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Dane B, Mabud T, Melamud K, Ginocchio L, Smereka P, Okyere M, O'Donnell T, Megibow A. Reduced Intravenous Contrast Dose Portal Venous Phase Photon-Counting Computed Tomography Compared With Conventional Energy-Integrating Detector Portal Venous Phase Computed Tomography. J Comput Assist Tomogr 2024:00004728-990000000-00308. [PMID: 38595174 DOI: 10.1097/rct.0000000000001617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE The aim of this study was to compare portal venous phase photon-counting CT (PCCT) using 20 cc less than weight-based contrast dosing with energy-integrating detector CT (EID-CT) using weight-based dosing by quantitative and qualitative analysis. METHODS Fifty adult patients who underwent a reduced intravenous contrast dose portal venous phase PCCT from May 1, 2023, to August 10, 2023, and a prior portal-venous EID-CT with weight-based contrast dosing were retrospectively identified. Hounsfield units (HU) and noise (SD of HU) were obtained from region-of-interest measurements on 70-keV PCCT and EID-CT in 4 hepatic segments, the main and right portal vein, and both paraspinal muscles. Signal-to-noise and contrast-to-noise ratios were computed. Three abdominal radiologists qualitatively assessed overall image quality, hepatic enhancement, and confidence for metastasis identification on 5-point Likert scales. Readers also recorded the presence/absence of hepatic metastases. Quantitative variables were compared with paired t tests, and multiple comparisons were accounted for with a Bonferroni-adjusted α level of .0016. Ordinal logistic regression was used to evaluate qualitative assessments. Interreader agreement for hepatic metastases was calculated using Fleiss' κ. RESULTS Fifty patients (32 women; mean [SD] age, 64 [13] years) were included. There was no significant difference in hepatic HU, portal vein HU, noise, and signal-to-noise or contrast-to-noise ratio between reduced contrast dose portal venous phase PCCT versus EID-CT (all Ps > 0.0016). Image quality, degree of hepatic enhancement, and confidence for metastasis identification were not different for reduced dose PCCT 70-keV images and EID-CT (P = 0.06-0.69). κ Value for metastasis identification was 0.86 (95% confidence interval, 0.70-1.00) with PCCT and 0.78 (95% confidence interval, 0.59-0.98) with EID-CT. CONCLUSION Reduced intravenous contrast portal venous phase PCCT 70-keV images had similar attenuation and image quality as EID-CT with weight-based dosing. Metastases were identified with near-perfect agreement in reduced dose PCCT 70-keV images.
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Affiliation(s)
- Bari Dane
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Tarub Mabud
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Kira Melamud
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Luke Ginocchio
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Paul Smereka
- From the Department of Radiology, NYU Langone Health, New York, NY
| | - Mabel Okyere
- From the Department of Radiology, NYU Langone Health, New York, NY
| | | | - Alec Megibow
- From the Department of Radiology, NYU Langone Health, New York, NY
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Dane B, Kim J, Qian K, Megibow A. Pancreatic cyst prevalence and detection with photon counting CT compared with conventional energy integrating detector CT. Eur J Radiol 2024; 175:111437. [PMID: 38520805 DOI: 10.1016/j.ejrad.2024.111437] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To calculate the prevalence of pancreatic cysts on photon counting CT (PCCT) and compare with that of 128-slice conventional energy-integrating detector CT (EIDCT). METHOD A retrospective single institution database search identified all contrast-enhanced abdominal CT examinations performed at an outpatient facility that has both a PCCT and EIDCT between 4/11/2022 and 7/26/2022. The presence and size of pancreatic cysts were recorded. In patients with PCCT reported pancreatic cysts, prior CT imaging (EIDCT) was reviewed for reported pancreatic cysts. Fisher's exact test was used to compare the pancreatic cyst detection rate for PCCT and EIDCT. Wilcoxon rank sum test was used to compare cyst size and patient age. A p <.05 indicated statistical significance. RESULTS 2494 patients were included. Our pancreatic cyst detection rate was 4.9 % (49/1009) with PCCT and 3.0 % (44/1485) for EIDCT (p =.017). For CT angiograms, pancreatic cysts were detected in 6.6 % (21/319) with PCCT and 0.0 % (0/141) with EIDCT (p <.001). Pancreatic cyst detection rate was not statistically different for portal venous, enterography, renal mass, pancreas, 3-phase liver, or venogram protocols (all p >.05). Mean[SD] pancreatic cyst size was 13.7[9.7]mm for PCCT and 15.3[14.7] for EIDCT (p =.95). 55.1 % (27/49) of PCCT and 61.4 % (27/44) of EIDCT that described pancreatic cysts had prior contrast-enhanced EIDCTs. Of these, 40.7 % (11/27) of PCCT and 14.8 % (4/27) of EIDCT described pancreatic cysts were not previously reported (p =.027). CONCLUSIONS Photon-counting CT afforded greater pancreatic cyst detection than conventional energy-integrating detector CT, particularly with CT angiograms.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 1(st) Avenue, New York, NY 10016.
| | - Jesi Kim
- Department of Radiology, NYU Langone Health, 660 1(st) Avenue, New York, NY 10016
| | - Kun Qian
- NYU Langone Health Department of Biostatistics, 180 Madison Avenue, New York, NY 10016
| | - Alec Megibow
- Department of Radiology, NYU Langone Health, 660 1(st) Avenue, New York, NY 10016
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Dane B, Ruff A, O'Donnell T, El-Ali A, Ginocchio L, Prabhu V, Megibow A. Photon-Counting Computed Tomography Versus Energy-Integrating Dual-Energy Computed Tomography: Virtual Noncontrast Image Quality Comparison. J Comput Assist Tomogr 2024; 48:251-256. [PMID: 38013203 DOI: 10.1097/rct.0000000000001562] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
PURPOSE This study aimed to compare the image quality of portal venous phase-derived virtual noncontrast (VNC) images from photon-counting computed tomography (PCCT) with energy-integrating dual-energy computed tomography (EI-DECT) in the same patient using quantitative and qualitative analyses. METHODS Consecutive patients retrospectively identified with available portal venous phase-derived VNC images from both PCCT and EI-DECT were included. Patients without available VNC in picture archiving and communication system in PCCT or prior EI-DECT and non-portal venous phase acquisitions were excluded. Three fellowship-trained radiologists blinded to VNC source qualitatively assessed VNC images on a 5-point scale for overall image quality, image noise, small structure delineation, noise texture, artifacts, and degree of iodine removal. Quantitative assessment used region-of-interest measurements within the aorta at 4 standard locations, both psoas muscles, both renal cortices, spleen, retroperitoneal fat, and inferior vena cava. Attenuation (Hounsfield unit), quantitative noise (Hounsfield unit SD), contrast-to-noise ratio (CNR) (CNR vascular , CNR kidney , CNR spleen , CNR fat ), signal-to-noise ratio (SNR) (SNR vascular , SNR kidney , SNR spleen , SNR fat ), and radiation dose were compared between PCCT and EI-DECT with the Wilcoxon signed rank test. A P < 0.05 indicated statistical significance. RESULTS A total of 74 patients (27 men; mean ± SD age, 63 ± 13 years) were included. Computed tomography dose index volumes for PCCT and EI-DECT were 9.2 ± 3.5 mGy and 9.4 ± 9.0 mGy, respectively ( P = 0.06). Qualitatively, PCCT VNC images had better overall image quality, image noise, small structure delineation, noise texture, and fewer artifacts (all P < 0.00001). Virtual noncontrast images from PCCT had lower attenuation (all P < 0.05), noise ( P = 0.006), and higher CNR ( P < 0.0001-0.04). Contrast-enhanced structures had lower SNR on PCCT ( P = 0.001, 0.002), reflecting greater contrast removal. The SNRfat (nonenhancing) was higher for PCCT than EI-DECT ( P < 0.00001). CONCLUSIONS Virtual noncontrast images from PCCT had improved image quality, lower noise, improved CNR and SNR compared with those derived from EI-DECT.
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Affiliation(s)
- Bari Dane
- From the Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - Andrew Ruff
- From the Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | | | - Alexander El-Ali
- From the Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - Luke Ginocchio
- From the Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - Vinay Prabhu
- From the Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
| | - Alec Megibow
- From the Department of Radiology, NYU Langone Health, NYU Grossman School of Medicine, New York, NY
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Dane B, Freedman D, Qian K, Ginocchio L, Smereka P, Megibow A. Photon-counting CT urogram: optimal acquisition potential (kV) determination for virtual noncontrast creation. Abdom Radiol (NY) 2024; 49:868-874. [PMID: 38006415 DOI: 10.1007/s00261-023-04113-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/27/2023]
Abstract
PURPOSE To quantitatively and qualitatively compare the degree of iodine removal in the collecting system from PCCT urographic phase-derived virtual noncontrast (VNC) images obtained at 140 kV versus 120 kV. METHODS A retrospective PACS search identified adult patients (>18 years) who underwent a PCCT urogram for hematuria from 4/2022 to 4/2023 with available urographic phase-derived VNC images in PACS. Tube voltage (120 kV, 140 kV), body mass index, CTDIvol, dose length product (DLP), and size-specific dose estimate (SSDE) were recorded. Hounsfield Unit (HU) in both renal pelvises and the urinary bladder on urographic-derived VNC were recorded. Three radiologists qualitatively assessed the degree of iodine removal (renal pelvis, urinary bladder) and diagnostic confidence for urinary stone detection. Continuous variables were compared for 140 kV versus 120 kV with the Wilcoxon rank sum test. A p < .05 indicated statistical significance. RESULTS 63 patients (34 male; median (Q1, Q3) age: 30 (26, 34) years; 140 kV/120 kV: 30 patients/33 patients) were included. BMI, CTDIvol, DLP, and SSDE were not different for 140 kV and 120 kV (all p > .05). Median (Q1, Q3) collecting system HU (renal pelvis and bladder) was 0.9 (- 3.6, 4.4) HU at 140 kV and 10.5 (3.6, 26.7) HU at 120 kV (p = .04). Diagnostic confidence for urinary calculi was 4.6 [1.1] at 140 kV and 4.1 [1.4] at 120 kV (p = .005). Diagnostic confidence was 5/5 (all readers) in 82.2% (74/90) at 140 kV and 59.6% (59/99) at 120 kV (p < .001). CONCLUSION PCCT urographic phase-derived VNC images obtained at 140 kV had better collecting system iodine removal than 120 kV with similar patient radiation exposure. With excellent PCCT urographic phase iodine removal at 140 kV, consideration can be made to utilize a single-phase CT urogram in young patients.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.
| | - Daniel Freedman
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
| | - Kun Qian
- Department of Biostatistics, NYU Langone Health, 180 Madison Avenue, New York, NY, 10016, USA
| | - Luke Ginocchio
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
| | - Paul Smereka
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
| | - Alec Megibow
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
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Dillman JR, Anupindi SA, Dane B. Proposal of an Abbreviated Noncontrast MR Enterography Protocol for Patients With Crohn Disease. AJR Am J Roentgenol 2024; 222:e2330422. [PMID: 38054957 DOI: 10.2214/ajr.23.30422] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
MR enterography (MRE) protocols used in patients with Crohn disease are burdened by long acquisition time, high cost, and suboptimal patient experience. For several indications, highly diagnostic MRE can be performed in five or fewer sequences, without IV contrast material or antiperistaltic medication and with an examination room time of less than 12 minutes. As such, MRE could be more patient friendly, more frequently performed, and require fewer health care resources.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH 45229
| | - Sudha A Anupindi
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Bari Dane
- Department of Radiology, NYU Langone Health, New York, NY
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Dane B, Qian K, Soni R, Megibow A. Crohn's disease inflammation severity assessment with iodine density from photon counting CT enterography: comparison with endoscopic histopathology. Abdom Radiol (NY) 2024; 49:271-278. [PMID: 37814149 DOI: 10.1007/s00261-023-04060-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To determine optimal iodine density thresholds for active inflammation in CD patients with PCCT enterography and determine if iodine density can be used to stratify CD activity severity. METHODS A retrospective PACS search identified patients with CD imaged with PCCT enterography from 4/11/2022 to 10/30/2022 and with clinical notes, endoscopic/surgical pathology and available source PCCT data for iodine density analysis. Two abdominal radiologists with expertise in CD each drew two region of interest measurements within the visibly most affected region of terminal or neoterminal ileum wall on commercially available system (SyngoVia). Radiologists were blinded to clinical information and pathologic findings. Disease activity and severity were recorded from the pathology report. Harvey-Bradshaw Index, medications, and laboratory values were recorded. Receiver operating characteristic (ROC) curves were utilized to determine the optimum iodine density threshold for active inflammation and mild versus moderate-to-severe inflammation. Intra- and inter-reader agreement was assessed by intra-class correlation coefficient (ICC). RESULTS 23 CD patients (15 females; mean [SD] age: 52 [17] years) imaged with PCCT enterography were included. 15/23 had active inflammation: 9/15 mild, 4/15 moderate, and 2/15 severe active inflammation. The optimal iodine density threshold for active inflammation was 2.7 mg/mL, with 97% sensitivity, 100% specificity, and 98% accuracy (AUC = 1.00). The optimal iodine density threshold for distinguishing mild from moderate-to-severe inflammation was 3.4 mg/mL, with 83% sensitivity, 89% specificity, and 87% accuracy (AUC = 0.85). Intra-reader reliability (R1/R2) ICC was 0.81/0.86. Inter-reader reliability ICC was 0.94. CONCLUSION Iodine density from PCCT enterography can distinguish mild from moderate-to-severe active inflammation.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.
| | - Kun Qian
- Department of Biostatistics, NYU Langone Health, 180 Madison Avenue, New York, NY, 10016, USA
| | - Ria Soni
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Alec Megibow
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
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Beaty W, Katragadda A, Condos R, Dane B, Sarkar S, Shaffer E, Chang S. Pulmonary Crohn's Disease Masquerading as Lymphoma. ACG Case Rep J 2024; 11:e01247. [PMID: 38179265 PMCID: PMC10766257 DOI: 10.14309/crj.0000000000001247] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/27/2023] [Indexed: 01/06/2024] Open
Abstract
Although extraintestinal manifestations of inflammatory bowel disease (IBD) are common, pulmonary IBD is extremely rare. Owing to its nonspecific clinical, radiologic, and pathologic features, pulmonary IBD is difficult to diagnose and may mimic more concerning disease processes. We present a rare case of a patient with known Crohn's disease whose initial presentation was highly suspicious for malignancy before further investigation revealed pulmonary IBD.
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Affiliation(s)
- William Beaty
- New York University Grossman School of Medicine, New York, NY
| | - Anila Katragadda
- Kansas City University College of Osteopathic Medicine Kansas City, MO
| | - Rany Condos
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
| | - Bari Dane
- Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Suparna Sarkar
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Emily Shaffer
- Department of Pathology, New York University Grossman School of Medicine, New York, NY
| | - Shannon Chang
- Department of Medicine, New York University Grossman School of Medicine, New York, NY
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Donnelly MR, Noh KJ, Silverman J, Donnelly JH, Azad A, Nicholas R, Reavey P, Dane B, Hacquebord JH. Body Mass Index Is Associated With Myocutaneous Free Flap Reliability: Overcoming the Obesity Obstacle With a Proposed Clinical Algorithm to Identify and Manage High-Risk Patients Undergoing Gracilis Free Flap With Skin Paddle Harvest. Ann Plast Surg 2024; 92:68-74. [PMID: 38117047 DOI: 10.1097/sap.0000000000003721] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
INTRODUCTION The purpose of this study was to evaluate the role of body mass index (BMI) in predicting postoperative complications following myocutaneous free flap transfer. In addition, we sought to identify certain body composition variables that may be used to stratify patients into low- versus high-risk for gracilis myocutaneous free flap with skin paddle failure. METHODS Using the National Surgical Quality Improvement Program database, we collected data for all patients who underwent myocutaneous free flap transfer from 2015 to 2021. Demographic data, medical history, surgical characteristics, and postoperative outcomes, including complications, reoperations, and readmissions, were collected. Body mass index was correlated with outcome measures to determine its role in predicting myocutaneous free flap reliability. Subsequently, we retrospectively obtained measurements of perigracilis anatomy in patients who underwent computed tomography angiography bilateral lower extremity scans with intravenous contrast at our institution. We compared body composition data with mathematical equations calculating the potential area along the skin of the thigh within which the gracilis perforator may be found. RESULTS Across the United States, 1549 patients underwent myocutaneous free flap transfer over the 7-year study period. Being in obesity class III (BMI ≥40 kg/m2) was associated with a 4-times greater risk of flap complications necessitating a return to the operating room compared with being within the normal BMI range. In our computed tomography angiography analysis, average perigracilis adipose thickness was 18.3 ± 8.0 mm. Adipose thickness had a strong, positive exponential relationship with the area of skin within which the perforator may be found. CONCLUSIONS In our study, higher BMI was associated with decreased myocutaneous free flap reliability. Specifically, inner thigh adipose thickness can be used to estimate the area along the skin within which the gracilis perforator may be found. This variable, along with BMI, can be used to identify patients who are considered high-risk for flap failure and who may benefit from additional postoperative monitoring, such as the use of a color flow Doppler probe and more frequent and prolonged skin paddle monitoring.
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Affiliation(s)
- Megan R Donnelly
- From the NYU Langone Health Department of Orthopedic Surgery, New York, NY
| | - Karen J Noh
- From the NYU Langone Health Department of Orthopedic Surgery, New York, NY
| | - Jeremy Silverman
- From the NYU Langone Health Department of Orthopedic Surgery, New York, NY
| | | | - Ali Azad
- From the NYU Langone Health Department of Orthopedic Surgery, New York, NY
| | - Rebecca Nicholas
- From the NYU Langone Health Department of Orthopedic Surgery, New York, NY
| | - Patrick Reavey
- University of Rochester Department of Orthopaedic Surgery, Department of Plastic Surgery, Rochester
| | - Bari Dane
- NYU Langone Health Department of Radiology
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Nehra AK, Dane B, Yeh BM, Fletcher JG, Leng S, Mileto A. Dual-Energy, Spectral and Photon Counting Computed Tomography for Evaluation of the Gastrointestinal Tract. Radiol Clin North Am 2023; 61:1031-1049. [PMID: 37758355 DOI: 10.1016/j.rcl.2023.06.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
The use of dual-energy computed tomography (CT) allows for reconstruction of energy- and material-specific image series. The combination of low-energy monochromatic images, iodine maps, and virtual unenhanced images can improve lesion detection and disease characterization in the gastrointestinal tract in comparison with single-energy CT.
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Affiliation(s)
- Avinash K Nehra
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Bari Dane
- Department of Radiology, New York University Langone Medical Center, 550 First Avenue, New York, NY 10016, USA
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Shuai Leng
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Achille Mileto
- Department of Radiology, Virginia Mason Medical Center, 1100 9th Avenue, Seattle, WA 98101, USA
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Chung R, Dane B, Yeh BM, Morgan DE, Sahani DV, Kambadakone A. Dual-Energy Computed Tomography: Technological Considerations. Radiol Clin North Am 2023; 61:945-961. [PMID: 37758362 DOI: 10.1016/j.rcl.2023.05.002] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Compared to conventional single-energy CT (SECT), dual-energy CT (DECT) provides additional information to better characterize imaged tissues. Approaches to DECT acquisition vary by vendor and include source-based and detector-based systems, each with its own advantages and disadvantages. Despite the different approaches to DECT acquisition, the most utilized DECT images include routine SECT equivalent, virtual monoenergetic, material density (eg, iodine map), and virtual non-contrast images. These images are generated either through reconstructions in the projection or image domains. Designing and implementing an optimal DECT workflow into routine clinical practice depends on radiologist and technologist input with special considerations including appropriate patient and protocol selection and workflow automation. In addition to better tissue characterization, DECT provides numerous advantages over SECT such as the characterization of incidental findings and dose reduction in radiation and iodinated contrast.
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Affiliation(s)
- Ryan Chung
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
| | - Bari Dane
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016, USA
| | - Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California - San Francisco, 505 Parnassus Avenue, M391, Box 0628, San Francisco, CA 94143-0628, USA
| | - Desiree E Morgan
- Department of Radiology, University of Alabama at Birmingham, 619 19th Street, South JTN 456, Birmingham, AL 35249-6830, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington, 1959 Northeast Pacific Street, RR220, Seattle, WA 98112, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
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Weinstein S, Kim DH, Fowler KJ, Birkholz JH, Cash BD, Cilenti E, Dane B, Horvat N, Kambadakone AR, Korngold EK, Liu PS, Lo BM, McCrary M, Mellnick V, Pietryga JA, Santillan CS, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Left Lower Quadrant Pain: 2023 Update. J Am Coll Radiol 2023; 20:S471-S480. [PMID: 38040465 DOI: 10.1016/j.jacr.2023.08.013] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/22/2023] [Indexed: 12/03/2023]
Abstract
The differential diagnosis for left lower quadrant pain is wide and conditions range from the benign and self-limited to life-threatening surgical emergencies. Along with patient history, physical examination, and laboratory tests, imaging is often critical to limit the differential diagnosis and identify life-threatening abnormalities. This document will discuss the guidelines for the appropriate use of imaging in the initial workup for patients who present with left lower quadrant pain, patients with suspected diverticulitis, and patients with suspected complications from diverticulitis. 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 process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - David H Kim
- Panel Chair, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California, San Diego, San Diego, California
| | - James H Birkholz
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Elizabeth Cilenti
- MedStar Georgetown University Hospital, Washington, District of Columbia, Primary care physician
| | - Bari Dane
- NYU Grossman School of Medicine, New York, New York
| | - Natally Horvat
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | | | | | - Bruce M Lo
- Sentara Norfolk General Hospital/Eastern Virginia Medical School, Norfolk, Virginia; American College of Emergency Physicians
| | - Marion McCrary
- Duke Signature Care, Durham, North Carolina; American College of Physicians
| | - Vincent Mellnick
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri; Committee on Emergency Radiology-GSER
| | - Jason A Pietryga
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Katherine Zukotynski
- McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Baker ME, Fletcher JG, Church J, Hull T, Dane B, Huang C, Flicek K, Ream J. Future directions in imaging pouches. Abdom Radiol (NY) 2023; 48:3000-3004. [PMID: 37340153 DOI: 10.1007/s00261-023-03971-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/22/2023]
Abstract
The sections of this special issue on the ileal pouch demonstrate that in the nearly 45 years since the ileal pouch has been utilized to treat patients with colitis and familial adenomatous polyposis, a substantial number of patients experience both short- and long-term morbidity and that imaging plays an important role in their management. Further, referral centers are encountering an increasing number of patients with pouch and peri-pouch complications and dysfunction. Many of these patients have had their pouches for years, and many have experienced a reduced quality of life as a result of their symptoms.As we look to the future, what are the specific questions that arise from this compilation of experience from institutions that see large numbers of patients with an ileal pouch? In what areas are we deficient? In what areas are we using the wrong methods? What should we be doing differently?
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Affiliation(s)
- Mark E Baker
- Imaging Institute/L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA.
| | | | - James Church
- Department of Surgery, Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| | - Tracy Hull
- Department of Colorectal Surgery, Cleveland Clinic, Cleveland, OH, USA
- Digestive Diseases and Surgery Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Bari Dane
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Chenchen Huang
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | | | - Justin Ream
- Imaging Institute/L10, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
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Ginocchio LA, Dane B, Smereka PN, Megibow AJ, Remzi FH, Esen E, Huang C. Structured versus non-structured reporting of pelvic MRI for ileal pouch evaluation: clarity and effectiveness. Abdom Radiol (NY) 2023; 48:2978-2985. [PMID: 36871233 DOI: 10.1007/s00261-023-03858-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/14/2023] [Accepted: 02/15/2023] [Indexed: 03/06/2023]
Abstract
PURPOSE Given that ileal pouch-anal anastomosis (IPAA) surgery is a technically challenging and high-morbidity procedure, there are numerous pertinent imaging findings that need to be clearly and efficiently communicated to the IBD surgeons for essential patient management and surgical planning. Structured reporting has been increasingly used over the past decade throughout various radiology subspecialties to improve reporting clarity and completeness. We compare structured versus non-structured reporting of pelvic MRI for ileal pouch to evaluate for clarity and effectiveness. METHODS 164 consecutive pelvic MRI's for ileal pouch evaluation, excluding subsequent exams for the same patient, acquired between 1/1/2019 and 7/31/2021 at one institution were included, before and after implementation (11/15/2020) of a structured reporting template, which was created with institutional IBD surgeons. Reports were assessed for the presence of 18 key features required for complete ileal pouch assessment: anastomosis (IPAA, tip of J, pouch body), cuff (length, cuffitis), pouch body (size, pouchitis, stricture), pouch inlet/pre-pouch ileum (stricture, inflammation, sharp angulation), pouch outlet (stricture), peripouch mesentery (position, mesentery twist), pelvic abscess, peri-anal fistula, pelvic lymph nodes, and skeletal abnormalities. Subgroup analysis was performed based on reader experience and divided into three categories: experienced (n = 2), other intra-institutional (n = 20), or affiliate site (n = 6). RESULTS 57 (35%) structured and 107 (65%) non-structured pelvic MRI reports were reviewed. Structured reports contained 16.6 [SD:4.0] key features whereas non-structured reports contained 6.3 [SD:2.5] key features (p < .001). The largest improvement following template implementation was for reporting sharp angulation of the pouch inlet (91.2% vs. 0.9%, p < .001), tip of J suture line and pouch body anastomosis (both improved to 91.2% from 3.7%). Structured versus non-structured reports contained mean 17.7 versus 9.1 key features for experienced readers, 17.0 versus 5.9 for other intra-institutional readers, and 8.7 versus 5.3 for affiliate site readers. CONCLUSION Structured reporting of pelvic MRI guides a systematic search pattern and comprehensive evaluation of ileal pouches, and therefore facilitates surgical planning and clinical management. This standardized reporting template can serve as baseline at other institutions for adaptation based on specific radiology and surgery preferences, fostering a collaborative environment between radiology and surgery, and ultimately improving patient care.
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Affiliation(s)
- Luke A Ginocchio
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA.
| | - Bari Dane
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Paul N Smereka
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Alec J Megibow
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Feza H Remzi
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Eren Esen
- Department of Surgery, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
| | - Chenchan Huang
- Department of Radiology, NYU Grossman School of Medicine, NYU Langone Health, New York, NY, 10016, USA
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Abstract
Ileal pouch surgery is the surgical gold standard treatment for patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP). However, ileal pouch surgery is a technically challenging procedure and is associated with high morbidity. Clinical presentations of pouch complications are often nonspecific but imaging can identify many of these complications and is essential in clinical management. This paper will focus on magnetic resonance imaging (MRI) of the ileal pouch, including recommended MRI protocol and approach to imaging interpretation with an emphasis on those ileal pouch complications particularly well evaluated with MRI.
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Affiliation(s)
- Chenchan Huang
- NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA.
| | - Bari Dane
- NYU Langone Health, 660 First Avenue, New York, NY, 10016, USA
| | | | - Justin Ream
- , 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Dane B, Huang C, Luk L, Ream J, Fletcher JG, Baker M. Contrast enema, CT, and small bowel series of the ileal pouch. Abdom Radiol (NY) 2023; 48:2935-2943. [PMID: 37043026 DOI: 10.1007/s00261-023-03903-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/13/2023]
Abstract
This manuscript is part of the ileal pouch symposium and will describe the water-soluble contrast enema, CT, and small bowel series. MRI and other imaging modalities are discussed elsewhere in the symposium. Water-soluble contrast enema and CT are excellent for the evaluation of the ileal pouch. Contrast enema and CT with anal contrast administration can allow for anastomotic integrity and pouch assessment. Pre-pouch ileum, extra-intestinal manifestations, and acute symptomatology are best assessed with CT. The contrast small bowel examination is of limited utility in pouch patients and should not be performed. Indications, imaging technique, and anatomic pouch assessment with water-soluble contrast enema, CT, and contrast small bowel examination will be reviewed here.
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Affiliation(s)
- Bari Dane
- NYU Langone Health, 660 1st Avenue, NewYork, NY, 10016, USA.
| | - Chenchan Huang
- NYU Langone Health, 660 1st Avenue, NewYork, NY, 10016, USA
| | - Lyndon Luk
- Columbia University, 622 West 168th Street, New York, NY, 10032, USA
| | - Justin Ream
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | | | - Mark Baker
- Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
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Dane B, Li X, Goldberg JD, O'Donnell T, Le L, Megibow A. Crohn's disease phenotype analysis with iodine density from dual-energy CT enterography. Abdom Radiol (NY) 2023; 48:2219-2227. [PMID: 37097450 DOI: 10.1007/s00261-023-03923-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE To compare dual-source dual-energy CT enterography (dsDECTE) obtained iodine density (I) (mg/mL) and I normalized to the aorta (I%) with Crohn's disease (CD) phenotypes defined by the SAR-AGA small bowel CD consensus statement. METHODS Fifty CD patients (31 male, 19 female; mean [SD] age: 50.4 [15.2] years) who underwent dsDECTE were retrospectively identified. Two abdominal radiologists assigned CD phenotypes: no active inflammation (group-2), active inflammation without (group-3) or with luminal narrowing (group-4), stricture with active inflammation (group-5), stricture without active inflammation (group-1), and penetrating disease (group-6). Semiautomatic prototype software was used to determine the median I and I% of CD-affected small bowel mucosa for each patient. The means of the I and I% medians were compared among 4 groups ("1 + 2", "3 + 4", "5", "6") using one-way ANOVA (significance level 0.05 for each outcome) for each outcome individually followed by Tukey's range test for pairwise comparisons with adjusted p-values (overall alpha = 0.05). RESULTS Mean [SD] I was 2.14 [1.07] mg/mL for groups 1 + 2 (n = 16), 3.54 [1.71] mg/mL for groups 3 + 4 (n = 15), 5.5 [3.27] mg/mL for group- "5" (n = 9), and 3.36 [1.43] mg/mL for group-"6" (n = 10) (ANOVA p = .001; group "1 + 2" versus "5" adj-p = .0005). Mean [SD] I% was 21.2 [6.13]% for groups 1 + 2, 39.47 [9.71]% for groups 3 + 4, 40.98 [11.76]% for group-5, and 35.01 [7.58]% for group-6 (ANOVA p < .0001; groups "1 + 2" versus "3 + 4" adj-p < .0001, group "1 + 2" versus "5" adj-p < .0001, and groups "1 + 2" versus "6" adj-p = .002). CONCLUSION Iodine density obtained from dsDECTE significantly differed among CD phenotypes defined by SAR-AGA, with I (mg/mL) increasing with phenotype severity and decreasing for penetrating disease. I and I% can be used to phenotype CD.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA.
| | - Xiaochun Li
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Judith D Goldberg
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | | | - Linda Le
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA
| | - Alec Megibow
- Department of Radiology, NYU Grossman School of Medicine, 660 1st Avenue, New York, NY, 10016, USA
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Ola D, Dane B, Shanbhogue K, Smereka P. Rectal and perirectal CT findings in patients with monkeypox virus infection. Abdom Radiol (NY) 2023; 48:2284-2291. [PMID: 37148320 DOI: 10.1007/s00261-023-03933-x] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To analyze the findings of proctitis in patients with laboratory-confirmed Mpox and correlate the patient clinical presentation and laboratory findings. METHODS 21 patients with PCR-positive Mpox who obtained abdominopelvic CT were retrospectively identified by electronic medical record search. Three radiologists independently evaluated CT images, measuring rectal wall thickness (cm), degree of perirectal fat stranding on a 5-point Likert scale, and size of perirectal lymph nodes (cm, short axis). Mann-Whitney U-test (Wilcoxon rank sum test) was used to assess the association of rectal wall thickness and perirectal fat standing between patients with rectal symptoms and patients without rectal symptoms. RESULTS 20 of 21 patients presented with perirectal fat stranding, with mean Likert score of 3.0 ± 1.4, indicating moderate perirectal stranding. Mean transverse rectal wall thickness was 1.1 ± 0.5 cm (range 0.3-2.3 cm); it was thicker among patients with HIV (1.2 cm vs 0.7 cm; p = .019). Mean perirectal fat stranding was greater among patients presenting with HIV, and with rectal symptoms, though not significantly so. 17/21 (81%) patients had abnormal mesorectal lymph nodes by at least two of three readers, with mean short-axis measurement 1.0 ± 0.3 cm (range 0.5-1.6 cm). Multiple linear regression showed no significant correlation between rectal thickness and laboratory values or HIV status. CONCLUSION Nearly all patients with Mpox who presented with additional symptoms warranting a CT demonstrated proctitis. Degree of proctitis varied greatly within the cohort, with greatest thickening among patients with HIV. Physicians should have a high suspicion for proctitis in patients with suspected Mpox.
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Affiliation(s)
- David Ola
- Department of Radiology, NYU Langone Health, 660, 1st Avenue, New York, NY, 10016, USA
| | - Bari Dane
- Department of Radiology, NYU Langone Health, 660, 1st Avenue, New York, NY, 10016, USA
| | - Krishna Shanbhogue
- Department of Radiology, NYU Langone Health, 660, 1st Avenue, New York, NY, 10016, USA
| | - Paul Smereka
- Department of Radiology, NYU Langone Health, 660, 1st Avenue, New York, NY, 10016, USA.
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Dane B, Gupta A, Wells ML, Anderson MA, Fidler JL, Naringrekar HV, Allen BC, Brook OR, Bruining DH, Gee MS, Grand DJ, Kastenberg D, Khandelwal A, Sengupta N, Soto JA, Guglielmo FF. Dual-Energy CT Evaluation of Gastrointestinal Bleeding. Radiographics 2023; 43:e220192. [PMID: 37167088 DOI: 10.1148/rg.220192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Gastrointestinal (GI) bleeding is a potentially life-threatening condition accounting for more than 300 000 annual hospitalizations. Multidetector abdominopelvic CT angiography is commonly used in the evaluation of patients with GI bleeding. Given that many patients with severe overt GI bleeding are unlikely to tolerate bowel preparation, and inpatient colonoscopy is frequently limited by suboptimal preparation obscuring mucosal visibility, CT angiography is recommended as a first-line diagnostic test in patients with severe hematochezia to localize a source of bleeding. Assessment of these patients with conventional single-energy CT systems typically requires the performance of a noncontrast series followed by imaging during multiple postcontrast phases. Dual-energy CT (DECT) offers several potential advantages for performing these examinations. DECT may eliminate the need for a noncontrast acquisition by allowing the creation of virtual noncontrast (VNC) images from contrast-enhanced data, affording significant radiation dose reduction while maintaining diagnostic accuracy. VNC images can help radiologists to differentiate active bleeding, hyperattenuating enteric contents, hematomas, and enhancing masses. Additional postprocessing techniques such as low-kiloelectron voltage virtual monoenergetic images, iodine maps, and iodine overlay images can increase the conspicuity of contrast material extravasation and improve the visibility of subtle causes of GI bleeding, thereby increasing diagnostic confidence and assisting with problem solving. GI bleeding can also be diagnosed with routine single-phase DECT scans by constructing VNC images and iodine maps. Radiologists should also be aware of the potential pitfalls and limitations of DECT. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Bari Dane
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Avneesh Gupta
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Michael L Wells
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Mark A Anderson
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Jeff L Fidler
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Haresh V Naringrekar
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Brian C Allen
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Olga R Brook
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David H Bruining
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Michael S Gee
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David J Grand
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - David Kastenberg
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Ashish Khandelwal
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Neil Sengupta
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Jorge A Soto
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
| | - Flavius F Guglielmo
- From the Department of Radiology, NYU Langone Health, 660 1st Ave, New York, NY 10016 (B.D.); Department of Radiology, Boston University Medical Center, Boston, Mass (A.G., J.A.S.); Department of Radiology (M.L.W., J.L.F., A.K.) and Division of Gastroenterology and Hepatology (D.H.B.), Mayo Clinic, Rochester, Minn; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.A.A., M.S.G.); Department of Radiology (H.V.N., F.F.G.) and Division of Gastroenterology (D.K.), Thomas Jefferson University, Philadelphia, Pa; Department of Radiology, Duke University Medical Center, Durham, NC (B.C.A.); Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (O.R.B.); Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI (D.J.G.); and Division of Gastroenterology, University of Chicago, Chicago, Ill (N.S.)
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19
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Dane B, Remzi FH, Grieco M, Ginocchio L, Erkan A, Esen E, Dogru V, Huang C. Preoperative cross-sectional imaging findings in patients with surgically complex ileocolic Crohn's disease. Abdom Radiol (NY) 2023; 48:486-493. [PMID: 36329208 DOI: 10.1007/s00261-022-03716-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/01/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE The aim of this study was to evaluate the diagnostic performance of preoperative cross-sectional imaging findings using the SAR-AGA definitions in Crohn's disease (CD) patients who underwent ileocolic resection (ICR) with and without surgically complex ileocolic CD (CIC-CD). METHODS 69 CD patients [38 men; mean (± SD) age: 40.6 (16.2) years] who underwent ICR were retrospectively classified by surgical complexity by a colorectal surgeon using operative findings. CIC-CD was defined as ileal CD, not confined to the distal ileum. Two radiologists retrospectively evaluated the preoperative imaging for the presence and type of penetrating disease, stricture, or probable stricture using the SAR-AGA consensus definitions. The diagnostic performance of preoperative imaging findings was compared for patients with and without CIC-CD. Estimated blood loss (EBL), operative time (OT), conversion to open surgery, diversion, and length of hospital stay (LOS) were compared. RESULTS 60.9% had CIC-CD and 79.7% underwent primary ICR. Penetrating disease was more common in patients with than without CIC-CD (76.2% vs. 40.7%, p = 0.0048) and similar among primary versus redo ICR (p = 0.12). Patients with CIC-CD had more complex fistulas (59.5% vs. 11.1%; p < 0.0001) and fewer simple fistulas (2.4% vs. 18.5%; p = 0.03) than those without. Mesenteric findings (abscess, inflammatory mass) were more frequent in patients with (35.7%) than without (0%) (p = 0.0002) CIC-CD. Stricture and probable stricture were similar (p = 0.59). CIC-CD patients had greater EBL (178 cc vs. 57 cc, p = 0.006), conversion rates (30% vs. 0%, p = 0.0026), and diversion (80% vs. 52%, p = 0.04). CONCLUSION Complex fistula, mesenteric abscess, or inflammatory mass defined by the SAR-AGA guidelines suggests CIC-CD. ICR for CIC-CD had greater EBL, conversion to open surgery, and diversion.
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Affiliation(s)
- Bari Dane
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA.
| | - Feza H Remzi
- NYU Langone Health Department of Surgery, 550 1st Avenue, New York, NY, 10016, USA
| | - Michael Grieco
- NYU Langone Health Department of Surgery, 550 1st Avenue, New York, NY, 10016, USA
| | - Luke Ginocchio
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Arman Erkan
- NYU Langone Health Department of Surgery, 550 1st Avenue, New York, NY, 10016, USA
| | - Eren Esen
- NYU Langone Health Department of Surgery, 550 1st Avenue, New York, NY, 10016, USA
| | - Volkan Dogru
- NYU Langone Health Department of Surgery, 550 1st Avenue, New York, NY, 10016, USA
| | - Chenchan Huang
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
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20
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Kambadakone AR, Santillan CS, Kim DH, Fowler KJ, Birkholz JH, Camacho MA, Cash BD, Dane B, Felker RA, Grossman EJ, Korngold EK, Liu PS, Marin D, McCrary M, Pietryga JA, Weinstein S, Zukotynski K, Carucci LR. ACR Appropriateness Criteria® Right Lower Quadrant Pain: 2022 Update. J Am Coll Radiol 2022; 19:S445-S461. [PMID: 36436969 DOI: 10.1016/j.jacr.2022.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
This document focuses on imaging in the adult and pregnant populations with right lower quadrant (RLQ) abdominal pain, including patients with fever and leukocytosis. Appendicitis remains the most common surgical pathology responsible for RLQ abdominal pain in the United States. Other causes of RLQ pain include right colonic diverticulitis, ureteral stone, and infectious enterocolitis. Appropriate imaging in the diagnosis of appendicitis has resulted in decreased negative appendectomy rate from as high as 25% to approximately 1% to 3%. Contrast-enhanced CT remains the primary and most appropriate imaging modality to evaluate this patient population. MRI is approaching CT in sensitivity and specificity as this technology becomes more widely available and utilization increases. Unenhanced MRI and ultrasound remain the diagnostic procedures of choice in the pregnant patient. MRI and ultrasound continue to perform best in the hands of the experts. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
- Avinash R Kambadakone
- Division Chief, Abdominal Imaging, Massachusetts General Hospital, Boston, Massachusetts; Medical Director, Martha's Vineyard Hospital Imaging.
| | - Cynthia S Santillan
- Vice Chair of Clinical Operations, University of California, San Diego, San Diego, California
| | - David H Kim
- Panel Chair; Vice Chair of Education, Department of Radiology, University of Wisconsin Hospital & Clinics, Madison, Wisconsin
| | - Kathryn J Fowler
- Panel Vice-Chair, University of California, San Diego, San Diego, California. ACR LI-RADS; Division Chief, SAR Portfolio Director; RSNA Radiology Senior DE
| | - James H Birkholz
- Divisional Director, Quality and Safety (Abdominal Imaging), Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania. Radiology Representative to the Interdisciplinary Dysmotility (GIMIG) Conference
| | - Marc A Camacho
- The University of South Florida Morsani College of Medicine, Tampa, Florida; Committee on Emergency Radiology-GSER
| | - Brooks D Cash
- Chief of Gastroenterology, Hepatology, and Nutrition Division, University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - Bari Dane
- Director of Body CT, Abdominal Imaging; Director of Quality and Safety Outpatient Imaging, NYU Grossman School of Medicine, New York, New York
| | - Robin A Felker
- Associate Clerkship Director for Internal Medicine, Georgetown University; Primary care physician, Medstar Georgetown University Hospital, Washington, District of Columbia
| | - Eric J Grossman
- Medical Director, Multi-Specialty Clinic, Santa Barbara Cottage Hospital, Santa Barbara, California; American College of Surgeons
| | - Elena K Korngold
- Section Chief, Body Imaging, Chair, Department of Radiology Promotion and Tenure Committee, Oregon Health and Science University, Portland, Oregon
| | - Peter S Liu
- Section Head, Abdominal Imaging, Cleveland Clinic, Cleveland, Ohio
| | - Daniele Marin
- Duke University Medical Center, Durham, North Carolina
| | - Marion McCrary
- Associate Director of Duke GME Coaching, Duke Signature Care, Durham, North Carolina; American College of Physicians; Governor-Elect, American College of Physicians North Carolina Chapter
| | | | | | - Katherine Zukotynski
- Co-Associate Chair for Research, Department of Radiology, McMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging
| | - Laura R Carucci
- Specialty Chair; Section Chief Abdominal Imaging, Director of MRI and CT, Virginia Commonwealth University Medical Center, Richmond, Virginia
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21
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Dane B, Qian K, Krieger R, Smereka P, Foster J, Huang C, Chang S, Kim S. Correlation between imaging findings on outpatient MR enterography (MRE) in adult patients with Crohn disease and progression to surgery within 5 years. Abdom Radiol (NY) 2022; 47:3424-3435. [PMID: 35916941 DOI: 10.1007/s00261-022-03624-z] [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] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/12/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To retrospectively evaluate which key imaging features described by SAR-AGA on outpatient surveillance MRE correlate with progression to surgery in adults with CD. METHODS 52 CD patients imaged with outpatient MRE from 10/2015 to 12/2016 and with available clinical information were included. Two abdominal radiologists reviewed the MRE for the presence of active inflammation, intramural edema, restricted diffusion, stricture, probable stricture, ulceration, sacculation, simple fistula, complex fistula, sinus tract, inflammatory mass, abscess, perienteric inflammation, engorged vasa recta, fibrofatty proliferation, and perianal disease. Bowel wall thickness, length of bowel involvement, and degree of upstream dilation in strictures were quantified. Subsequent bowel resection, prior bowel surgery, and available laboratory values were recorded. The association between progression to surgery and imaging features was evaluated using a logistic regression model adjusting for demographics, prior bowel surgery, medication usage, and body mass index. RESULTS 19.2% (10/52) of patients progressed to surgery. Restricted diffusion, greater degree of upstream dilation from stricture, complex fistula, perienteric inflammation, and fibrofatty proliferation were significantly more common in patients progressing to surgery (all p < 0.05). κ for these significant findings ranged 0.568-0.885. Patients progressing to surgery had longer length bowel involvement (p = 0.03). Platelet count, ESR, and fecal calprotectin were significantly higher, and serum albumin was significantly lower in patients progressing to surgery. Prior bowel surgery, sex, age, and all other parameters were similar. CONCLUSION Radiologists should carefully describe bowel dilation upstream from strictures, penetrating and perienteric findings on outpatient MRE in CD patients, as these findings may herald progression to surgery.
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Affiliation(s)
- Bari Dane
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA.
| | - Kun Qian
- NYU Langone Health Department of Biostatistics, 180 Madison Avenue, New York, NY, 10016, USA
| | - Rachel Krieger
- NYU Grossman School of Medicine, New York, NY, 10016, USA
| | - Paul Smereka
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Jonathan Foster
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Chenchan Huang
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
| | - Shannon Chang
- NYU Langone Health Department of Gastroenterology, 305 E 33rd Street, New York, NY, 10016, USA
| | - Sooah Kim
- NYU Langone Health Department of Radiology, 660 1st Avenue, New York, NY, 10016, USA
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22
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Bachour SP, Shah RS, Lyu R, Nakamura T, Shen M, Li T, Dane B, Barnes EL, Rieder F, Cohen B, Qazi T, Lashner B, Achkar JP, Philpott J, Holubar SD, Lightner AL, Regueiro M, Axelrad J, Baker ME, Click B. Test Characteristics of Cross-sectional Imaging and Concordance With Endoscopy in Postoperative Crohn's Disease. Clin Gastroenterol Hepatol 2022; 20:2327-2336.e4. [PMID: 34968729 PMCID: PMC9234099 DOI: 10.1016/j.cgh.2021.12.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/10/2021] [Accepted: 12/17/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Postoperative Crohn's disease (CD) surveillance relies on endoscopic monitoring. The role of cross-sectional imaging is less clear. We evaluated the concordance of cross-sectional enterography with endoscopic recurrence and the predictive ability of radiography for future CD postoperative recurrence. METHODS We performed a multi-institution retrospective cohort study of postoperative adult patients with CD who underwent ileocolonoscopy and cross-sectional enterography within 90 days of each other following ileocecal resection. Imaging studies were interpreted by blinded, expert CD radiologists. Patients were categorized by presence of endoscopic postoperative recurrence (E+) (modified Rutgeerts' score ≥i2b) or radiographic disease activity (R+) and grouped by concordance status. RESULTS A total of 216 patients with CD with paired ileocolonoscopy and imaging were included. A majority (54.2%) exhibited concordance (34.7% E+/R+; 19.4% E-/R-) between studies. The plurality (41.7%; n = 90) were E-/R+ discordant. Imaging was highly sensitive (89.3%), with low specificity (31.8%), in detecting endoscopic postoperative recurrence. Intestinal wall thickening, luminal narrowing, mural hyper-enhancement, and length of disease on imaging were associated with endoscopic recurrence (all P < .01). Radiographic disease severity was associated with increasing Rutgeerts' score (P < .001). E-/R+ patients experienced more rapid subsequent endoscopic recurrence (hazard ratio, 4.16; P = .033) and increased rates of subsequent endoscopic (43.8% vs 22.7%) and surgical recurrence (20% vs 9.5%) than E-/R- patients (median follow-up, 4.5 years). CONCLUSIONS Cross-sectional imaging is highly sensitive, but poorly specific, in detecting endoscopic disease activity and postoperative recurrence. Advanced radiographic disease correlates with endoscopic severity. Patients with radiographic activity in the absence of endoscopic recurrence may be at increased risk for future recurrence, and closer monitoring should be considered.
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Affiliation(s)
- Salam P Bachour
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio
| | - Ravi S Shah
- Cleveland Clinic Department of Internal Medicine, Cleveland, Ohio
| | - Ruishen Lyu
- Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio
| | - Takahiro Nakamura
- New York University Department of Internal Medicine, New York, New York
| | - Michael Shen
- New York University Department of Internal Medicine, New York, New York
| | - Terry Li
- New York University Department of Internal Medicine, New York, New York
| | - Bari Dane
- New York University Department of Radiology, New York, New York
| | - Edward L Barnes
- University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina
| | - Florian Rieder
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Benjamin Cohen
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Taha Qazi
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Bret Lashner
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Jean Paul Achkar
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Jessica Philpott
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Stefan D Holubar
- Cleveland Clinic Department of Colorectal Surgery, Cleveland, Ohio
| | - Amy L Lightner
- Cleveland Clinic Department of Colorectal Surgery, Cleveland, Ohio
| | - Miguel Regueiro
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio
| | - Jordan Axelrad
- New York University Department of Gastroenterology and Hepatology, New York, New York
| | - Mark E Baker
- Cleveland Clinic Imaging Institute, Cleveland, Ohio
| | - Benjamin Click
- Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio.
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23
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Dane B, Kernizan A, O'Donnell T, Petrocelli R, Rabbenou W, Bhattacharya S, Chang S, Megibow A. Crohn's disease active inflammation assessment with iodine density from dual-energy CT enterography: comparison with endoscopy and conventional interpretation. Abdom Radiol (NY) 2022; 47:3406-3413. [PMID: 35833999 DOI: 10.1007/s00261-022-03605-2] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To compare terminal ileum (TI) mucosal iodine density obtained at dual-energy CT enterography (DECTE) with conventional CT interpretation and endoscopy in patients with Crohn's disease (CD). MATERIALS AND METHODS Twenty-three CD patients (14 men; mean[SD] age:48.1[16.7] years) with endoscopy within 30 days of DECTE were retrospectively identified. An inflammatory bowel disease gastroenterologist reviewed endoscopic images. Two radiologists qualitatively assessed the presence of active TI inflammation. Mean iodine density normalized to the aorta (I%), mean absolute iodine density (I), and iodine density standard deviation (ISD) from the distal 2 cm ileum (TI) mucosa obtained using semiautomatic prototype software were compared with endoscopic assessment using Mann Whitney tests. The optimal threshold I% and I were determined from receiver operating curves (ROC). Sensitivity and specificity of conventional interpretation and determined iodine thresholds were compared using McNemar's test. Inter-reader agreement was assessed using kappa. A p < 0.05 indicated statistical significance. RESULTS Twelve (52.1%) patients had endoscopic active inflammation. I% was 37.9[13.3]% for patients with and 21.7[7.5]% for patients without endoscopic active inflammation (p = 0.001). The optimal ROC threshold 24.6% had 100% sensitivity and 81.8% specificity (AUC = 0.909, 95% CI 0.777-1). I was 2.44[0.73]mg/mL for patients with and 1.77[1.00]mg/mL for patients without active endoscopic inflammation (p = 0.0455). The optimal ROC threshold 1.78 mg/mL I had 91.7% sensitivity and 63.6% specificity (AUC = 0.75, 95% CI 0.532-0.968). ISD was similar for patients with and without endoscopic active inflammation (0.82[0.33]mg/mL and 0.77[0.28]mg/mL, respectively, p = 0.37). Conventional interpretation sensitivity and specificity (R1/R2) were 83.3%/91.7% and 72.7%/54.5%, respectively (all p > 0.05) with moderate inter-reader agreement (Κ = 0.542[95% CI 0.0202-0.088]). CONCLUSION Mean normalized iodine density is highly sensitive and specific for endoscopic active inflammation. DECTE could be considered as a surrogate to endoscopy in CD patients. Despite trends towards improved sensitivity and specificity compared with conventional interpretation, future larger studies are needed.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA. .,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.
| | - Amelia Kernizan
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Thomas O'Donnell
- Siemens Healthineers, 40 Liberty Blvd, Malvern, PA, 19355, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Robert Petrocelli
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
| | - Wendy Rabbenou
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Sumona Bhattacharya
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Shannon Chang
- Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA.,Overlook Medical Center, 33 Overlook Road, Suite 201, Summit, NJ, 07901, USA
| | - Alec Megibow
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.,Department of Gastroenterology, NYU Langone Health, 305 E 33rd Street, New York, NY, 10016, USA
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24
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Lee B, Dane B, Katz S. Current and Emerging Approaches to the Diagnosis and Treatment of Crohn's Disease Strictures. Gastroenterol Hepatol (N Y) 2022; 18:186-195. [PMID: 35505943 PMCID: PMC9053491] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The management and understanding of Crohn's disease (CD) continues to evolve quickly. Intestinal strictures were previously thought to be an inevitable result of irreversible fibrosis caused by chronic inflammation. However, increased understanding of the dynamic nature of strictures and of the pathophysiology of this condition has highlighted emerging targets for potential treatment. In the diagnosis of strictures, a distinction must be made between inflammatory and fibrotic types, as the former may respond to medical therapy. Emerging technologies, such as dual-energy computed tomography enterography and iodine density, have allowed more accurate characterization of strictures. Surgical and endoscopic treatment remains the mainstay for fibrotic strictures, but developments in systemic and intralesional biologic therapy have shown efficacy. This article reviews the pathophysiology of this debilitating complication of CD as well as current and emerging diagnostics and treatments.
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Affiliation(s)
- Briton Lee
- Department of Medicine, NYU Langone Medical Center, New York, New York
| | - Bari Dane
- Department of Radiology, NYU Langone Medical Center, New York, New York
| | - Seymour Katz
- Department of Gastroenterology, NYU Langone Medical Center, New York, New York
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25
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Chandarana H, Pisuchpen N, Krieger R, Dane B, Mikheev A, Feng Y, Kambadakone A, Rusinek H. Association of body composition parameters measured on CT with risk of hospitalization in patients with Covid-19. Eur J Radiol 2021; 145:110031. [PMID: 34801878 PMCID: PMC8592118 DOI: 10.1016/j.ejrad.2021.110031] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To assess prognostic value of body composition parameters measured at CT to predict risk of hospitalization in patients with COVID-19 infection. METHODS 177 patients with SARS-CoV-2 infection and with abdominopelvic CT were included in this retrospective IRB approved two-institution study. Patients were stratified based on disease severity as outpatients (no hospital admission) and patients who were hospitalized (inpatients). Two readers blinded to the clinical outcome segmented axial CT images at the L3 vertebral body level for visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), muscle adipose tissue (MAT), muscle mass (MM). VAT to total adipose tissue ratio (VAT/TAT), MAT/MM ratio, and muscle index (MI) at L3 were computed. These measures, along with detailed clinical risk factors, were compared in patients stratified by severity. Various logistic regression clinical and clinical + imaging models were compared to discriminate inpatients from outpatients. RESULTS There were 76 outpatients (43%) and 101 inpatients. Male gender (p = 0.013), age (p = 0.0003), hypertension (p = 0.0003), diabetes (p = 0.0001), history of cardiac disease (p = 0.007), VAT/TAT (p < 0.0001), and MAT/MM (p < 0.0001), but not BMI, were associated with hospitalization. A clinical model (age, gender, BMI) had AUC of 0.70. Addition of VAT/TAT to the clinical model improved the AUC to 0.73. Optimal model that included gender, BMI, race (Black), MI, VAT/TAT, as well as interaction between gender and VAT/TAT and gender and MAT/MM demonstrated the highest AUC of 0.83. CONCLUSION MAT/MM and VAT/TAT provides important prognostic information in predicting patients with COVID-19 who are likely to require hospitalization.
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Affiliation(s)
- Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States.
| | - Nisanard Pisuchpen
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Rachel Krieger
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Bari Dane
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Artem Mikheev
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
| | - Yang Feng
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, United States
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States
| | - Henry Rusinek
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, New York, NY, United States
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Chandarana H, Bagga B, Huang C, Dane B, Petrocelli R, Bruno M, Keerthivasan M, Grodzki D, Block KT, Stoffel D, Sodickson DK. Diagnostic abdominal MR imaging on a prototype low-field 0.55 T scanner operating at two different gradient strengths. Abdom Radiol (NY) 2021; 46:5772-5780. [PMID: 34415411 DOI: 10.1007/s00261-021-03234-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/27/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To develop a protocol for abdominal imaging on a prototype 0.55 T scanner and to benchmark the image quality against conventional 1.5 T exam. METHODS In this prospective IRB-approved HIPAA-compliant study, 10 healthy volunteers were recruited and imaged. A commercial MRI system was modified to operate at 0.55 T (LF) with two different gradient performance levels. Each subject underwent non-contrast abdominal examinations on the 0.55 T scanner utilizing higher gradients (LF-High), lower adjusted gradients (LF-Adjusted), and a conventional 1.5 T scanner. The following pulse sequences were optimized: fat-saturated T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and Dixon T1-weighted imaging (T1WI). Three readers independently evaluated image quality in a blinded fashion on a 5-point Likert scale, with a score of 1 being non-diagnostic and 5 being excellent. An exact paired sample Wilcoxon signed-rank test was used to compare the image quality. RESULTS Diagnostic image quality (overall image quality score ≥ 3) was achieved at LF in all subjects for T2WI, DWI, and T1WI with no more than one unit lower score than 1.5 T. The mean difference in overall image quality score was not significantly different between LF-High and LF-Adjusted for T2WI (95% CI - 0.44 to 0.44; p = 0.98), DWI (95% CI - 0.43 to 0.36; p = 0.92), and for T1 in- and out-of-phase imaging (95%C I - 0.36 to 0.27; p = 0.91) or T1 fat-sat (water only) images (95% CI - 0.24 to 0.18; p = 1.0). CONCLUSION Diagnostic abdominal MRI can be performed on a prototype 0.55 T scanner, either with conventional or with reduced gradient performance, within an acquisition time of 10 min or less.
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Affiliation(s)
- Hersh Chandarana
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA.
| | - Barun Bagga
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - Chenchan Huang
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - Bari Dane
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - Robert Petrocelli
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - Mary Bruno
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | | | | | - Kai Tobias Block
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - David Stoffel
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - Daniel K Sodickson
- Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI2R), New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
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Smereka P, Anthopolos R, Latson LA, Kirsch P, Dane B. Using Lung Base Covid-19 Findings to Predict Future Disease Trends and New Variant Outbreaks: Study of First New York City (NYC) Outbreak. Acad Radiol 2021; 28:1645-1653. [PMID: 34740527 PMCID: PMC8484077 DOI: 10.1016/j.acra.2021.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES Asymptomatic COVID-19 carriers and insufficient testing make containment of the virus difficult. The purpose of this study was to determine if unexpected lung base findings on abdominopelvic CTs concerning for COVID-19 infection could serve as a surrogate for the diagnosis of COVID-19 in the community. MATERIALS AND METHODS A database search of abdominopelvic CT reports from March 1,2020 to May 2,2020 was performed for keywords suggesting COVID-19 infection by lung base findings. COVID-19 status, respiratory symptoms, laboratory parameters and patient outcomes (hospitalization, ICU admission and/or intubation, and death) were recorded. The trend in cases of unexpected concerning lung base findings on abdominopelvic CT at our institution was compared to the total number of confirmed new cases in NYC over the same time period. RESULTS The trend in abnormal lung base findings on abdominopelvic CT at our institution correlated with the citywide number of confirmed new cases, including rise and subsequent fall in total cases. The trend was not mediated by COVID-19 testing status or number of tests performed. Patients with respiratory symptoms had significantly higher ferritin (median = 995ng/ml vs 500ng/ml, p = 0.027) and death rate (8/24, 33% vs 4/54, 9%, p = 0.018) compared to those without. CONCLUSION The rise and fall of unexpected lung base findings suggestive of COVID-19 infection on abdominopelvic CT in patients without COVID-19 symptoms correlated with the number of confirmed new cases throughout NYC from the same time period. A model using abdominopelvic CT lung base findings can serve as a surrogate for future COVID-19 outbreaks.
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Affiliation(s)
- Paul Smereka
- Department of Radiology (P.S., R.A., L.L., P.K., B.D.), NYU Langone Health, 660 1(st) Avenue, New York, NY 10016.
| | - Rebecca Anthopolos
- Department of Radiology (P.S., R.A., L.L., P.K., B.D.), NYU Langone Health, 660 1(st) Avenue, New York, NY 10016
| | - Larry A Latson
- Department of Radiology (P.S., R.A., L.L., P.K., B.D.), NYU Langone Health, 660 1(st) Avenue, New York, NY 10016
| | - Polly Kirsch
- Department of Radiology (P.S., R.A., L.L., P.K., B.D.), NYU Langone Health, 660 1(st) Avenue, New York, NY 10016
| | - Bari Dane
- Department of Radiology (P.S., R.A., L.L., P.K., B.D.), NYU Langone Health, 660 1(st) Avenue, New York, NY 10016
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Dane B, Qian K, Gauvin S, Ji H, Karajgikar J, Kim N, Chang S, Chandarana H, Kim S. Inter-reader agreement of the Society of Abdominal Radiology-American Gastroenterological Association (SAR-AGA) consensus reporting for key phenotypes at MR enterography in adults with Crohn disease: impact of radiologist experience. Abdom Radiol (NY) 2021; 46:5095-5104. [PMID: 34324038 DOI: 10.1007/s00261-021-03229-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To assess inter-reader agreement of key features from the SAR-AGA recommendations for the interpretation and reporting of MRE in adult patients with CD, focusing on the impact of radiologist experience on inter-reader agreement of CD phenotypes. METHODS Two experienced and two less-experienced radiologists retrospectively evaluated 99 MRE in CD patients (50 initial MRE, 49 follow-up MRE) performed from 1/1/2019 to 3/20/2020 for the presence of active bowel inflammation (stomach, proximal small bowel, ileum, colon), stricture, probable stricture, penetrating disease, and perianal disease. The MRE protocol did not include dedicated perianal sequences. Inter-rater agreement was determined for each imaging feature using prevalence-adjusted bias-adjusted kappa and compared by experience level. RESULTS All readers had almost-perfect inter-reader agreement (κ > 0.90) for penetrating disease, abscess, and perianal abscess in all 99 CD patients. All readers had strong inter-reader agreement (κ: 0.80-0.90) in 99 CD patients for active ileum inflammation, proximal small bowel inflammation, and stricture. Less-experienced readers had significantly lower inter-reader agreement for active ileum inflammation on initial than follow-up MRE (κ 0.68 versus 0.96, p = 0.018) and for strictures on follow-up than initial MRE (κ 0.76 versus 1.0, p = 0.027). Experienced readers had significantly lower agreement for perianal fistula on follow-up than initial MRE (κ: 0.55 versus 0.92, p = 0.008). CONCLUSION There was strong to almost-perfect inter-reader agreement for key CD phenotypes described in the SAR-AGA consensus recommendations including active ileum and proximal small bowel inflammation, stricture, penetrating disease, abscess, and perianal abscess. Areas of lower inter-reader agreement could be targeted for future education efforts to further standardize CD MRE reporting. Dedicated perianal sequences should be included on follow-up MRE.
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Dane B, Hindman N. Feasibility of Abdominal Magnetic Resonance Imaging in Patients With Residual Concentrated Enteric Contrast After Fluoroscopic Abdominal Examination. J Comput Assist Tomogr 2021; 45:678-683. [PMID: 34546677 DOI: 10.1097/rct.0000000000001233] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to evaluate the image quality, image artifacts, radiologist confidence, and ability to provide definitive diagnosis for all patients with magnetic resonance imaging (MRI) performed after an abdominal fluoroscopic examination and to determine the utility of MRI in this setting. METHODS Thirty-one MRI examinations performed a median of 2 days after fluoroscopic bowel evaluation (barium, n = 13; iodine, n = 18), 20 within 3 days of MRI, were retrospectively reviewed. The image quality, artifact emanating from bowel, inhomogeneity artifact, radiologist confidence, ability to render a definitive diagnosis, and identification of emergent or important findings for all MRI examinations were assessed. These same features were evaluated on 5 computed tomographies performed after fluoroscopy (before the MRI) in the same cohort. RESULTS All 31 MRI examinations performed after fluoroscopic studies with concentrated barium or iodine solutions were diagnostic for answering the clinical question according to radiologist and report review, regardless of magnet strength and type of fluoroscopic contrast ingested. Magnetic resonance imaging after fluoroscopy had excellent overall image quality (mean score, 4.74/5), minimal to no artifact emanating from bowel (mean, 4.63/5), minimal inhomogeneity artifact (mean, 4.38/5), and excellent diagnostic confidence (mean, 4.98/5). No additional imaging was necessary for diagnosis after MRI. Computed tomography after fluoroscopy had lower overall image quality, more image artifacts, and lower diagnostic confidence (P < 0.05). CONCLUSIONS Magnetic resonance imaging is a useful tool for evaluating patients with retained concentrated enteric contrast from recent fluoroscopic examinations. In the absence of contraindication, MRI should be considered in the evaluation of urgent clinical problems in patients who recently underwent a fluoroscopic bowel evaluation.
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Affiliation(s)
- Bari Dane
- From the Department of Radiology, NYU Langone Medical Center, New York, NY
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Dane B, Sarkar S, Nazarian M, Galitzer H, O'Donnell T, Remzi F, Chang S, Megibow A. Crohn Disease Active Inflammation Assessment with Iodine Density from Dual-Energy CT Enterography: Comparison with Histopathologic Analysis. Radiology 2021; 301:144-151. [PMID: 34342502 DOI: 10.1148/radiol.2021204405] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Dual-energy CT enterography (DECTE) has been shown to be useful in characterizing Crohn disease activity compared with clinical markers of inflammation but, to the knowledge of the authors, comparison has not been made with histopathologic specimens. Purpose To compare mucosal iodine density obtained at DECTE from Crohn disease-affected bowel with histopathologic specimens from surgically resected ileocolectomy bowel segments or terminal ileum colonoscopic biopsies in the same patients. Materials and Methods This was a retrospective study. Bowel segments in adults with Crohn disease who underwent DECTE from January 2017 to April 2019 within 90 days of ileocolectomy or colonoscopy were retrospectively evaluated with prototype software allowing the semiautomatic determination of inner hyperdense bowel wall (mucosal) mean iodine density, normalized to the aorta. Mean normalized iodine density and clinical activity indexes (Crohn Disease Activity Index [CDAI] and Harvey-Bradshaw Index [HBI]) were compared with histologic active inflammation grades by using two-tailed t tests. Receiver operating characteristic curves were generated for mean normalized iodine density, CDAI, and HBI to determine sensitivity, specificity, and accuracy. A P value less than .05 was considered to indicate statistical significance. Results The following 16 patients were evaluated (mean age, 41 years ± 14 [standard deviation]): 10 patients (five men, five women; mean age, 41 years ± 15) with 19 surgical resection specimens and six patients with terminal ileum colonoscopic mucosal biopsies (four men, two women; mean age, 43 years ± 14). Mean normalized iodine density was 16.5% ± 5.7 for bowel segments with no active inflammation (n = 8) and 34.7% ± 9.7 for segments with any active inflammation (n = 17; P < .001). A 20% mean normalized iodine density threshold had sensitivity, specificity, and accuracy of 17 of 17 (100%; 95% CI: 80.5, 100), six of eight (75%; 95% CI: 35, 97), and 23 of 25 (92%; 95% CI: 74, 99), respectively, for active inflammation. Clinical indexes were similar for patients with and without active inflammation at histopathologic analysis (CDAI score, 261 vs 251, respectively [P = .77]; HBI score, 7.8 vs 6.4, respectively [P = .36]). Conclusion Iodine density from dual-energy CT enterography may be used as a radiologic marker of Crohn disease activity as correlated with histopathologic analysis. © RSNA, 2021 See also the editorial by Ohliger in this issue.
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Affiliation(s)
- Bari Dane
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Suparna Sarkar
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Matthew Nazarian
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Hayley Galitzer
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Thomas O'Donnell
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Feza Remzi
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Shannon Chang
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
| | - Alec Megibow
- From the Departments of Radiology (B.D., M.N., A.M.), Pathology (S.S.), Surgery (F.R.), and Gastroenterology (S.C.), NYU Langone Health, 660 1st Ave, New York, NY 10016; Department of Internal Medicine, NYU Grossman School of Medicine, New York, NY 10016 (H.G.); and Siemens Healthineers, Malvern, Pa (T.O.)
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Dane B, Bearison C, Kim S. Frequency and significance of incidental liver lesions on MR enterography in adult patients. Clin Imaging 2021; 80:6-10. [PMID: 34217035 DOI: 10.1016/j.clinimag.2021.06.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the frequency and significance of incidental liver lesions identified on MR enterography (MRE) examinations to determine if dedicated sequences for liver evaluation are necessary in the routine MRE protocol. METHODS A retrospective departmental database search identified 353 adult (212 women and 141 men; mean [±SD] age, 41.4 [17.0] years; range 18.1-91.9 years) MRE examinations performed in 2017. Radiology reports were reviewed for the presence and characterization of liver lesions, follow-up recommendation, and known malignancy. Follow-up cross-sectional imaging reports were reviewed for liver lesion stability. A senior abdominal radiologist with expertise in liver imaging categorized liver lesions as benign, indeterminate, or malignant and re-characterized indeterminate lesions using follow-up imaging as benign or malignant. RESULTS Seventy-nine MRE (22.4%) described liver lesions and follow-up imaging was recommended in 4/79 (5.1%). Seventy-six liver lesions (96.2%) were characterized as benign (cysts/hemangiomas) on routine interpretation and expert review. One of these was recommended for follow-up imaging on initial report, which was characterized as hemangioma by expert review. The remaining 3 lesions (3.8%) were characterized as indeterminate both by initial report and expert radiologist review but re-characterized as benign after reviewing follow-up examinations. CONCLUSION All incidental liver lesions identified on MRE in our cohort were benign. Therefore, additional sequences evaluating the liver are unnecessary for routine MRE.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Medical Center, New York, NY 10016, United States of America.
| | - Craig Bearison
- Department of Radiology, NYU Langone Medical Center, New York, NY 10016, United States of America.
| | - Sooah Kim
- Department of Radiology, NYU Langone Medical Center, New York, NY 10016, United States of America.
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Affiliation(s)
- Juliet June Ray
- Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA.
| | | | - Bari Dane
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Feza Remzi
- Division of Colon and Rectal Surgery, NYU Langone Health, New York, NY, USA
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Chandarana H, Dane B, Mikheev A, Taffel MT, Feng Y, Rusinek H. Visceral adipose tissue in patients with COVID-19: risk stratification for severity. Abdom Radiol (NY) 2021; 46:818-825. [PMID: 32748252 PMCID: PMC7398639 DOI: 10.1007/s00261-020-02693-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/23/2020] [Accepted: 07/25/2020] [Indexed: 01/22/2023]
Abstract
Purpose To assess visceral (VAT), subcutaneous (SAT), and total adipose tissue (TAT) estimates at abdominopelvic CT in COVID-19 patients with different severity, and analyze Body Mass Index (BMI) and CT estimates of fat content in patients requiring hospitalization. Methods In this retrospective IRB approved HIPPA compliant study, 51 patients with SARS-CoV-2 infection with abdominopelvic CT were included. Patients were stratified based on disease severity as outpatient (no hospital admission) and patients who were hospitalized. Subset of hospitalized patient required mechanical ventilation (MV). A radiologist blinded to the clinical outcome evaluated single axial slice on CT at L3 vertebral body for VATL3, SATL3, TATL3, and VAT/TATL3. These measures along with age, gender, and BMI were compared. A clinical model that included age, sex, and BMI was compared to clinical + CT model that also included VATL3 to discriminate hospitalized patients from outpatients. Results There were ten outpatients and 41 hospitalized patients. 11 hospitalized patients required MV. There were no significant differences in age and BMI between the hospitalized and outpatients (all p > 0.05). There was significantly higher VATL3 and VAT/TATL3 in hospitalized patients compared to the outpatients (all p < 0.05). Area under the curve (AUC) of the clinical + CT model was higher compared to the clinical model (AUC 0.847 versus 0.750) for identifying patients requiring hospitalization. Conclusion Higher VATL3 was observed in COVID-19 patients that required hospitalization compared to the outpatients, and addition of VATL3 to the clinical model improved AUC in discriminating hospitalized from outpatients in this preliminary study.
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Affiliation(s)
- Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA.
| | - Bari Dane
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - Artem Mikheev
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - Myles T Taffel
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
| | - Yang Feng
- Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA
| | - Henry Rusinek
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, New York, NY, 10016, USA
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Dane B, O'Donnell T, Liu S, Vega E, Mohammed S, Singh V, Kapoor A, Megibow A. Radiation dose reduction, improved isocenter accuracy and CT scan time savings with automatic patient positioning by a 3D camera. Eur J Radiol 2021; 136:109537. [PMID: 33454459 DOI: 10.1016/j.ejrad.2021.109537] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 09/03/2020] [Revised: 12/25/2020] [Accepted: 01/08/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare CT isocenter accuracy, patient dose, and scan time in adults imaged with and without use of a 3D camera. METHOD 571 CT examinations utilizing a 3D camera for initial patient positioning (optional radiographer isocenter adjustment) and 504 examinations scanned without the camera between 10/1/2018 and 3/19/2019 were retrospectively identified. All exams were chest or abdominopelvic CTs. The isocenters of these exams were compared with the true isocenters defined as the manually delineated centroid of the body in the CT volume. The size specific dose estimate (SSDE) (mGy) of radiation dose obtained from departmental software for the 4 most common protocols on one CT scanner was compared before and after implementation of the 3D camera. The times required for the entire scan and just the topogram "scout" were compared with and without the 3D camera for noncontrast chest and abdominopelvic CT enterography protocols. 2-tailed t-tests and Mann-Whitney U tests were used (P < 0.05 indicated statistical significance). RESULTS The deviation from true isocenter was 6.8 ± 6.1 mm (P = 0.043) and 16.3 ± 14.0 mm (P < 0.01) with and without the 3D camera, respectively (P < 0.01). CT radiographers accepted isocenter location without alteration in 93 % of examinations. Average SSDE savings with the 3D camera ranged 1.0-2.4 mGy (21-31 %) for the 4 most commonly performed protocols (p < 0.01). Median scout time savings was 32 s (Camera vs. No-Camera cohorts) (P < 0.01). Average noncontrast chest CT and CT enterography scan time savings were 19 s and 17 s with the 3D camera, respectively (P < 0.01). CONCLUSIONS The 3D camera improved accuracy of patient positioning while reducing radiation dose and examination time. Implementation of a 3D camera helps standardize workflow in a busy clinical practice.
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Affiliation(s)
- Bari Dane
- NYU Langone Health, Department of Radiology, New York, NY, 10016, United States.
| | - Thomas O'Donnell
- Siemens Healthineers, 40 Liberty Blvd, Malvern, PA, 19355, United States.
| | - Shu Liu
- NYU Langone Health, Department of Radiology, New York, NY, 10016, United States.
| | - Emilio Vega
- NYU Langone Health, Department of Radiology, New York, NY, 10016, United States.
| | - Sharon Mohammed
- NYU Langone Health, Department of Radiology, New York, NY, 10016, United States.
| | - Vivek Singh
- Siemens Healthineers, 40 Liberty Blvd, Malvern, PA, 19355, United States.
| | - Ankur Kapoor
- Siemens Healthineers, 40 Liberty Blvd, Malvern, PA, 19355, United States.
| | - Alec Megibow
- NYU Langone Health, Department of Radiology, New York, NY, 10016, United States.
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Dane B, Shanbhogue K, Menias CO, Taffel MT. The humbling hemangioma: uncommon CT and MRI imaging features and mimickers of hepatic hemangiomas. Clin Imaging 2021; 74:55-63. [PMID: 33434867 DOI: 10.1016/j.clinimag.2020.12.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 08/27/2020] [Revised: 11/12/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
Cavernous hemangiomas are among the most common liver lesions encountered in abdominal imaging. While classical imaging characteristics usually aid the radiologist in confidently arriving at its diagnosis, atypical hemangiomas can prove to be difficult to distinguish from other more worrisome hepatic lesions such as metastases and hepatocellular carcinoma. Furthermore, some malignant lesions can display features that simulate hemangiomas. The radiologist must be aware of these pitfalls to make an accurate diagnosis, when possible.
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Affiliation(s)
- Bari Dane
- NYU Langone Health, Department of Radiology, United States of America.
| | | | - Christine O Menias
- Mayo Clinic, Department of Radiology, Scottsdale, AZ, United States of America
| | - Myles T Taffel
- NYU Langone Health, Department of Radiology, United States of America
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King MJ, Tong A, Dane B, Huang C, Zhan C, Shanbhogue K. Response assessment of hepatocellular carcinoma treated with yttrium-90 radioembolization: inter-reader variability, comparison with 3D quantitative approach, and role in the prediction of clinical outcomes. Eur J Radiol 2020; 133:109351. [DOI: 10.1016/j.ejrad.2020.109351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/05/2020] [Accepted: 10/11/2020] [Indexed: 12/26/2022]
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Recht MP, Fefferman NR, Bittman ME, Dane B, Fritz J, Hoffmann JC, Hood J, Mercado CL, Mahajan S, Sheth MM. Preserving Radiology Resident Education During the COVID-19 Pandemic: The Simulated Daily Readout. Acad Radiol 2020; 27:1154-1161. [PMID: 32553278 PMCID: PMC7833746 DOI: 10.1016/j.acra.2020.05.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/21/2020] [Accepted: 05/29/2020] [Indexed: 11/06/2022]
Abstract
RATIONALE AND OBJECTIVES The educational value of the daily resident readout, a vital component of resident training, has been markedly diminished due to a significant decrease in imaging volume and case mix diversity. The goal of this study was to create a "simulated" daily readout (SDR) to restore the educational value of the daily readout. MATERIALS AND METHODS To create the SDR the following tasks were performed; selection of cases for a daily worklist for each resident rotation, comprising a combination of normal and abnormal cases; determination of the correct number of cases and the appropriate mix of imaging modalities for each worklist; development of an "educational" environment consisting of separate "instances" of both our Picture Archive Communication System and reporting systems; and the anonymization of all of the cases on the worklists. Surveys of both residents and faculty involved in the SDR were performed to assess its effectiveness. RESULTS Thirty-two residents participated in the SDR. The daily worklists for the first 20 days of the SDR included 3682 cases. An average of 480 cases per day was dictated by the residents. Surveys of the residents and the faculty involved in the SDR demonstrated that both agreed that the SDR effectively mimics a resident's daily work on rotations and preserves resident education during the Coronavirus Disease 2019 crisis. CONCLUSION The development of the SDR provided an effective method of preserving the educational value of the daily readout experience of radiology residents, despite severe decreases in imaging exam volume and case mix diversity during the Coronavirus Disease 2019 pandemic.
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Affiliation(s)
- Michael P Recht
- Department of Radiology, New York University Grossman School of Medicine, New York, New York.
| | - Nancy R Fefferman
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Mark E Bittman
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Bari Dane
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Jan Fritz
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Jason C Hoffmann
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Joseph Hood
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Cecilia L Mercado
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Sonia Mahajan
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
| | - Monica M Sheth
- Department of Radiology, New York University Grossman School of Medicine, New York, New York
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Chitiboi T, Muckley M, Dane B, Huang C, Feng L, Chandarana H. Pancreas deformation in the presence of tumors using feature tracking from free-breathing XD-GRASP MRI. J Magn Reson Imaging 2019; 50:1633-1640. [PMID: 30854767 DOI: 10.1002/jmri.26714] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 06/11/2018] [Revised: 02/24/2019] [Accepted: 02/25/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Quantifying the biomechanical properties of pancreatic tumors could potentially help with assessment of tumor aggressiveness, prognosis, and prediction of therapy response. PURPOSE To quantify respiratory-induced deformation in the pancreas and pancreatic lesions using XD-GRASP (eXtra-Dimensional Golden-angle RAdial Sparse Parallel), MRI. STUDY TYPE Retrospective study where patients undergoing clinically indicated abdominal MRI which included free-breathing radial T1 -weighted (T1 W) imaging were studied. SUBJECTS Thirty-two patients (12 male and 20 female) including nine with pancreatic lesions constituted our study cohort. FIELD STRENGTH/SEQUENCE 3.0 T with T1 WI contrast-enhanced gradient echo radial free-breathing acquisition. ASSESSMENT Using the XD-GRASP imaging technique, the acquired free-breathing radial data were sorted and binned into 10 consecutive respiratory motion states that were jointly reconstructed. 3D deformation fields along the respiratory dimension were computed using an optical flow method and were analyzed in the pancreas. STATISTICAL TESTS The Wilcoxon signed-rank test was used to assess the difference in average displacement across pancreatic regions, while the Wilcoxon rank-sum test was used for displacement differences between patients with and without tumors. The interclass correlation coefficient (ICC) was computed to assess consistency between observers for each image quality measure. RESULTS There was a significantly larger displacement in the pancreatic tail compared with the head (8.2 ± 3.7 mm > 5.8 ± 2.4 mm; P < 0.001) and body regions (8.2 ± 3.7 mm > 6.6 ± 2.9 mm; P < 0.001). Furthermore, there was reduced normalized average displacement in patients with pancreatic lesions compared with subjects without lesions (0.33 ± 0.1 < 0.69 ± 0.26, P < 0.001 for the head; 0.30 ± 0.1 < 0.84 ± 0.31, P < 0.001 for the body; and 0.44 ± 0.31 < 1.08 ± 0.53, P < 0.001 for the tail, respectively). DATA CONCLUSION Free-breathing respiratory motion-sorted XD-GRASP MRI has the potential to noninvasively characterize the biomechanical properties of the pancreas by quantifying breathing-induced mechanical displacement. LEVEL OF EVIDENCE 4 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:1633-1640.
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Affiliation(s)
- Teodora Chitiboi
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.,Siemens Healthineers, Princeton, New Jersey, USA
| | - Matthew Muckley
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Bari Dane
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Chenchan Huang
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Li Feng
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hersh Chandarana
- Center for Advanced Imaging Innovation and Research (CAI2R), and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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Dane B, Rosenkrantz AB. Exploring CMS Quality Measure #405 for Small Incidental Abdominal Lesions. J Am Coll Radiol 2018; 15:1243-1245. [DOI: 10.1016/j.jacr.2018.05.012] [Citation(s) in RCA: 1] [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: 05/01/2018] [Accepted: 05/04/2018] [Indexed: 12/21/2022]
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Dane B, Patel H, O'Donnell T, Girvin F, Brusca-Augello G, Alpert JB, Niu B, Attia M, Babb J, Ko JP. Image Quality on Dual-energy CTPA Virtual Monoenergetic Images: Quantitative and Qualitative Assessment. Acad Radiol 2018; 25:1075-1086. [PMID: 29398436 DOI: 10.1016/j.acra.2017.12.012] [Citation(s) in RCA: 16] [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: 09/01/2017] [Revised: 12/08/2017] [Accepted: 12/17/2017] [Indexed: 01/14/2023]
Abstract
RATIONALE AND OBJECTIVES This study aims to determine the optimal photon energy for image quality of the pulmonary arteries (PAs) on dual-energy computed tomography (CT) pulmonary angiography (CTPA) utilizing low volumes of iodinated contrast. MATERIALS AND METHODS The study received institutional review board exemption and was Health Insurance Portability and Accountability Act compliant. Adults (n = 56) who underwent dual-energy CTPA with 50-60 cc of iodinated contrast on a third-generation dual-source multidetector CT were retrospectively and consecutively identified. Twelve virtual monoenergetic kiloelectron volt (keV) image data sets (40-150 keV, 10-keV increments) were generated with a second-generation noise-reducing algorithm. Standard regions of interest were placed on main, right, left, and right interlobar pulmonary arteries; pectoralis muscle; and extrathoracic air. Attenuation [mean CT number (Hounsfield unit, HU)], noise [standard deviation (HU)], signal to noise (SNR), and contrast to noise ratio were evaluated. Three blinded chest radiologists rated (from 1 to 5, with 5 being the best) randomized monoenergetic and weighted-average images for attenuation and noise. P <.05 was considered significant. RESULTS Region of interest mean CT number increased as keV decreased, with 40 keV having the highest value (P < .001). Mean SNR was highest for 40-60 keV (P <.05) (14.5-14.7) and was higher (P <.05) than all remaining energies (90-150 keV) for all vessel regions combined. Contrast to noise ratio was highest for 40 keV (P <.001) and decreased as keV increased. SNR was highest at 60 and 70 keV, only slightly higher than 40-50 keV (P <.05). Reader scores for 40-50 keV were greater than other energies and weighted-average images (P <.05). CONCLUSIONS Kiloelectron volt images of 40-50 keV from the second-generation algorithm optimize attenuation on dual-energy CTPA and can potentially aid in interpretation and avoiding nondiagnostic examinations.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016.
| | - Hersh Patel
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - Francis Girvin
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - Jeffrey B Alpert
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | - Bowen Niu
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | | | - James Babb
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
| | - Jane P Ko
- Department of Radiology, NYU Langone Health, 660 First Avenue, New York, NY 10016
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Dane B, Doshi A, Gfytopoulos S, Bhattacharji P, Recht M, Moore W. Automated Radiology-Pathology Module Correlation Using a Novel Report Matching Algorithm by Organ System. Acad Radiol 2018; 25:673-680. [PMID: 29373209 DOI: 10.1016/j.acra.2017.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/01/2017] [Revised: 11/03/2017] [Accepted: 11/06/2017] [Indexed: 12/18/2022]
Abstract
OBJECTIVES AND RATIONALE Radiology-pathology correlation is time-consuming and is not feasible in most clinical settings, with the notable exception of breast imaging. The purpose of this study was to determine if an automated radiology-pathology report pairing system could accurately match radiology and pathology reports, thus creating a feedback loop allowing for more frequent and timely radiology-pathology correlation. METHODS An experienced radiologist created a matching matrix of radiology and pathology reports. These matching rules were then exported to a novel comprehensive radiology-pathology module. All distinct radiology-pathology pairings at our institution from January 1, 2016 to July 1, 2016 were included (n = 8999). The appropriateness of each radiology-pathology report pairing was scored as either "correlative" or "non-correlative." Pathology reports relating to anatomy imaged in the specific imaging study were deemed correlative, whereas pathology reports describing anatomy not imaged with the particular study were denoted non-correlative. RESULTS Overall, there was 88.3% correlation (accuracy) of the radiology and pathology reports (n = 8999). Subset analysis demonstrated that computed tomography (CT) abdomen/pelvis, CT head/neck/face, CT chest, musculoskeletal CT (excluding spine), mammography, magnetic resonance imaging (MRI) abdomen/pelvis, MRI brain, musculoskeletal MRI (excluding spine), breast MRI, positron emission tomography (PET), breast ultrasound, and head/neck ultrasound all demonstrated greater than 91% correlation. When further stratified by imaging modality, CT, MRI, mammography, and PET demonstrated excellent correlation (greater than 96.3%). Ultrasound and non-PET nuclear medicine studies demonstrated poorer correlation (80%). CONCLUSION There is excellent correlation of radiology imaging reports and appropriate pathology reports when matched by organ system. Rapid, appropriate radiology-pathology report pairings provide an excellent opportunity to close feedback loop to the interpreting radiologist.
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Affiliation(s)
- Bari Dane
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016
| | - Ankur Doshi
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016
| | - Soterios Gfytopoulos
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016
| | - Priya Bhattacharji
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016
| | - Michael Recht
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016
| | - William Moore
- Department of Radiology, New York University Langone Medical Center, 660 First Avenue, New York, NY 10016.
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Esses SJ, Lu X, Zhao T, Shanbhogue K, Dane B, Bruno M, Chandarana H. Automated image quality evaluation of T 2 -weighted liver MRI utilizing deep learning architecture. J Magn Reson Imaging 2017; 47:723-728. [PMID: 28577329 DOI: 10.1002/jmri.25779] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [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: 03/09/2017] [Accepted: 05/15/2017] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To develop and test a deep learning approach named Convolutional Neural Network (CNN) for automated screening of T2 -weighted (T2 WI) liver acquisitions for nondiagnostic images, and compare this automated approach to evaluation by two radiologists. MATERIALS AND METHODS We evaluated 522 liver magnetic resonance imaging (MRI) exams performed at 1.5T and 3T at our institution between November 2014 and May 2016 for CNN training and validation. The CNN consisted of an input layer, convolutional layer, fully connected layer, and output layer. 351 T2 WI were anonymized for training. Each case was annotated with a label of being diagnostic or nondiagnostic for detecting lesions and assessing liver morphology. Another independently collected 171 cases were sequestered for a blind test. These 171 T2 WI were assessed independently by two radiologists and annotated as being diagnostic or nondiagnostic. These 171 T2 WI were presented to the CNN algorithm and image quality (IQ) output of the algorithm was compared to that of two radiologists. RESULTS There was concordance in IQ label between Reader 1 and CNN in 79% of cases and between Reader 2 and CNN in 73%. The sensitivity and the specificity of the CNN algorithm in identifying nondiagnostic IQ was 67% and 81% with respect to Reader 1 and 47% and 80% with respect to Reader 2. The negative predictive value of the algorithm for identifying nondiagnostic IQ was 94% and 86% (relative to Readers 1 and 2). CONCLUSION We demonstrate a CNN algorithm that yields a high negative predictive value when screening for nondiagnostic T2 WI of the liver. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:723-728.
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Affiliation(s)
- Steven J Esses
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | | | - Tiejun Zhao
- Siemens Healthineers, New York, New York, USA
| | - Krishna Shanbhogue
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Bari Dane
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Mary Bruno
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
| | - Hersh Chandarana
- Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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Batmaz G, Kιlιç E, Özcan P, Sarιoğlu EA, Karaca N, Dane B. The role of oxidative stress in premalignant lesions. EUR J GYNAECOL ONCOL 2017; 38:282-285. [PMID: 29953796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF INVESTIGATION The authors aimed to evaluate serum total oxidant status (TOS), total antioxidant status (TAS), and oxida- tive stress index (OSI) in women with abnormal cervical cytology, to determine the association between serum oxidant and antioxidant status of these women, and the progression of abnormal cervical cytology. MATERIALS AND METHODS A total of 75 women enrolled in the study: 20 women with a determination of atypical squamous cells of undetermined significance (ASCUS), 20 women with low squamous intraepithelial lesions (LSIL), 15 women with high squamous intraepithelial lesions (HSIL) and 20 healthy controls. Serum TOS and TAS were determined and OSI was calculated as the indicator of degree of oxidative stress. RESULTS Serum TOS levels and OSI were highest in the HSIL group and there was a trend toward increasing serum TOS levels and OSI from ASCUS to HSIL group. CONCLUSION The authors demonstrated that increased oxidative stress with altered antioxidant level is associated with abnormal cervical cytology. Serum oxidant and antioxidant status may provide guidance as a simple and cost-effective method for follow-up, treatment, and recommendation in all stages of lesions.
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Abstract
Contrast-enhanced multidetector computed tomography (MDCT) has become a critical tool in the evaluation of the trauma patient. MDCT can quickly and accurately assess trauma patients for renal, ureteral, and bladder injuries. Moreover, CT guides clinical management triaging patients to those requiring discharge, observation, angioembolization, and surgery. Recognition of urinary tract trauma on initial scan acquisition should prompt delayed excretory phase imaging to identify urine leaks. Urethral and testicular trauma are imaged with retrograde urethrography and sonography, respectively.
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Affiliation(s)
- Bari Dane
- Division of Trauma and Emergency Imaging, Department of Radiology, Bellevue Hospital/NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA
| | - Alexander B Baxter
- Division of Trauma and Emergency Imaging, Department of Radiology, Bellevue Hospital/NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA
| | - Mark P Bernstein
- Division of Trauma and Emergency Imaging, Department of Radiology, Bellevue Hospital/NYU Langone Medical Center, 550 1st Avenue, New York, NY 10016, USA.
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Affiliation(s)
- Bari Dane
- Department of Radiology, NYU Langone Medical Center/Bellevue Hospital, New York, NY
| | - Mark P Bernstein
- Department of Radiology, NYU Langone Medical Center/Bellevue Hospital, New York, NY.
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Batmaz G, Aksoy A, Aydin S, Ozcan P, Dane C, Dane B. The early pregnancy volume measurements in predicting pregnancy outcome. CLIN EXP OBSTET GYN 2016. [DOI: 10.12891/ceog2090.2016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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47
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Batmaz G, Aksoy A, Aydin S, Ozcan P, Dane C, Dane B. The early pregnancy volume measurements in predicting pregnancy outcome. CLIN EXP OBSTET GYN 2016; 43:241-244. [PMID: 27132419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The authors' aim was to develop a logistic regression model based on the ultrasonographic parameters on maternities which are showing a healthy improvement process during the first trimester of pregnancy. MATERIAL AND METHODS Using 2D transvaginal ultrasound imaging, the crown rump length (CRL), yolk sac (YS), and gestational sac (GS) diameters were recorded in 225 women with gestational age < 11 weeks. Simplified V = 0.523 x length x height x width formula was used for the volume calculations. The results which ended in abortion were not included in the study. RESULTS Linear regression analyses between yolk sac volume (YSV), YSV = 0.026 + 0.0018 x CRL (r²: 0.15; p < 0.001), gestational sac volume (GSV), GSV= -9.6 + 1.7 x CRL (r²: 0.52; p < 0.001), and embryo volume (EV), EV = -1.64 + 0.18 x CRL (r²: 0.4; p < 0.001), and CRL was made and a linear relationship was detected. The volume measurements showed a meaningful correlation with the week of pregnancy. The space in the GS (GS volume-embryo volume) increased as the age of pregnancy became older (r² = 0.46; p < 0.001). DISCUSSION The first volume value was made in the first trimester by transvaginal ultrasonography, which showed a correlation with the age of pregnancy.
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Batmaz G, Aksoy AN, Aydın S, Ay NK, Dane B. QT interval changes in term pregnant women living at moderately high altitude. Niger J Clin Pract 2016; 19:611-5. [DOI: 10.4103/1119-3077.188707] [Citation(s) in RCA: 3] [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] [Indexed: 11/04/2022]
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Slabach B, Corey T, Aprille J, Starks P, Dane B. Geophagic behavior in the mountain goat (Oreamnos americanus): support for meeting metabolic demands. CAN J ZOOL 2015. [DOI: 10.1139/cjz-2015-0067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Geophagy, the intentional consumption of earth or earth matter, occurs across taxa. Nutrient and mineral supplementation is most commonly cited to explain its adaptive benefits; yet many specific hypotheses exist. Previous research on mountain goats (Oreamnos americanus (Blainville, 1816)) broadly supports nutrient supplementation as the adaptive benefit of geophagy. Here, we use data from an undisturbed population of mountain goats inhabiting a geologically distinct coastal mountain range in southwestern British Columbia to test the hypothesis that geophagic behavior is a proximate mechanism for nutrient supplementation to meet metabolic demands. Our population, observed for over 30 consecutive years, returned each year with high fidelity to the same geophagic lick sites. Logistic regression demonstrated an overall effect of sodium and phosphorus, but not magnesium and calcium, on lick preferences. These data, in conjunction with field observations, provide support for the hypothesis that geophagy provides nutrient supplementation and that geophagy may be an obligate behavior to meet necessary metabolic demands within this population. The implications of our results suggest the necessity to preserve historically important habitats that may be necessary for population health.
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Affiliation(s)
- B.L. Slabach
- Department of Biology, University of Kentucky, 101 T.H. Morgan Building, Lexington, KY 40502, USA
| | - T.B. Corey
- Department of Biology, Tufts University, 163 Packard Avenue, Medford, MA 02155, USA
| | - J.R. Aprille
- Department of Biology, Tufts University, 163 Packard Avenue, Medford, MA 02155, USA
| | - P.T. Starks
- Department of Biology, Tufts University, 163 Packard Avenue, Medford, MA 02155, USA
| | - B. Dane
- Department of Biology, Tufts University, 163 Packard Avenue, Medford, MA 02155, USA
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