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Ivanidze J, Nordvig AS, Fajardo AR, Tsiouris AJ, Chiang GCY, Osborne JR. Medicare Coverage of Amyloid PET: Implications for Clinical Practice. AJNR Am J Neuroradiol 2023; 44:E45. [PMID: 37827714 PMCID: PMC10631537 DOI: 10.3174/ajnr.a8027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Affiliation(s)
- J Ivanidze
- Department of RadiologyWeill Cornell MedicineNew York, New York
| | - A S Nordvig
- Department of NeurologyWeill Cornell MedicineNew York, New York
| | - A R Fajardo
- Department of RadiologyWeill Cornell MedicineNew York, New York
| | - A J Tsiouris
- Department of RadiologyWeill Cornell MedicineNew York, New York
| | - G C-Y Chiang
- Department of RadiologyWeill Cornell MedicineNew York, New York
| | - J R Osborne
- Department of RadiologyWeill Cornell MedicineNew York, New York
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2
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Goldberg JL, Carnevale JA, Xia J, Sommer F, Gadjradj P, Medary B, Giantini-Larsen A, Navarro-Ramirez R, Tsiouris AJ, Chakravarthy V, Schwarz JT, McGrath LB, Virk MS, Fu KM, Riew KD, Hussain I, Härtl R. Variation in Cervical Pedicle Morphology: Important Considerations for Posterior Cervical Procedures. Oper Neurosurg (Hagerstown) 2023; 24:e85-e91. [PMID: 36637311 PMCID: PMC10158926 DOI: 10.1227/ons.0000000000000489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/30/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Safe posterior cervical spine surgery requires in-depth understanding of the surgical anatomy and common variations. The cervical pedicle attachment site to the vertebral body (VB) affects the location of exiting nerve roots and warrants preoperative evaluation. The relative site of attachment of the cervical pedicle has not been previously described. OBJECTIVE To describe the site of the pedicle attachment to the VB in the subaxial cervical spine. METHODS Cervical spine computed tomography scans without any structural, degenerative, or traumatic pathology as read by a board-certified neuroradiologist during 2021 were reviewed. Multiplanar reconstructions were created and cross-registered. The pedicle's attachment to the VB was measured relative to the VB height using a novel calculation system. RESULTS Fifty computed tomography scans met inclusion criteria yielding 600 total pedicles between C3-T1 (100 per level). The average patient age was 26 ± 5.3 years, and 21/50 (42%) were female. 468/600 (78%) pedicles attached in the cranial third of the VB, 132/600 (22%) attached in the middle third, and 0 attached to the caudal third. The highest prevalence of variant anatomy occurred at C3 (36/100 C3 pedicles; 36%). CONCLUSION In the subaxial cervical spine, pedicles frequently attach to the top third of the VB, but significant variation is observed. The rate of variation is highest at C3 and decreases linearly with caudal progression down the subaxial cervical spine to T1. This is the first report investigating this morphological phenomenon.
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Affiliation(s)
- Jacob L. Goldberg
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Joseph A. Carnevale
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Jimmy Xia
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Pravesh Gadjradj
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Alexandra Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Rodrigo Navarro-Ramirez
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - A. John Tsiouris
- Department of Radiology, Division of Neuroradiology, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Vikram Chakravarthy
- Department of Neurological Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Justin T. Schwarz
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Lynn B. McGrath
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Michael S. Virk
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Kai-Ming Fu
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - K. Daniel Riew
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Medical Center, New York Presbyterian Hospital, New York, New York, USA
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3
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Goldberg JL, Wipplinger C, Kirnaz S, Xia J, Sommer F, Meng A, Schwarz J, Giantini-Larsen A, Meaden RM, Sugino R, Gadjradj P, Medary B, Carnevale JA, Navarro R, Tsiouris AJ, Hussain I, Härtl R. Clinical Significance of Redundant Nerve Roots in Patients with Lumbar Stenosis Undergoing Minimally Invasive Tubular Decompression. World Neurosurg 2022; 164:e868-e876. [PMID: 35598849 DOI: 10.1016/j.wneu.2022.05.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/14/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Symptomatic lumbar spinal stenosis (LSS) is a common indication for surgery in the elderly. Preoperative radiographic evaluation of patients with LSS often reveals redundant nerve roots (RNRs). The clinical significance of RNRs is uncertain. RNRs have not been studied in the setting of minimally invasive surgery. This study investigates the relationship between RNRs and clinical outcomes after minimally invasive tubular decompression. METHODS Chart review was performed for patients with degenerative LSS who underwent minimally invasive decompression. Preoperative magnetic resonance imaging parameters were assessed, and patient-reported outcomes were analyzed. RESULTS Fifty-four patients underwent surgery performed at an average of 1.8 ± 0.8 spinal levels. Thirty-one patients (57%) had RNRs. Patients with RNRs were older (median = 72 years vs. 66 years, P = 0.050), had longer median symptom duration (32 months vs. 15 months, P < 0.01), and had more levels operated on (2.1 vs. 1.4; P < 0.01). The median follow-up after surgery was 2 months (range = 1.3-12 months). Preoperative and postoperative patient-reported outcomes were similar based on RNR presence. Patients without RNRs had larger lumbar cross-sectional areas (CSAs) (median = 121 mm2 vs. 95 mm2, P = 0.014) and the index-level CSA (52 mm2 vs. 34 mm2, P = 0.007). The CSA was not correlated with RNR morphology or location. CONCLUSIONS Preoperative RNRs are associated with increased age, symptom duration, and lumbar stenosis severity. Patients improved after minimally invasive decompression regardless of RNR presence. RNR presence had no effect on short-term clinical outcomes. Further study is required to assess their long-term significance.
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Affiliation(s)
- Jacob L Goldberg
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA.
| | - Christoph Wipplinger
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Sertac Kirnaz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Jimmy Xia
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Fabian Sommer
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Alicia Meng
- Department of Neuroradiology, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Justin Schwarz
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Alexandra Giantini-Larsen
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Ross M Meaden
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Rafael Sugino
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Pravesh Gadjradj
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Branden Medary
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Joseph A Carnevale
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Rodrigo Navarro
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - A John Tsiouris
- Department of Neuroradiology, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medical College, New York, New York, USA
| | - Ibrahim Hussain
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
| | - Roger Härtl
- Department of Neurological Surgery, Weill Cornell Brain and Spine Center, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, New York, USA
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Shih RY, Burns J, Ajam AA, Broder JS, Chakraborty S, Kendi AT, Lacy ME, Ledbetter LN, Lee RK, Liebeskind DS, Pollock JM, Prall JA, Ptak T, Raksin PB, Shaines MD, Tsiouris AJ, Utukuri PS, Wang LL, Corey AS. ACR Appropriateness Criteria® Head Trauma: 2021 Update. J Am Coll Radiol 2021; 18:S13-S36. [PMID: 33958108 DOI: 10.1016/j.jacr.2021.01.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 01/14/2021] [Indexed: 12/13/2022]
Abstract
Head trauma (ie, head injury) is a significant public health concern and is a leading cause of morbidity and mortality in children and young adults. Neuroimaging plays an important role in the management of head and brain injury, which can be separated into acute (0-7 days), subacute (<3 months), then chronic (>3 months) phases. Over 75% of acute head trauma is classified as mild, of which over 75% have a normal Glasgow Coma Scale score of 15, therefore clinical practice guidelines universally recommend selective CT scanning in this patient population, which is often based on clinical decision rules. While CT is considered the first-line imaging modality for suspected intracranial injury, MRI is useful when there are persistent neurologic deficits that remain unexplained after CT, especially in the subacute or chronic phase. Regardless of time frame, head trauma with suspected vascular injury or suspected cerebrospinal fluid leak should also be evaluated with CT angiography or thin-section CT imaging of the skull base, respectively. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Judah Burns
- Panel Chair, Montefiore Medical Center, Bronx, New York
| | | | - Joshua S Broder
- Duke University School of Medicine, Durham, North Carolina, American College of Emergency Physicians, Residency Program Director for Emergency Medicine, Vice Chief for Education, Division of Emergency Medicine, Department of Surgery, Duke University School of Medicine
| | - Santanu Chakraborty
- Ottawa Hospital Research Institute and the Department of Radiology, The University of Ottawa, Ottawa, Ontario, Canada, Canadian Association of Radiologists, CAR representative in ACR Quality Commission
| | - A Tuba Kendi
- Mayo Clinic, Rochester, Minnesota, Head of Nuclear Medicine Therapies at Mayo Clinic
| | - Mary E Lacy
- University of New Mexico, Albuquerque, New Mexico, American College of Physicians
| | | | - Ryan K Lee
- Einstein Healthcare Network, Philadelphia, Pennsylvania
| | - David S Liebeskind
- University of California Los Angeles, Los Angeles, California, American Academy of Neurology, President of SVIN
| | - Jeffrey M Pollock
- Oregon Health and Science University, Portland, Oregon, Editor, ACR Case in Point; Functional MRI Director, Oregon Health and Science University
| | - J Adair Prall
- Littleton Adventist Hospital, Littleton, Colorado, Neurosurgery expert, Chair, Guidelines Committee, Joint Section for Trauma and Critical Care
| | - Thomas Ptak
- R. Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, Maryland, Vice Chair of Community Radiology, University of Maryland Medical Center, Chief of Emergency and Trauma Imaging, R Adams Cowley Shock Trauma Center
| | - P B Raksin
- John H. Stroger Jr Hospital of Cook County, Chicago, Illinois, Neurosurgery expert, Chair Elect, American Association of Neurological Surgeons/Congress of Neurological Surgeons Section on Neurotrauma & Neurocritical Care; Vice Chair, American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Review Committee; Director, Neurosurgery ICU
| | - Matthew D Shaines
- Albert Einstein College of Medicine Montefiore Medical Center, Bronx, New York, Internal Medicine Physician, Associate Program Director for the Moses-Weiler Internal Medicine Residency Program, Albert Einstein College of Medicine; Associate Chief, Division of Hospital Medicine
| | | | | | - Lily L Wang
- University of Cincinnati Medical Center, Cincinnati, Ohio, Neuroradiology Fellowship Program Director
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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5
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Abstract
While the diagnosis of traumatic brain injury (TBI) is a clinical decision, neuroimaging remains vital for guiding management on the basis of identification of intracranial pathologic conditions. CT is the mainstay of imaging of acute TBI for both initial triage and follow-up, as it is fast and accurate in detecting both primary and secondary injuries that require neurosurgical intervention. MRI is more sensitive for the detection of certain intracranial injuries (eg, axonal injuries) and blood products 24-48 hours after injury, but it has limitations (eg, speed, accessibility, sensitivity to motion, and cost). The evidence primarily supports the use of MRI when CT findings are normal and there are persistent unexplained neurologic findings or at subacute and chronic periods. Radiologists should understand the role and optimal imaging modality to use, in addition to patterns of primary brain injury and their influence on the risk of developing secondary brain injuries related to herniation. ©RSNA, 2019 See discussion on this article by Mathur and Nicolaou.
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Affiliation(s)
- Andrew D Schweitzer
- From the Department of Radiology, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 E 68th St, Starr 630C, New York, NY 10075 (A.D.S., S.N.N., A.J.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (C.T.W.)
| | - Sumit N Niogi
- From the Department of Radiology, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 E 68th St, Starr 630C, New York, NY 10075 (A.D.S., S.N.N., A.J.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (C.T.W.)
| | - Christopher T Whitlow
- From the Department of Radiology, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 E 68th St, Starr 630C, New York, NY 10075 (A.D.S., S.N.N., A.J.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (C.T.W.)
| | - A John Tsiouris
- From the Department of Radiology, Weill Cornell Medicine/New York-Presbyterian Hospital, 525 E 68th St, Starr 630C, New York, NY 10075 (A.D.S., S.N.N., A.J.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, N.C. (C.T.W.)
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6
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Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is on the rise due its ability to provide detailed cross-sectional anatomy without ionizing radiation. Despite the favorable radiation profile, theoretically concerns regarding the safety of MRI and gadolinium-based contrast agent (GBCA) administration have been raised. Currently there are no studies that have shown any attributable harms of MRI during any trimester of pregnancy although prospective and longitudinal studies are lacking. GBCA administration may be associated with a slightly higher rate of neonatal death, although this is based on a single, large cohort study. Understanding the available evidence regarding MRI safety during pregnancy in the context of current society guidelines will help the radiologist serve as a valuable resource to patients and referring providers.
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Affiliation(s)
- Mark Lum
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065, United States of America.
| | - A John Tsiouris
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065, United States of America
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Miranda C, Mahta A, Wheeler LA, Tsiouris AJ, Kamel H. Tension pneumocephalus mimicking septic shock: a case report. Radiol Case Rep 2017; 13:241-243. [PMID: 29487661 PMCID: PMC5826457 DOI: 10.1016/j.radcr.2017.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 10/04/2017] [Accepted: 10/07/2017] [Indexed: 11/02/2022] Open
Abstract
Tension pneumocephalus can lead to rapid neurologic deterioration. We report for the first time its association with aseptic systemic inflammatory response syndrome mimicking septic shock and the efficacy of prompt neurosurgical intervention and critical care support in treating this condition. A 64-year-old man underwent 2-stage olfactory groove meningioma resection. The patient developed altered mental status and gait instability on postoperative day 6. Imaging showed significant pneumocephalus. The patient subsequently developed worsening mental status, respiratory failure, and profound shock requiring multiple vasopressors. Bedside needle decompression, identification and repair of the cranial fossa defect, and critical care support led to improved mental status and reversal of shock and multiorgan dysfunction. Thorough evaluation revealed no evidence of an underlying infection. In this case, tension pneumocephalus incited an aseptic systemic inflammatory response syndrome mimicking septic shock. Prompt neurosurgical correction of pneumocephalus and critical care support not only improved neurologic status, but also reversed shock. Such a complication indicates the importance of close monitoring of patients with progressive pneumocephalus.
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Affiliation(s)
| | - Ali Mahta
- Department of Neurology, Weill Cornell Medicine, New York, NY.,Division of Critical Care Neurology, Columbia University Medical Center, New York, NY
| | - Lee Adam Wheeler
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY
| | - A John Tsiouris
- Department of Neuroradiology, Weill Cornell Medicine, New York, NY
| | - Hooman Kamel
- Department of Neurology, Weill Cornell Medicine, New York, NY
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8
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Maravilla KR, San-Juan D, Kim SJ, Elizondo-Riojas G, Fink JR, Escobar W, Bag A, Roberts DR, Hao J, Pitrou C, Tsiouris AJ, Herskovits E, Fiebach JB. Comparison of Gadoterate Meglumine and Gadobutrol in the MRI Diagnosis of Primary Brain Tumors: A Double-Blind Randomized Controlled Intraindividual Crossover Study (the REMIND Study). AJNR Am J Neuroradiol 2017; 38:1681-1688. [PMID: 28663267 DOI: 10.3174/ajnr.a5316] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 06/06/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Effective management of patients with brain tumors depends on accurate detection and characterization of lesions. This study aimed to demonstrate the noninferiority of gadoterate meglumine versus gadobutrol for overall visualization and characterization of primary brain tumors. MATERIALS AND METHODS This multicenter, double-blind, randomized, controlled intraindividual, crossover, noninferiority study included 279 patients. Both contrast agents (dose = 0.1 mmol/kg of body weight) were assessed with 2 identical MRIs at a time interval of 2-14 days. The primary end point was overall lesion visualization and characterization, scored independently by 3 off-site readers on a 4-point scale, ranging from "poor" to "excellent." Secondary end points were qualitative assessments (lesion border delineation, internal morphology, degree of contrast enhancement, diagnostic confidence), quantitative measurements (signal intensity), and safety (adverse events). All qualitative assessments were also performed on-site. RESULTS For all 3 readers, images of most patients (>90%) were scored good or excellent for overall lesion visualization and characterization with either contrast agent; and the noninferiority of gadoterate meglumine versus gadobutrol was statistically demonstrated. No significant differences were observed between the 2 contrast agents regarding qualitative end points despite quantitative mean lesion percentage enhancement being higher with gadobutrol (P < .001). Diagnostic confidence was high/excellent for all readers in >81% of the patients with both contrast agents. Similar percentages of patients with adverse events related to the contrast agents were observed with gadoterate meglumine (7.8%) and gadobutrol (7.3%), mainly injection site pain. CONCLUSIONS The noninferiority of gadoterate meglumine versus gadobutrol for overall visualization and characterization of primary brain tumors was demonstrated.
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Affiliation(s)
- K R Maravilla
- From the Department of Radiology (K.R.M., J.R.F.), University of Washington Medical Center, Seattle, Washington
| | - D San-Juan
- Clinical Research Department (D.S.-J.), National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - S J Kim
- Department of Radiology (S.J.K.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - G Elizondo-Riojas
- Universidad Autonoma de Nuevo Leon (G.E.-R.), Hospital Universitario Dr. Jose Eleuterio Gonzalez, Monterrey, Mexico
| | - J R Fink
- From the Department of Radiology (K.R.M., J.R.F.), University of Washington Medical Center, Seattle, Washington
| | - W Escobar
- Centro Medico Imbanaco (W.E.), Cali, Colombia
| | - A Bag
- Department of Radiology (A.B.), University of Alabama, Birmingham, Alabama
| | - D R Roberts
- Medical University of South Carolina (D.R.R.), Charleston, South Carolina
| | - J Hao
- Guerbet (J.H., C.P.), Roissy-Charles de Gaulle, France
| | - C Pitrou
- Guerbet (J.H., C.P.), Roissy-Charles de Gaulle, France
| | - A J Tsiouris
- Department of Radiology (A.J.T.), Weill Cornell Medical College, New York, New York
| | - E Herskovits
- Department of Radiology (E.H.), University of Maryland, Baltimore, Maryland
| | - J B Fiebach
- Center for Stroke Research Berlin (J.B.F.), Charité-Universitätsmedizin, Berlin, Germany
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9
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Tanenbaum LN, Tsiouris AJ, Johnson AN, Naidich TP, DeLano MC, Melhem ER, Quarterman P, Parameswaran SX, Shankaranarayanan A, Goyen M, Field AS. Synthetic MRI for Clinical Neuroimaging: Results of the Magnetic Resonance Image Compilation (MAGiC) Prospective, Multicenter, Multireader Trial. AJNR Am J Neuroradiol 2017; 38:1103-1110. [PMID: 28450439 DOI: 10.3174/ajnr.a5227] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/02/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND AND PURPOSE Synthetic MR imaging enables reconstruction of various image contrasts from 1 scan, reducing scan times and potentially providing novel information. This study is the first large, prospective comparison of synthetic-versus-conventional MR imaging for routine neuroimaging. MATERIALS AND METHODS A prospective multireader, multicase noninferiority trial of 1526 images read by 7 blinded neuroradiologists was performed with prospectively acquired synthetic and conventional brain MR imaging case-control pairs from 109 subjects (mean, 53.0 ± 18.5 years of age; range, 19-89 years of age) with neuroimaging indications. Each case included conventional T1- and T2-weighted, T1 and T2 FLAIR, and STIR and/or proton density and synthetic reconstructions from multiple-dynamic multiple-echo imaging. Images were randomized and independently assessed for diagnostic quality, morphologic legibility, radiologic findings indicative of diagnosis, and artifacts. RESULTS Clinical MR imaging studies revealed 46 healthy and 63 pathologic cases. Overall diagnostic quality of synthetic MR images was noninferior to conventional imaging on a 5-level Likert scale (P < .001; mean synthetic-conventional, -0.335 ± 0.352; Δ = 0.5; lower limit of the 95% CI, -0.402). Legibility of synthetic and conventional morphology agreed in >95%, except in the posterior limb of the internal capsule for T1, T1 FLAIR, and proton-density views (all, >80%). Synthetic T2 FLAIR had more pronounced artifacts, including +24.1% of cases with flow artifacts and +17.6% cases with white noise artifacts. CONCLUSIONS Overall synthetic MR imaging quality was similar to that of conventional proton-density, STIR, and T1- and T2-weighted contrast views across neurologic conditions. While artifacts were more common in synthetic T2 FLAIR, these were readily recognizable and did not mimic pathology but could necessitate additional conventional T2 FLAIR to confirm the diagnosis.
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Affiliation(s)
- L N Tanenbaum
- From Lenox Hill Radiology (L.N.T.), RadNet Inc, New York, New York
| | - A J Tsiouris
- Department of Radiology (A.J.T.), Weill Cornell Medical Center, New York, New York
| | - A N Johnson
- Department of Technical Communication (A.N.J.), Science and Healthcare, Texas Tech University, Lubbock, Texas.,Technology and Medical Innovation Organization (A.N.J., S.X.P.)
| | - T P Naidich
- Department of Neuroradiology (T.P.N.), The Mount Sinai Hospital, New York, New York
| | - M C DeLano
- Division of Radiology and Biomedical Imaging (M.C.D.), Michigan State University, Advanced Radiology Services, PC, and Spectrum Health, Grand Rapids, Michigan
| | - E R Melhem
- Department of Diagnostic Radiology and Nuclear Medicine (E.R.M.), University of Maryland School of Medicine, Baltimore, Maryland
| | | | | | | | - M Goyen
- Medical Affairs (M.G.), GE Healthcare, Milwaukee, Wisconsin
| | - A S Field
- Department of Radiology (A.S.F.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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10
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Qian JM, Mahajan A, Yu JB, Tsiouris AJ, Goldberg SB, Kluger HM, Chiang VLS. Comparing available criteria for measuring brain metastasis response to immunotherapy. J Neurooncol 2017; 132:479-485. [PMID: 28275886 DOI: 10.1007/s11060-017-2398-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 02/26/2017] [Indexed: 01/08/2023]
Abstract
The response assessment in neuro-oncology (RANO) working group recently proposed standardized response criteria for brain metastases (RANO-BM). We sought to compare RANO-BM to other criteria in an ongoing brain metastasis trial. The first 36 patients enrolled on NCT02085070, an ongoing trial of pembrolizumab for patients with untreated brain metastases, were included in this analysis. As RANO-BM had not been proposed when the protocol was written, response on trial was assessed using an institutional modification of RECIST 1.1 (mRECIST), wherein minimum target brain lesion size was 5 mm in longest diameter and up to five target brain lesions were followed. We here additionally assessed response using standard RECIST 1.1, RANO high-grade glioma (RANO-HGG), and RANO-BM. Comparison between the four criteria sets using cases eligible across the board revealed excellent concordance (kappa statistic > 0.8), with only one discordant case. However, compared to RECIST 1.1 or RANO-BM, using a 5 mm threshold for target brain lesions in mRECIST allowed enrollment of 13 additional patients, five of whom had durable responses. Compared to RANO-HGG, 19 additional patients were enrolled using mRECIST, eight of whom had durable responses. Consequently, this resulted in response rates ranging from 12% with RANO-HGG to 28% with mRECIST. This study supports using a 5 mm threshold for target brain lesions when using high resolution MRI with ≤2 mm slices to facilitate accrual to similar clinical trials and provide earlier access to novel therapies for brain metastasis patients. Concordance among the four criteria studied was otherwise very high.
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Affiliation(s)
- Jack M Qian
- Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Amit Mahajan
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - A John Tsiouris
- Department of Radiology, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Sarah B Goldberg
- Department of Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Harriet M Kluger
- Department of Medicine, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
| | - Veronica L S Chiang
- Department of Therapeutic Radiology, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
- Department of Neurosurgery, Yale School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA.
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Chakraborty S, Filippi CG, Wong T, Ray A, Fralin S, Tsiouris AJ, Praminick B, Demopoulos A, McCrea HJ, Bodhinayake I, Ortiz R, Langer DJ, Boockvar JA. Erratum to: Superselective intraarterial cerebral infusion of cetuximab after osmotic blood/brain barrier disruption for recurrent malignant glioma: phase I study. J Neurooncol 2016; 128:417. [PMID: 27270719 DOI: 10.1007/s11060-016-2153-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Shamik Chakraborty
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Departments of Neurosurgery, Neurology, Radiology, and Pathology, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Christopher G Filippi
- Departments of Neurosurgery, Neurology, Radiology, and Pathology, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Tamika Wong
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Ashley Ray
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Sherese Fralin
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - A John Tsiouris
- Departments of Neurosurgery and Radiology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Bidyut Praminick
- Departments of Neurosurgery, Neurology, Radiology, and Pathology, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Alexis Demopoulos
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Departments of Neurosurgery, Neurology, Radiology, and Pathology, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - Heather J McCrea
- Departments of Neurosurgery and Radiology, Weill Cornell Medical College of Cornell University, New York, NY, USA
| | - Imithri Bodhinayake
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Rafael Ortiz
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Departments of Neurosurgery, Neurology, Radiology, and Pathology, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - David J Langer
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Departments of Neurosurgery, Neurology, Radiology, and Pathology, Hofstra Northwell School of Medicine, Manhasset, NY, USA
| | - John A Boockvar
- Lenox Hill Brain Tumor Center, Lenox Hill Hospital, Northwell Health, New York, NY, USA.
- Departments of Neurosurgery, Neurology, Radiology, and Pathology, Hofstra Northwell School of Medicine, Manhasset, NY, USA.
- Department of Neurological Surgery, Hofstra Northwell School of Medicine, Manhasset, NY, USA.
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12
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Singh R, Kesavabhotla K, Kishore SA, Zhou Z, Tsiouris AJ, Filippi CG, Boockvar JA, Kovanlikaya I. Dynamic Susceptibility Contrast-Enhanced MR Perfusion Imaging in Assessing Recurrent Glioblastoma Response to Superselective Intra-Arterial Bevacizumab Therapy. AJNR Am J Neuroradiol 2016; 37:1838-1843. [PMID: 27231225 DOI: 10.3174/ajnr.a4823] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 03/30/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Recurrent glioblastoma currently has no established standard of care. We evaluated the response of recurrent glioblastoma to superselective intra-arterial cerebral infusion of bevacizumab by using dynamic susceptibility contrast-enhanced MR perfusion imaging. We hypothesized that treatment response would be associated with decreased relative CBV and relative CBF. MATERIALS AND METHODS Patients were accrued for this study from larger ongoing serial Phase I/II trials. Twenty-five patients (14 men, 11 women; median age, 55 years) were analyzed. Four distinct ROIs were chosen: 1) normal-appearing white matter on the contralateral side, 2) the location of the highest T1 enhancement in the lesion (maximum enhancing), 3) the location of highest relative CBV in the lesion (maximum relative CBV), and 4) nonenhancing T2 hyperintense signal abnormality surrounding the tumor (nonenhancing T2 hyperintensity). RESULTS There was a statistically significant median percentage change of -32.34% (P = .001) in relative CBV in areas of maximum relative CBV following intra-arterial bevacizumab therapy. There was also a statistically significant median percentage decrease in relative CBF of -30.67 (P = .001) and -27.25 (P = .037) in areas of maximum relative CBV and maximum tumor enhancement, respectively. Last, a trend toward statistical significance for increasing relative CBV in nonenhancing T2 hyperintense areas (median percent change, 30.04; P = .069) was noted. CONCLUSIONS Dynamic susceptibility contrast-enhanced MR perfusion imaging demonstrated a significant decrease in tumor perfusion metrics within recurrent glioblastomas in response to superselective intra-arterial cerebral infusion of bevacizumab; however, these changes did not correlate with time to progression or overall survival.
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Affiliation(s)
- R Singh
- From the Departments of Neurological Surgery (R.S., Z.Z.)
| | - K Kesavabhotla
- Department of Neurological Surgery (K.K.), Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - S A Kishore
- Radiology (S.A.K., A.J.T., I.K.), Weill Cornell Medical College, New York, New York
| | - Z Zhou
- From the Departments of Neurological Surgery (R.S., Z.Z.)
| | - A J Tsiouris
- Radiology (S.A.K., A.J.T., I.K.), Weill Cornell Medical College, New York, New York
| | | | - J A Boockvar
- Neurological Surgery (J.A.B.), Lenox Hill Hospital, Hofstra-North Shore-LIJ School of Medicine, New York, New York
| | - I Kovanlikaya
- Radiology (S.A.K., A.J.T., I.K.), Weill Cornell Medical College, New York, New York
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Guisado DI, Singh R, Minkowitz S, Zhou Z, Haque S, Peck KK, Young RJ, Tsiouris AJ, Souweidane MM, Thakur SB. A Novel Methodology for Applying Multivoxel MR Spectroscopy to Evaluate Convection-Enhanced Drug Delivery in Diffuse Intrinsic Pontine Gliomas. AJNR Am J Neuroradiol 2016; 37:1367-73. [PMID: 26939629 DOI: 10.3174/ajnr.a4713] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/05/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Diffuse intrinsic pontine gliomas are inoperable high-grade gliomas with a median survival of less than 1 year. Convection-enhanced delivery is a promising local drug-delivery technique that can bypass the BBB in diffuse intrinsic pontine glioma treatment. Evaluating tumor response is critical in the assessment of convection-enhanced delivery of treatment. We proposed to determine the potential of 3D multivoxel (1)H-MR spectroscopy to evaluate convection-enhanced delivery treatment effect in these tumors. MATERIALS AND METHODS We prospectively analyzed 3D multivoxel (1)H-MR spectroscopy data for 6 patients with nonprogressive diffuse intrinsic pontine gliomas who received convection-enhanced delivery treatment of a therapeutic antibody (Phase I clinical trial NCT01502917). To compare changes in the metabolite ratios with time, we tracked the metabolite ratios Cho/Cr and Cho/NAA at several ROIs: normal white matter, tumor within the convection-enhanced delivery infusion site, tumor outside of the infused area, and the tumor average. RESULTS There was a comparative decrease in both Cho/Cr and Cho/NAA metabolite ratios at the tumor convection-enhanced delivery site versus tumor outside the infused area. We used MR spectroscopy voxels with dominant white matter as a reference. The difference between changes in metabolite ratios became more prominent with increasing time after convection-enhanced delivery treatment. CONCLUSIONS The comparative change in metabolite ratios between the convection-enhanced delivery site and the tumor site outside the infused area suggests that multivoxel (1)H-MR spectroscopy, in combination with other imaging modalities, may provide a clinical tool to accurately evaluate local tumor response after convection-enhanced delivery treatment.
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Affiliation(s)
- D I Guisado
- From the Weill Medical College of Cornell University (D.I.G., R.S.), New York, NY
| | - R Singh
- From the Weill Medical College of Cornell University (D.I.G., R.S.), New York, NY
| | | | - Z Zhou
- Neurological Surgery (Z.Z., M.M.S.), Weill Medical College of Cornell University, New York, New York
| | - S Haque
- Departments of Radiology (S.H., K.K.P., R.J.Y., S.B.T.)
| | - K K Peck
- Departments of Radiology (S.H., K.K.P., R.J.Y., S.B.T.) Medical Physics (K.K.P., S.B.T.), Memorial Sloan Kettering Cancer Center, New York, New York
| | - R J Young
- Departments of Radiology (S.H., K.K.P., R.J.Y., S.B.T.)
| | | | - M M Souweidane
- Neurological Surgery (Z.Z., M.M.S.), Weill Medical College of Cornell University, New York, New York Neurosurgery (M.M.S.)
| | - S B Thakur
- Departments of Radiology (S.H., K.K.P., R.J.Y., S.B.T.) Medical Physics (K.K.P., S.B.T.), Memorial Sloan Kettering Cancer Center, New York, New York.
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14
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Weidman EK, Tsiouris AJ, Heier LA. Toxic encephalopathy due to paradichlorobenzene toxicity: a case report and review of imaging characteristics. Clin Imaging 2015; 39:1095-8. [DOI: 10.1016/j.clinimag.2015.08.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/12/2015] [Accepted: 08/24/2015] [Indexed: 10/23/2022]
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15
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Goldberg SB, Gettinger SN, Mahajan A, Herbst RS, Chiang AC, Tsiouris AJ, Vortmeyer A, Jilaveanu L, Speaker S, Madura M, Rowen E, Gerrish H, Knapp-Perry E, Yao X, Chiang V, Kluger HM. Activity and safety of pembrolizumab in patients with metastatic non-small cell lung cancer with untreated brain metastases. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.8035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Anne C. Chiang
- Yale Cancer Center, Smilow Cancer Hospital, New Haven, CT
| | | | | | | | | | | | | | | | | | - Xiaopan Yao
- Yale Center for Analytical Sciences, New Haven, CT
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16
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Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT, Druzgal TJ, Gean AD, Lui YW, Norbash AM, Raji C, Wright DW, Zeineh M. Imaging Evidence and Recommendations for Traumatic Brain Injury: Conventional Neuroimaging Techniques. J Am Coll Radiol 2015; 12:e1-14. [DOI: 10.1016/j.jacr.2014.10.014] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 10/14/2014] [Accepted: 10/18/2014] [Indexed: 12/14/2022]
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Wintermark M, Sanelli PC, Anzai Y, Tsiouris AJ, Whitlow CT. Imaging evidence and recommendations for traumatic brain injury: advanced neuro- and neurovascular imaging techniques. AJNR Am J Neuroradiol 2014; 36:E1-E11. [PMID: 25424870 DOI: 10.3174/ajnr.a4181] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
SUMMARY Neuroimaging plays a critical role in the evaluation of patients with traumatic brain injury, with NCCT as the first-line of imaging for patients with traumatic brain injury and MR imaging being recommended in specific settings. Advanced neuroimaging techniques, including MR imaging DTI, blood oxygen level-dependent fMRI, MR spectroscopy, perfusion imaging, PET/SPECT, and magnetoencephalography, are of particular interest in identifying further injury in patients with traumatic brain injury when conventional NCCT and MR imaging findings are normal, as well as for prognostication in patients with persistent symptoms. These advanced neuroimaging techniques are currently under investigation in an attempt to optimize them and substantiate their clinical relevance in individual patients. However, the data currently available confine their use to the research arena for group comparisons, and there remains insufficient evidence at the time of this writing to conclude that these advanced techniques can be used for routine clinical use at the individual patient level. TBI imaging is a rapidly evolving field, and a number of the recommendations presented will be updated in the future to reflect the advances in medical knowledge.
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Affiliation(s)
- M Wintermark
- From the Division of Neuroradiology (M.W.), Stanford University, Palo Alto, California
| | - P C Sanelli
- Department of Radiology (P.C.S.), North Shore-LIJ Health System, Manhasset, New York
| | - Y Anzai
- Department of Radiology (Y.A.), University of Washington, Seattle, Washington
| | - A J Tsiouris
- Department of Radiology (A.J.T.), Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York
| | - C T Whitlow
- Department of Radiology and Translational Science Institute (C.T.W.), Wake Forest School of Medicine, Winston-Salem, North Carolina
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18
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Ottenhausen M, Banu MA, Placantonakis DG, Tsiouris AJ, Khan OH, Anand VK, Schwartz TH. Endoscopic endonasal resection of suprasellar meningiomas: the importance of case selection and experience in determining extent of resection, visual improvement, and complications. World Neurosurg 2014; 82:442-9. [PMID: 24657254 DOI: 10.1016/j.wneu.2014.03.032] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 01/27/2014] [Accepted: 03/13/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Suprasellar meningiomas have been resected via various open cranial approaches. During the past 2 decades, the endoscopic endonasal approach has been shown to be an option in selected patients. We wished to examine the learning curve for parameters such as extent of resection, visual outcome, and complications. METHODS We retrospectively reviewed a consecutive series of patients in whom suprasellar meningiomas were resected via an endonasal endoscopic approach between 2005 and 2013 at our institution. After June 2008, our surgical technique matured. Using this time point, we divided our case series into 2 chronological groups, group 1 (n=8) and group 2 (n=12). This cut-off also was used to examine rates of gross total resection (GTR) and visual improvement. Case selection criteria in successful and unsuccessful cases were examined to determine important principals for case selection. RESULTS Mean patient age at surgery was 57.05 years (range, 31-81 years). Mean tumor volume was 11.98 cm3 (range, 0.43-28.93 cm3). Overall, GTR was achieved in 80%, and vision improved or normalized in 14 patients (82.4%) with no occurrence of postoperative visual deterioration. Rates of GTR increased from 62.5% (group 1) to 91.7% (group 2). Visual improvement increased from 75% (group 1) to 88.9% (group 2). Rates of cerebrospinal fluid leak were 25% in group 1 and 0% in group 2. Average follow-up was 51.5 month (range, 3-96 months). CONCLUSION Once the learning curve is overcome, surgeons performing endonasal endoscopic resection of suprasellar meningiomas can achieve high rates of GTR with low complication rates in well-selected cases.
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Affiliation(s)
- Malte Ottenhausen
- Department of Neurological Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA
| | - Matei A Banu
- Department of Neurological Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA
| | | | - A John Tsiouris
- Department of Radiology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA
| | - Osaama H Khan
- Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Vijay K Anand
- Department of Otolaryngology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA
| | - Theodore H Schwartz
- Department of Neurological Surgery, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA; Department of Otolaryngology, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA; Department of Neurology and Neurosciences, Brain and Mind Institute, Weill Medical College of Cornell University, New York-Presbyterian Hospital, New York, New York, USA.
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19
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Boikov AS, Schweitzer AD, Young RJ, Lavi E, Tsiouris AJ, Gupta A. Glioblastoma-arteriovenous fistula complex: imaging characteristics and treatment considerations. Clin Imaging 2014; 38:187-90. [DOI: 10.1016/j.clinimag.2013.11.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 11/15/2013] [Accepted: 11/25/2013] [Indexed: 10/26/2022]
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Wang S, Liu T, Chen W, Spincemaille P, Wisnieff C, Tsiouris AJ, Zhu W, Pan C, Zhao L, Wang Y. Noise Effects in Various Quantitative Susceptibility Mapping Methods. IEEE Trans Biomed Eng 2013; 60:3441-8. [PMID: 23751950 PMCID: PMC5553691 DOI: 10.1109/tbme.2013.2266795] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Various regularization methods have been proposed for single-orientation quantitative susceptibility mapping (QSM), which is an ill-posed magnetic field to susceptibility source inverse problem. Noise amplification, a major issue in inverse problems, manifests as streaking artifacts and quantification errors in QSM and has not been comparatively evaluated in these algorithms. In this paper, various QSM methods were systematically categorized for noise analysis. Six representative QSM methods were selected from four categories: two non-Bayesian methods with alteration or approximation of the dipole kernel to overcome the ill conditioning; four Bayesian methods using a general mathematical prior or a specific physical structure prior to select a unique solution, and using a data fidelity term with or without noise weighting. The effects of noise in these QSM methods were evaluated by reconstruction errors in simulation and image quality in 50 consecutive human subjects. Bayesian QSM methods with noise weighting consistently reduced root mean squared errors in numerical simulations and increased image quality scores in the human brain images, when compared to non-Bayesian methods and to corresponding Bayesian methods without noise weighting (p ≤ 0.001). In summary, noise effects in QSM can be reduced using Bayesian methods with proper noise weighting.
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21
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Killeen RP, Gupta A, Delaney H, Johnson CE, Tsiouris AJ, Comunale J, Fink ME, Mangat HS, Segal AZ, Mushlin AI, Sanelli PC. Appropriate use of CT perfusion following aneurysmal subarachnoid hemorrhage: a Bayesian analysis approach. AJNR Am J Neuroradiol 2013; 35:459-65. [PMID: 24200901 DOI: 10.3174/ajnr.a3767] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE In recent years CTP has been used as a complementary diagnostic tool in the evaluation of delayed cerebral ischemia and vasospasm. Our aim was to determine the test characteristics of CTP for detecting delayed cerebral ischemia and vasospasm in SAH, and then to apply Bayesian analysis to identify subgroups for its appropriate use. MATERIALS AND METHODS Our retrospective cohort comprised consecutive patients with SAH and CTP performed between days 6 and 8 following aneurysm rupture. Delayed cerebral ischemia was determined according to primary outcome measures of infarction and/or permanent neurologic deficits. Vasospasm was determined by using DSA. The test characteristics of CTP and its 95% CIs were calculated. Graphs of conditional probabilities were constructed by using Bayesian techniques. Local treatment thresholds (posttest probability of delayed cerebral ischemia needed to initiate induced hypertension, hypervolemia, and hemodilution or intra-arterial therapy) were determined via a survey of 6 independent neurologists. RESULTS Ninety-seven patients with SAH were included in the study; 39% (38/97) developed delayed cerebral ischemia. Qualitative CTP deficits were seen in 49% (48/97), occurring in 84% (32/38) with delayed cerebral ischemia and 27% (16/59) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.84 (0.73-0.96), 0.73 (0.62-0.84), 0.67 (0.51-0.79), and 0.88 (0.74-0.94), respectively. A subgroup of 57 patients underwent DSA; 63% (36/57) developed vasospasm. Qualitative CTP deficits were seen in 70% (40/57), occurring in 97% (35/36) with vasospasm and 23% (5/21) without. The sensitivity, specificity, and positive and negative predictive values (95% CI) for CTP were 0.97 (0.92-1.0), 0.76 (0.58-0.94), 0.88 (0.72-0.95), and 0.94 (0.69-0.99), respectively. Treatment thresholds were determined as 30% for induced hypertension, hypervolemia, and hemodilution and 70% for intra-arterial therapy. CONCLUSIONS Positive CTP findings identify patients who should be carefully considered for induced hypertension, hypervolemia, and hemodilution and/or intra-arterial therapy while negative CTP findings are useful in guiding a no-treatment decision.
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Affiliation(s)
- R P Killeen
- From the Departments of Radiology (R.P.K., A.G., H.D., C.E.J., A.J.T., J.C., P.C.S.)
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22
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Hersh EH, Virk MS, Shao H, Tsiouris AJ, Bonci GA, Schwartz TH. Bone flap explantation, steroid use, and rates of infection in patients with epilepsy undergoing craniotomy for implantation of subdural electrodes. J Neurosurg 2013; 119:48-53. [DOI: 10.3171/2013.3.jns121489] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Subdural implantation of electrodes is commonly performed to localize an epileptic focus. Whether to temporarily explant the bone plate and whether to treat patients with perioperative steroid agents is unclear. The authors' aim was to evaluate the utility and risk of bone plate explantation and perioperative steroid use.
Methods
The authors reviewed the records of all patients who underwent unilateral craniotomy for electrode implantation performed between November 2001 and June 2011 at their institution. Patients were divided into 3 groups: Group 1 (n = 24), bone explanted, no perioperative steroid use; Group 2 (n = 42), bone left in place, no perioperative steroid use; Group 3 (n = 25), bone left in place, steroid agents administered perioperatively. Complications, mass effect, and seizure rates were examined by means of statistical analysis.
Results
Of 324 cranial epilepsy surgeries, 91 were unilateral subdural electrode implants that met our inclusion criteria. A total of 11 infections were reported, and there was a significantly higher rate of infection when the bone was explanted (8 cases [33.3%]) than when the bone was left in place (3 cases [4.5%], p < 0.01). Leaving the bone in place also increased the rate of asymptomatic subdural hematomas and frequency of seizures, although there was no increase in midline shift, severity of headache, or rate of emergency reoperation. The use of steroid agents did not appear to have an effect on any of the outcome measures.
Conclusions
Temporary bone flap explantation during craniotomy for implantation of subdural electrodes can result in high rates of infection, possibly due to the frequent change of hands in transferring the bone to the bone bank. Leaving the bone in place may increase the frequency of seizures and appearance of asymptomatic subdural hematomas but does not increase the rate of complications. These results may be institution dependent.
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Affiliation(s)
| | | | | | - A. John Tsiouris
- 4Neuroradiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
| | - Gregory A. Bonci
- 4Neuroradiology, Weill Cornell Medical College, NewYork-Presbyterian Hospital, New York, New York
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Liu T, Eskreis-Winkler S, Schweitzer AD, Chen W, Kaplitt MG, Tsiouris AJ, Wang Y. Improved subthalamic nucleus depiction with quantitative susceptibility mapping. Radiology 2013; 269:216-23. [PMID: 23674786 DOI: 10.1148/radiol.13121991] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess quantitative susceptibility mapping (QSM) in the depiction of the subthalamic nucleus (STN) by using 3-T magnetic resonance (MR) imaging. MATERIALS AND METHODS This study was HIPAA compliant and institutional review board approved. Ten healthy subjects (five men, five women; mean age, 24 years ± 3 [standard deviation]; age range, 21-33 years) and eight patients with Parkinson disease (five men, three women; mean age, 57 years ± 14; age range, 25-69 years) who were referred by neurologists for preoperative navigation MR imaging prior to deep brain stimulator placement were included in this study. T2-weighted (T2w), T2*-weighted (T2*w), R2* mapping (R2*), phase, susceptibility-weighted (SW), and QSM images were reconstructed for STN depiction. Qualitative visualization scores of STN and internal globus pallidus (GPi) were recorded by two neuroradiologists on all images. Contrast-to-noise ratios (CNRs) of the STN and GPi were also measured. Measurement differences were assessed by using the Wilcoxon rank sum test and the signed rank test. RESULTS Qualitative scores were significantly higher on QSM images than on T2w, T2*w, R2*, phase, or SW images (P < .05) for STN and GPi visualization. Median CNR was 6.4 and 10.7 times higher on QSM images than on T2w images for differentiation of STN from the zona incerta and substantia nigra, respectively, and was 22.7 and 9.1 times higher on QSM images than on T2w images for differentiation of GPi from the internal capsule and external globus pallidus, respectively. CNR differences between QSM images and all other images were significant (P < .01). CONCLUSION QSM at 3-T MR imaging performs significantly better than current standard-of-care sequences in the depiction of the STN.
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Affiliation(s)
- Tian Liu
- Departments of Radiology and Neurological Surgery, Weill Cornell Medical College, 525 E 68th St, Box 141, New York, NY, 10021
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Sanelli PC, Anumula N, Johnson CE, Comunale JP, Tsiouris AJ, Riina H, Segal AZ, Stieg PE, Zimmerman RD, Mushlin AI. Evaluating CT perfusion using outcome measures of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol 2013; 34:292-8. [PMID: 22859289 DOI: 10.3174/ajnr.a3225] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DCI is a serious complication following aneurysmal SAH and remains a leading cause of morbidity and mortality. Our aim was to evaluate CTP in aneurysmal SAH by using outcome measures of DCI. MATERIALS AND METHODS This was a retrospective study of consecutive patients with SAH enrolled in a prospective institutional review board-approved clinical accuracy trial. Qualitative CTP deficits were determined by 2 neuroradiologists blinded to clinical and imaging data. Quantitative CTP was performed by using a standardized protocol with region-of-interest placement sampling of the cortex. Primary outcome measures were permanent neurologic deficits and infarction. The secondary outcome measure was DCI, defined as clinical deterioration. CTP test characteristics (95% CI) were determined for each outcome measure. Statistical significance was calculated by using the Fisher exact and Student t tests. ROC curves were generated to determine accuracy and threshold analysis. RESULTS Ninety-six patients were included. Permanent neurologic deficits developed in 33% (32/96). CTP deficits were seen in 78% (25/32) of those who developed permanent neurologic deficits and 34% (22/64) of those without (P < .0001). CTP deficits had 78% (61%-89%) sensitivity, 66% (53%-76%) specificity, and 53% (39%-67%) positive and 86% (73%-93%) negative predictive values. Infarction occurred in 18% (17/96). CTP deficits were seen in 88% (15/17) of those who developed infarction and 41% (32/79) of those without (P = .0004). CTP deficits had an 88% (66%-97%) sensitivity, 59% (48%-70%) specificity, and 32% (20%-46%) positive and 96% (86%-99%) negative predictive values. DCI was diagnosed in 50% (48/96). CTP deficits were seen in 81% (39/48) of patients with DCI and in 17% (8/48) of those without (P < .0001). CTP deficits had 81% (68%-90%) sensitivity, 83% (70%-91%) specificity, and 83% (70%-91%) positive and 82% (69%-90%) negative predictive values. Quantitative CTP revealed significantly reduced CBF and prolonged MTT for DCI, permanent neurologic deficits, and infarction. ROC analysis showed that CBF and MTT had the highest accuracy. CONCLUSIONS CTP may add prognostic information regarding DCI and poor outcomes in aneurysmal SAH.
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Affiliation(s)
- P C Sanelli
- Departments of Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York 10065, USA.
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Shin BJ, Njoku IU, Tsiouris AJ, Härtl R. Navigated guide tube for the placement of mini-open pedicle screws using stereotactic 3D navigation without the use of K-wires. J Neurosurg Spine 2013. [DOI: 10.3171/2012.10.spine12569] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Three-dimensional spinal navigation increases screw accuracy, but its implementation in clinical practice has been difficult, mainly because of surgeons' concerns about increased operative times, disturbance of workflow, and safety. The authors present a custom-designed navigated guide that addresses some of these concerns by allowing for drilling, tapping, and placing the final screw via a minimally invasive approach without the need for K-wires. In this paper, the authors' goal was to describe the technical aspects of the navigated guide tube as well as pedicle screw accuracy.
Methods
The authors present the technical details of a navigated guide that allows drilling, tapping, and the placement of the final screw without the need for K-wires. The first 10 patients who received minimally invasive mini-open spinal pedicle screws are presented. The case series focuses on the immediate postoperative outcomes, pedicle screw accuracy, and pedicle screw–related complications. An independent board-certified neuroradiologist determined pedicle screw accuracy according to a 4-tiered grading system.
Results
The navigated guide allowed successful placement of mini-open pedicle screws as part of posterior fixation from L-1 to S-1 without the use of K-wires. Only 7-mm-diameter screws were placed, and 72% of screws were completely contained within the pedicle. Breaches less than 2 mm were seen in 23% of cases, and these were all lateral except for one screw. Breaches were related to the lateral to medial trajectory chosen to avoid the superior facet joint. There were no complications related to pedicle screw insertion.
Conclusions
A novel customized navigated guide tube is presented that facilitates the workflow and allows accurate placement of mini-open pedicle screws without the need for K-wires.
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Affiliation(s)
- Benjamin J. Shin
- 2Brain and Spine Center, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | - Innocent U. Njoku
- 2Brain and Spine Center, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
| | | | - Roger Härtl
- 2Brain and Spine Center, NewYork-Presbyterian Hospital, Weill Cornell Medical College, New York, New York
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Jeon JY, Kovanlikaya I, Boockvar JA, Mao X, Shin B, K Burkhardt J, Kesavabhotla K, Christos P, Riina H, Shungu DC, Tsiouris AJ. Metabolic response of glioblastoma to superselective intra-arterial cerebral infusion of bevacizumab: a proton MR spectroscopic imaging study. AJNR Am J Neuroradiol 2012; 33:2095-102. [PMID: 22576886 DOI: 10.3174/ajnr.a3091] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE SIACI of bevacizumab has emerged as a promising novel therapy in the treatment of recurrent GB. This study assessed the potential of (1)H-MRS as an adjunctive technique in detecting metabolic changes reflective of antiproliferative effects of targeted infusion of bevacizumab in the treatment of GB. MATERIALS AND METHODS Eighteen patients enrolled in a phase I/II study of SIACI of bevacizumab for treatment of recurrent GB were included. Concurrent MR imaging and (1)H-MRS scans were performed before and after treatment. Five distinct morphologic ROIs were evaluated for structural and metabolic changes on MR imaging and (1)H-MRS, which included enhancing, nonenhancing T2 hyperintense signal abnormality, and multiple control regions. Pre- and post-SIACI of bevacizumab peak areas for NAA, tCho, tCr, as well as tCho/tCr and tCho/NAA ratios, were derived for all 5 ROIs and compared using the Wilcoxon signed-rank test. RESULTS A significant median decrease of 25.99% (range -55.76 to 123.94; P = .006) in tCho/NAA was found post-SIACI of bevacizumab relative to pretreatment values in regions of enhancing disease. A trend-level significant median decrease of 6.45% (range -23.71 to 37.67; P = .06) was noted in tCho/NAA posttreatment in regions of nonenhancing T2-hyperintense signal abnormality. CONCLUSIONS The results of this (1)H-MRS analysis suggest that GB treatment with SIACI of bevacizumab may be associated with a direct antiproliferative effect, as demonstrated by significant reductions of tCho/NAA after the intervention.
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Affiliation(s)
- J Y Jeon
- Departments of Neuroradiology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY 10065, USA
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Smith MJ, Mascitelli J, Santillan A, Brennan JS, Tsiouris AJ, Riina HA, Gobin YP. Bare platinum vs matrix detachable coils for the endovascular treatment of intracranial aneurysms: a multivariate logistic regression analysis and review of the literature. Neurosurgery 2011; 69:557-64; discussion 565. [PMID: 21499161 DOI: 10.1227/neu.0b013e31821a86da] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite increasing acceptance of endovascular coiling for treating intracranial aneurysms, incomplete occlusion remains a limitation. Attempts to reduce recanalization have prompted creation of polyglycolic/polylactic acid-coated (Matrix) coils shown to improve neointima formation; however, previous publications demonstrate conflicting results regarding their efficacy. Few studies account for factors influencing recurrence, and only 4 studies include bare platinum (BP) coil control groups. OBJECTIVE To compare initial and short- and mid-term occlusion as well as retreatment rates using Matrix compared with BP coils. METHODS Retrospective review of patients undergoing coiling of cerebral aneurysms from 2001 to 2005 was performed. Analysis included a multivariate logistic regression model designed to detect a 35% absolute difference in initial occlusion between coil treatment groups with 80% power. RESULTS Complete initial occlusion was achieved in 64% of BP (n = 45) and 63% of Matrix (n = 56) cases (P = 1.0). Follow-up occlusion rates in the short term and mid term were 52% and 60%, respectively, for BP cases and 42% and 67%, respectively, for Matrix cases (P = .24 and P = .38, respectively). After adjusting for size, morphology, volumetric packing density, location, rupture, and balloon remodeling, no difference in initial and subsequent occlusion or retreatment rates for BP coils versus Matrix coils was appreciated. CONCLUSION After controlling for factors influencing recanalization, this investigation failed to show a significant difference between coil groups.
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Affiliation(s)
- Michelle J Smith
- Division of Interventional Neuroradiology, Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical Center, New York, New York 10021, USA.
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Sanelli PC, Ugorec I, Johnson CE, Tan J, Segal AZ, Fink M, Heier LA, Tsiouris AJ, Comunale JP, John M, Stieg PE, Zimmerman RD, Mushlin AI. Using quantitative CT perfusion for evaluation of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage. AJNR Am J Neuroradiol 2011; 32:2047-53. [PMID: 21960495 DOI: 10.3174/ajnr.a2693] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE DCI is a serious complication following aneurysmal SAH leading to permanent neurologic deficits, infarction, and death. Our aim was to prospectively evaluate the diagnostic accuracy of CTP and to determine a quantitative threshold for DCI in aneurysmal SAH. MATERIALS AND METHODS Patients with SAH were prospectively enrolled in a protocol approved by the institutional review board. CTP was performed during the typical time period for DCI, between days 6 and 8 following SAH. Quantitative CBF, CBV, and MTT values were obtained by using standard region-of-interest placement sampling of gray matter. The reference standard for DCI is controversial and consisted of clinical and imaging criteria in this study. In a subanalysis of vasospasm, DSA was used as the reference standard. ROC curves determined the diagnostic accuracy by using AUC. Optimal threshold values were calculated by using the patient population utility method. RESULTS Ninety-seven patients were included; 41% (40/97) had DCI. Overall diagnostic accuracy was 93% for CBF, 88% for MTT, and 72% for CBV. Optimal threshold values were 35 mL/100 g/min (90% sensitivity, 68% specificity) for CBF and 5.5 seconds (73% sensitivity, 79% specificity) for MTT. In the subanalysis (n = 57), 63% (36/57) had vasospasm. Overall diagnostic accuracy was 94% for CBF, 85% for MTT, and 72% for CBV. Optimal threshold values were 36.5 mL/100 g/min (95% sensitivity, 70% specificity) for CBF and 5.4 seconds (78% sensitivity, 70% specificity) for MTT. CONCLUSIONS CBF and MTT have the highest overall diagnostic accuracy. Threshold values of 35 mL/100 g/min for CBF and 5.5-second MTT are suggested for DCI on the basis of the patient population utility method. Absolute threshold values may not be generalizable due to differences in scanner equipment and postprocessing methods.
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Affiliation(s)
- P C Sanelli
- Department of Radiology, New York-Presbyterian Hospital, New York, NY, USA.
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Liu T, Khalidov I, de Rochefort L, Spincemaille P, Liu J, Tsiouris AJ, Wang Y. A novel background field removal method for MRI using projection onto dipole fields (PDF). NMR Biomed 2011; 24:1129-36. [PMID: 21387445 PMCID: PMC3628923 DOI: 10.1002/nbm.1670] [Citation(s) in RCA: 307] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Revised: 12/06/2010] [Accepted: 12/11/2010] [Indexed: 05/06/2023]
Abstract
For optimal image quality in susceptibility-weighted imaging and accurate quantification of susceptibility, it is necessary to isolate the local field generated by local magnetic sources (such as iron) from the background field that arises from imperfect shimming and variations in magnetic susceptibility of surrounding tissues (including air). Previous background removal techniques have limited effectiveness depending on the accuracy of model assumptions or information input. In this article, we report an observation that the magnetic field for a dipole outside a given region of interest (ROI) is approximately orthogonal to the magnetic field of a dipole inside the ROI. Accordingly, we propose a nonparametric background field removal technique based on projection onto dipole fields (PDF). In this PDF technique, the background field inside an ROI is decomposed into a field originating from dipoles outside the ROI using the projection theorem in Hilbert space. This novel PDF background removal technique was validated on a numerical simulation and a phantom experiment and was applied in human brain imaging, demonstrating substantial improvement in background field removal compared with the commonly used high-pass filtering method.
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Affiliation(s)
- Tian Liu
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Ildar Khalidov
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Ludovic de Rochefort
- Molecular Imaging Research Center (MIRCen), LMN, I2BM, DSV, CEA, Fontenay-aux-roses, France
| | | | - Jing Liu
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - A. John Tsiouris
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA
- Department of Biomedical Engineering, Cornell University, Ithaca, NY, USA
- Correspondence to: Y. Wang, Cornell MRI, 416 E 55th Street, New York, NY 10022, USA,
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Liu J, Liu T, de Rochefort L, Ledoux J, Khalidov I, Chen W, Tsiouris AJ, Wisnieff C, Spincemaille P, Prince MR, Wang Y. Morphology enabled dipole inversion for quantitative susceptibility mapping using structural consistency between the magnitude image and the susceptibility map. Neuroimage 2011; 59:2560-8. [PMID: 21925276 DOI: 10.1016/j.neuroimage.2011.08.082] [Citation(s) in RCA: 341] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 08/12/2011] [Accepted: 08/25/2011] [Indexed: 02/02/2023] Open
Abstract
The magnetic susceptibility of tissue can be determined in gradient echo MRI by deconvolving the local magnetic field with the magnetic field generated by a unit dipole. This Quantitative Susceptibility Mapping (QSM) problem is unfortunately ill-posed. By transforming the problem to the Fourier domain, the susceptibility appears to be undersampled only at points where the dipole kernel is zero, suggesting that a modest amount of additional information may be sufficient for uniquely resolving susceptibility. A Morphology Enabled Dipole Inversion (MEDI) approach is developed that exploits the structural consistency between the susceptibility map and the magnitude image reconstructed from the same gradient echo MRI. Specifically, voxels that are part of edges in the susceptibility map but not in the edges of the magnitude image are considered to be sparse. In this approach an L1 norm minimization is used to express this sparsity property. Numerical simulations and phantom experiments are performed to demonstrate the superiority of this L1 minimization approach over the previous L2 minimization method. Preliminary brain imaging results in healthy subjects and in patients with intracerebral hemorrhages illustrate that QSM is feasible in practice.
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Affiliation(s)
- Jing Liu
- Department of Radiology, Weill Medical College of Cornell University, New York, NY 10022, USA
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Lin K, Zink WE, Tsiouris AJ, John M, Tekchandani L, Sanelli PC. Risk assessment of hemorrhagic transformation of acute middle cerebral artery stroke using multimodal CT. J Neuroimaging 2010; 22:160-6. [PMID: 21143549 DOI: 10.1111/j.1552-6569.2010.00562.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Multimodal CT with CT angiography (CTA) and CT perfusion (CTP) are increasingly used in stroke triage. Our aim was to identify parameters most predictive of hemorrhagic transformation (HT), especially symptomatic intracerebral hemorrhage (SICH). METHODS This retrospective study included patients evaluated by baseline multimodal CT ≤ 9 hours from ictus with acute nonlacunar middle cerebral artery (MCA) territory infarction. Two readers independently evaluated CTP maps for ischemic severity and CTA source images (CTA-SI) for infarct extent (as measured by ASPECTS). Presence of proximal occlusion (ICA or M1) and degree of collateralization (collateral score) were also assessed on CTA. HT was defined as SICH if associated with deterioration ≥ 4-points on NIHSS. Multivariate logistic regression analysis identified independent predictors of SICH. ROC curves selected optimal thresholds. RESULTS Of 84 patients reviewed, HT occurred in 22 (26.2%) and SICH in 8 (9.5%). Univariate predictors for SICH were proximal occlusion (OR = 8.65, P= .049), collateral score (OR = .34, P= .017), ASPECTS (OR = .46, P= .001), and CBV (OR = .001, P= .005). Multivariate analysis revealed ASPECTS as the only independent predictor with optimal threshold ≤ 5 and sensitivity and specificity of 75.0% and 85.5%, respectively. CONCLUSION For acute MCA infarcts ≤ 9 hours, the strongest predictor of SICH on multimodal CT was ASPECTS on CTA-SI.
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Affiliation(s)
- Ke Lin
- Department of Radiology, New York Presbyterian Hospital, Weill-Cornell Medical College, New York, NY, USA.
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Patsalides A, Knopman J, Santillan A, Tsiouris AJ, Riina H, Gobin YP. Endovascular treatment of spinal arteriovenous lesions: beyond the dural fistula. AJNR Am J Neuroradiol 2010; 32:798-808. [PMID: 20651018 DOI: 10.3174/ajnr.a2190] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
During the past few decades, there have been significant advances in the understanding of spinal vascular lesions, mainly because of the evolution of imaging technology and selective spinal angiography techniques. In this article, we discuss the classification, pathophysiology, and clinical manifestations of spinal vascular lesions other than DAVFs and provide a review of the endovascular approach to treat these lesions.
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Affiliation(s)
- A Patsalides
- Division of Interventional Neuroradiology, Departments of Radiology and Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical College, NY 10065, USA.
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Tomasino A, Parikh K, Koller H, Zink W, Tsiouris AJ, Steinberger J, Härtl R. The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood. J Neurosurg Spine 2010; 13:52-60. [DOI: 10.3171/2010.3.spine09231] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this retrospective study was to quantify the anatomical relationship between the vertebral artery (VA), the cervical pedicle, and its surrounding structures, including the incidence of irregularities. Additionally, data delineating a “safe zone,” and these data's application during instrumentation with transpedicular cervical screw fixation were considered. The anatomical proximity of the VA to the cervical pedicle prevents spine surgeons from preferring cervical pedicle screws (CPSs) over lateral mass screws at levels C3–6. Accurate placement of CPSs is often difficult to determine, because this definition can vary between 1 and 4 mm of lateral “noncritical” and “critical” pedicle breaches. No previous study in a western population has investigated the VA's proximity to the cervical pedicle, its percentage of occupancy in the transverse foramen (TF), and the incidence of irregular VA pathways.
Methods
One hundred twenty-seven consecutive patients who underwent CT angiography of the neck were enrolled in this study. The measurements included the following: medial pedicle border to VA; lateral pedicle border to VA; pedicle diameter (PD); sagittal diameter of the VA; coronal diameter of the VA; sagittal diameter of the TF; and coronal diameter of the TF. The cross-sections of the VA and the TF were measured to determine the occupation ratio of the VA. In addition, a safe zone was defined based on all lateral pedicle border to VA measurements in which the VA was within the TF. The level of entry of the VA into the TF as well as irregularities of the VA and the cervical pedicles were recorded.
Results
Vertebral artery dominance on the left side was seen in 69.3% of cases. The mean PD increased from 4.9 to 6.5 mm (from C-3 to C-7, respectively). Statistically significantly bigger PDs were seen in males. The mean PD at C-2 was 5.6 mm. Entry of the VA at C-6 was seen in approximately 80% of cases. The TF occupation ratio of the VA was found to be the greatest in C-4 and C-7 (37.1 and 74.2%, respectively). The safe zone increased from C-2 to C-6 (1.1 to 1.7 mm, respectively), but was only 0.65 mm at C-7. In 23.6% of cases, an irregular pathway of the VA or irregular anatomy of a cervical pedicle was seen, with the highest incidence of irregularities found at C-2.
Conclusions
Computed tomography angiography is a valuable tool that can help determine the relationships between cervical pedicles and the VA as well as irregular VA pathways. Pedicle diameter, safe zone, and occupational ratio of the VA in the foramen determine the risk associated with instrumentation and should be assessed individually. Based on the authors' measurements, C-4 and C-7 can be considered critical levels for CPS placement. Because of this and the high incidence of irregular VA pathways and different entry points, it may be helpful to review neck CT angiography studies before considering posterior instrumentation procedures in the cervical spine.
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Affiliation(s)
- Andre Tomasino
- 1Department of Neurological Surgery, Hospital Munich Bogenhausen, Teaching Hospital of the Technical University Munich
| | | | - Heiko Koller
- 3German Scoliosis Center Bad Wildungen, Werner-Wicker Klinik Im Kreuzfeld, Bad Wildungen, Germany
| | - Walter Zink
- 4Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York; and
| | - A. John Tsiouris
- 4Radiology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York; and
| | - Jeremy Steinberger
- 5Albert Einstein College of Medicine, Yeshiva University, Bronx, New York
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Riina HA, Knopman J, Greenfield JP, Fralin S, Gobin YP, Tsiouris AJ, Souweidane MM, Boockvar JA. Balloon-assisted superselective intra-arterial cerebral infusion of bevacizumab for malignant brainstem glioma. A technical note. Interv Neuroradiol 2010; 16:71-6. [PMID: 20377982 DOI: 10.1177/159101991001600109] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 03/04/2010] [Indexed: 12/22/2022] Open
Abstract
Malignant brainstem gliomas (BSG) are rare tumors in adults, associated with a grim prognosis and limited treatment options. Currently, radiotherapy represents the mainstay of treatment, although new studies suggest an increased role for certain chemotherapeutic agents. Intravenous (IV) administration of bevacizumab (Avastin, Genentech Pharmaceuticals) has been shown to be active in the treatment of some enhancing malignant brainstem gliomas. The IV route of administration, however, carries a risk of systemic side effects such as bowel perforation, wound disrepair and pulmonary embolism. In addition, the percentage of IV drug that reaches the tumor site is restricted by the blood brain barrier (BBB).Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Cornell Medical College of Cornell University: New York, NY, USA. This technical report describes our protocol in performing superselective intra-arterial cerebral infusion (SIACI) of bevacizumab using endovascular balloon-assistance in the top of the basilar artery in a patient with a recurrent malignant brainstem glioma. It represents the first time such a technique has been performed for this disease. This method of drug delivery may have important implications in the treatment of both adult and pediatric brainstem gliomas.
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Affiliation(s)
- H A Riina
- Weill Cornell Brain Tumor Center, Department of Neurosurgery, Weill Cornell Medical College of Cornell University, New York, NY, USA
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Abstract
Venous sinus thrombosis is a rare entity that usually arises secondary to underlying thrombophilia, neoplasm, head injury, or infection. Tympanic infection accounts for the majority of infectious etiologies, and the sigmoid sinus becomes the likely anatomical site of thrombosis. The authors report a case involving a child with recurrent otitis media who presented with an atraumatic epidural hematoma secondary to sigmoid sinus thrombosis. Intraoperative evaluation revealed epidural hemorrhage that originated from the venous sinus, with hemorrhagic products of varying ages. To the authors' knowledge, this is the first reported case of a venous sinus thrombosis resulting in an epidural hematoma.
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Affiliation(s)
- Jared Knopman
- Department of Neurological Surgery and, Weill Medical College of Cornell University, New York, New York 10021, USA.
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Sanelli PC, Nicola G, Johnson R, Tsiouris AJ, Ougorets I, Knight C, Frommer B, Veronelli S, Zimmerman RD. Effect of training and experience on qualitative and quantitative CT perfusion data. AJNR Am J Neuroradiol 2007; 28:428-32. [PMID: 17353307 PMCID: PMC7977860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND AND PURPOSE To evaluate interobserver reliability of obtaining CT perfusion (CTP) data for qualitative identification of perfusion abnormality and quantitative assessment through regions-of-interest (ROIs) placement. MATERIALS AND METHODS Six observers participated in the study (neuroradiology attending physician, neurology attending physician, neuroradiology fellow, radiology resident physician, senior and junior CT technologists). After a brief training session, each observer evaluated 20 CTP datasets for qualitative identification of a right- or left-sided perfusion abnormality or symmetric perfusion. Observers also placed a single ROI of standard size to obtain quantitative data on the most severely hypoperfused region. An additional 10 ROIs were placed on the cortex to quantitatively evaluate global cortical perfusion. Mean quantitative cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) values were analyzed. RESULTS The kappa values for qualitative assessment of a perfusion abnormality ranged from 0.55 to 1.0. Coefficients of variation for quantitative assessment of ischemia/infarct region were 27.10% for CBF, 13.33% for CBV, and 4.66% for MTT. Coefficients of variation for quantitative assessment of global cortical perfusion were 11.88% for CBF, 13.66% for CBV, and 3.55% for MTT. The junior CT technologist and neuroradiology fellow showed significant differences compared with other observers for the ischemia/infarct region and global cortical perfusion, respectively. CONCLUSION Overall, quantitative differences seen in this study would not necessarily affect quality of interpretation of ischemia/infarct region or global cortical perfusion. Therefore, obtaining qualitative and quantitative CTP data can reliably be performed in the clinical setting among observers with various levels of skill and experience when using a uniform and standard technique.
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Affiliation(s)
- P C Sanelli
- Department of Radiology, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Affiliation(s)
- Martin Begemann
- Max Planck Institute for Molecular Genetics, Department of Human Genetics, Ihnestrasse 73, 14195 Berlin, Germany.
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