Masoom A Haider
- University Medical Imaging Toronto; Joint Department of Medical Imaging; University Health Network-Sinai Health System-Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Adriano B Dias
- University Medical Imaging Toronto; Joint Department of Medical Imaging; University Health Network-Sinai Health System-Women's College Hospital, University of Toronto, Toronto, ON, Canada
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Feng X, Chen X, Peng P, Zhou H, Hong Y, Zhu C, Lu L, Xie S, Zhang S, Long L. Values of multiparametric and biparametric MRI in diagnosing clinically significant prostate cancer: a multivariate analysis. BMC Urol 2024; 24:40. [PMID: 38365673 PMCID: PMC10870467 DOI: 10.1186/s12894-024-01411-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 01/16/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND To investigate the value of semi-quantitative and quantitative parameters (PI-RADS score, T2WI score, ADC, Ktrans, and Kep) based on multiparametric MRI (mpMRI) or biparametric MRI (bpMRI) combined with prostate specific antigen density (PSAD) in detecting clinically significant prostate cancer (csPCa). METHODS A total of 561 patients (276 with csPCa; 285 with non-csPCa) with biopsy-confirmed prostate diseases who underwent preoperative mpMRI were included. Prostate volume was measured for calculation of PSAD. Prostate index lesions were scored on a five-point scale on T2WI images (T2WI score) and mpMRI images (PI-RADS score) according to the PI-RADS v2.1 scoring standard. DWI and DCE-MRI images were processed to measure the quantitative parameters of the index lesion, including ADC, Kep, and Ktrans values. The predictors of csPCa were screened by logistics regression analysis. Predictive models of bpMRI and mpMRI were established. ROC curves were used to evaluate the efficacy of parameters and the model in diagnosing csPCa. RESULTS The independent diagnostic accuracy of PSA density, PI-RADS score, T2WI score, ADCrec, Ktrans, and Kep for csPCa were 80.2%, 89.5%, 88.3%, 84.6%, 58.5% and 61.6%, respectively. The diagnostic accuracy of bpMRI T2WI score and ADC value combined with PSAD was higher than that of PI-RADS score. The combination of mpMRI PI‑RADS score, ADC value with PSAD had the highest diagnostic accuracy. CONCLUSIONS PI-RADS score according to the PI-RADS v2.1 scoring standard was the most accurate independent diagnostic index. The predictive value of bpMRI model for csPCa was slightly lower than that of mpMRI model, but higher than that of PI-RADS score.
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Affiliation(s)
- Xiao Feng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Xin Chen
- Department of Radiology, Jiangjin Hospital, Chongqing University, No.725, Jiangzhou Avenue, Dingshan Street, Chongqing, 402260, China
| | - Peng Peng
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - He Zhou
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Yi Hong
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Chunxia Zhu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Libing Lu
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Siyu Xie
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Sijun Zhang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China
| | - Liling Long
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, No.6 Shuangyong Road, Qingxiu District, Nanning, 530021, Guangxi, P.R. China.
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Hu C, Qiao X, Hu C, Cao C, Wang X, Bao J. The practical clinical role of machine learning models with different algorithms in predicting prostate cancer local recurrence after radical prostatectomy. Cancer Imaging 2024; 24:23. [PMID: 38326860 PMCID: PMC10848341 DOI: 10.1186/s40644-024-00667-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 01/21/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The detection of local recurrence for prostate cancer (PCa) patients following radical prostatectomy (RP) is challenging and can influence the treatment plan. Our aim was to construct and verify machine learning models with three different algorithms based on post-operative mpMRI for predicting local recurrence of PCa after RP and explore their potential clinical value compared with the Prostate Imaging for Recurrence Reporting (PI-RR) score of expert-level radiologists. METHODS A total of 176 patients were retrospectively enrolled and randomly divided into training (n = 123) and testing (n = 53) sets. The PI-RR assessments were performed by two expert-level radiologists with access to the operative histopathological and pre-surgical clinical results. The radiomics models to predict local recurrence were built by utilizing three different algorithms (i.e., support vector machine [SVM], linear discriminant analysis [LDA], and logistic regression-least absolute shrinkage and selection operator [LR-LASSO]). The combined model integrating radiomics features and PI-RR score was developed using the most effective classifier. The classification performances of the proposed models were assessed by receiver operating characteristic (ROC) curve analysis. RESULTS There were no significant differences between the training and testing sets concerning age, prostate-specific antigen (PSA), Gleason score, T-stage, seminal vesicle invasion (SVI), perineural invasion (PNI), and positive surgical margins (PSM). The radiomics model based on LR-LASSO exhibited superior performance than other radiomics models, with an AUC of 0.858 in the testing set; the PI-RR yielded an AUC of 0.833, and there was no significant difference between the best radiomics model and the PI-RR score. The combined model achieved the best predictive performance with an AUC of 0.924, and a significant difference was observed between the combined model and PI-RR score. CONCLUSIONS Our radiomics model is an effective tool to predict PCa local recurrence after RP. By integrating radiomics features with the PI-RR score, our combined model exhibited significantly better predictive performance of local recurrence than expert-level radiologists' PI-RR assessment.
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Affiliation(s)
- Chenhan Hu
- Department of Radiology, the First Affiliated Hospital of Soochow University, 188#, Shizi Road, Suzhou, 215006, China
| | - Xiaomeng Qiao
- Department of Radiology, the First Affiliated Hospital of Soochow University, 188#, Shizi Road, Suzhou, 215006, China
| | - Chunhong Hu
- Department of Radiology, the First Affiliated Hospital of Soochow University, 188#, Shizi Road, Suzhou, 215006, China
| | - Changhao Cao
- Department of Radiology, the First Affiliated Hospital of Soochow University, 188#, Shizi Road, Suzhou, 215006, China
| | - Ximing Wang
- Department of Radiology, the First Affiliated Hospital of Soochow University, 188#, Shizi Road, Suzhou, 215006, China.
| | - Jie Bao
- Department of Radiology, the First Affiliated Hospital of Soochow University, 188#, Shizi Road, Suzhou, 215006, China.
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Awiwi MO, Gjoni M, Vikram R, Altinmakas E, Dogan H, Bathala TK, Naik S, Ravizzini G, Kandemirli SG, Elsayes KM, Salem UI. MRI and PSMA PET/CT of Biochemical Recurrence of Prostate Cancer. Radiographics 2023; 43:e230112. [PMID: 37999983 DOI: 10.1148/rg.230112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
Prostate cancer may recur several years after definitive treatment, such as prostatectomy or radiation therapy. A rise in serum prostate-specific antigen (PSA) level is the first sign of disease recurrence, and this is termed biochemical recurrence. Patients with biochemical recurrence have worse survival outcomes. Radiologic localization of recurrent disease helps in directing patient management, which may vary from active surveillance to salvage radiation therapy, androgen-deprivation therapy, or other forms of systemic and local therapy. The likelihood of detecting the site of recurrence increases with higher serum PSA level. MRI provides optimal diagnostic performance for evaluation of the prostatectomy bed. Prostate-specific membrane antigen (PSMA) PET radiotracers currently approved by the U.S. Food and Drug Administration demonstrate physiologic urinary excretion, which can obscure recurrence at the vesicourethral junction. However, MRI and PSMA PET/CT have comparable diagnostic performance for evaluation of local recurrence after external-beam radiation therapy or brachytherapy. PSMA PET/CT outperforms MRI in identifying recurrence involving the lymph nodes and bones. Caveats for use of both PSMA PET/CT and MRI do exist and may cause false-positive or false-negative results. Hence, these techniques have complementary roles and should be interpreted in conjunction with each other, taking the patient history and results of any additional prior imaging studies into account. Novel PSMA agents at various stages of investigation are being developed, and preliminary data show promising results; these agents may revolutionize the landscape of prostate cancer recurrence imaging in the future. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Turkbey in this issue. The slide presentation from the RSNA Annual Meeting is available for this article.
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Affiliation(s)
- Muhammad O Awiwi
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Migena Gjoni
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Raghunandan Vikram
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Emre Altinmakas
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Hakan Dogan
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Tharakeswara K Bathala
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Sagar Naik
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Gregory Ravizzini
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Sedat Giray Kandemirli
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Khaled M Elsayes
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
| | - Usama I Salem
- From the Division of Diagnostic Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.132, Houston, TX 77030 (M.O.A.); Department of Medicine, Istanbul University-Cerrahpasa Hospital, Istanbul, Turkey (M.G.); Departments of Abdominal Imaging (R.V., T.K.B., S.N., K.M.E., U.I.S.) and Nuclear Medicine (G.R.), Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (E.A.); Department of Radiology, Koç University School of Medicine, Istanbul, Turkey (E.A., H.D.); and Department of Nuclear Medicine, Division of Diagnostic Imaging, University of Iowa Hospitals and Clinics, Iowa City, Iowa (S.G.K.)
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