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Cavion CC, Altmayer S, Forte GC, Feijó Andrade RG, Hochhegger DQDR, Zaguini Francisco M, Camargo C, Patel P, Hochhegger B. Diagnostic Performance of MRI for the Detection of Pulmonary Nodules: A Systematic Review and Meta-Analysis. Radiol Cardiothorac Imaging 2024; 6:e230241. [PMID: 38634743 DOI: 10.1148/ryct.230241] [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: 04/19/2024]
Abstract
Purpose To perform a meta-analysis of the diagnostic performance of MRI for the detection of pulmonary nodules, with use of CT as the reference standard. Materials and Methods PubMed, Embase, Scopus, and other databases were systematically searched for studies published from January 2000 to March 2023 evaluating the performance of MRI for diagnosis of lung nodules measuring 4 mm or larger, with CT as reference. Studies including micronodules, nodules without size stratification, or those from which data for contingency tables could not be extracted were excluded. Primary outcomes were the per-lesion sensitivity of MRI and the rate of false-positive nodules per patient (FPP). Subgroup analysis by size and meta-regression with other covariates were performed. The study protocol was registered in the International Prospective Register of Systematic Reviews, or PROSPERO (no. CRD42023437509). Results Ten studies met inclusion criteria (1354 patients and 2062 CT-detected nodules). Overall, per-lesion sensitivity of MRI for nodules measuring 4 mm or larger was 87.7% (95% CI: 81.1, 92.2), while the FPP rate was 12.4% (95% CI: 7.0, 21.1). Subgroup analyses demonstrated that MRI sensitivity was 98.5% (95% CI: 90.4, 99.8) for nodules measuring at least 8-10 mm and 80.5% (95% CI: 71.5, 87.1) for nodules less than 8 mm. Conclusion MRI demonstrated a good overall performance for detection of pulmonary nodules measuring 4 mm or larger and almost equal performance to CT for nodules measuring at least 8-10 mm, with a low rate of FPP. Systematic review registry no. CRD42023437509 Keywords: Lung Nodule, Lung Cancer, Lung Cancer Screening, MRI, CT Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- César Campagnolo Cavion
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Stephan Altmayer
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Gabriele Carra Forte
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Rubens Gabriel Feijó Andrade
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Daniela Quinto Dos Reis Hochhegger
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Martina Zaguini Francisco
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Capitulino Camargo
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Pratik Patel
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
| | - Bruno Hochhegger
- From the Department of Radiology, Pontifícia Universidade Católica do Rio Grande do Sul, Av Ipiranga, 6681 - Partenon, Porto Alegre, Rio Grande do Sul, Brazil, 90619-900 (C.C.C., G.C.F., R.G.F.A.); Department of Radiology, Stanford University, Stanford, Calif (S.A.); Department of Radiology, College of Medicine, University of Florida, Gainesville, Fla (D.Q.d.R.H., P.P., B.H.); and Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil (M.Z.F., C.C.J.)
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Braithwaite D, Karanth SD, Divaker J, Shoenborn N, Lin K, Richman I, Hochhegger B, O'Neill S, Schonberg M. Evaluating ChatGPT's accuracy in providing screening mammography recommendations among older women: Artificial Intelligence and cancer communication. J Am Geriatr Soc 2024. [PMID: 38485652 DOI: 10.1111/jgs.18854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/05/2024] [Accepted: 02/11/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Dejana Braithwaite
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida, USA
- University of Florida Health Cancer Center, Gainesville, Florida, USA
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Shama D Karanth
- University of Florida Health Cancer Center, Gainesville, Florida, USA
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Joel Divaker
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Nancy Shoenborn
- Department of Geriatric Medicine and Gerontology, Johns Hopkins Medical Center, Baltimore, Maryland, USA
| | - Kenneth Lin
- Penn Medicine Lancaster General Health, Lancaster, Pennsylvania, USA
| | - Ilana Richman
- General Internal Medicine, Yale University, New Haven, Connecticut, USA
| | - Bruno Hochhegger
- Department of Radiology, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Suzanne O'Neill
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, USA
| | - Mara Schonberg
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard University, Cambridge, Massachusetts, USA
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Griffin I, Kundalia R, Steinberg B, Prodigios J, Verma N, Hochhegger B, Mohammed TL. Evaluating Acute Pulmonary Changes in Coronavirus Disease 2019: A Comparative Analysis of Computed Tomography, Chest Radiography, Lung Ultrasound, Magnetic Resonance Imaging, and Positron Emission Tomography with Fluorodeoxyglucose Modalities. Semin Ultrasound CT MR 2024:S0887-2171(24)00014-3. [PMID: 38428620 DOI: 10.1053/j.sult.2024.02.007] [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: 03/03/2024]
Abstract
This review explores imaging's crucial role in acute Coronavirus Disease 2019 (COVID-19) assessment. High Resolution Computer Tomography is especially effective in detection of lung abnormalities. Chest radiography has limited utility in the initial stages of COVID-19 infection. Lung Ultrasound has emerged as a valuable, radiation-free tool in critical care, and Magnetic Resonance Imaging shows promise as a Computed Tomography alternative. Typical and atypical findings of COVID-19 by each of these modalities are discussed with emphasis on their prognostic value. Considerations for pediatric and immunocompromised cases are outlined. A comprehensive diagnostic approach is recommended, as radiological diagnosis remains challenging in the acute phase.
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Affiliation(s)
- Ian Griffin
- College of Medicine, University of Florida, Gainesville, FL.
| | - Ronak Kundalia
- College of Medicine, University of Florida, Gainesville, FL
| | | | - Joice Prodigios
- Department of Radiology, University of Florida, Gainesville, FL
| | - Nupur Verma
- Department of Radiology, Baystate Medical Center, Springfield, MA
| | - Bruno Hochhegger
- College of Medicine, University of Florida, Gainesville, FL; Department of Radiology, University of Florida, Gainesville, FL
| | - Tan L Mohammed
- Department of Radiology, New York University, New York, NY
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Soldera J, Corso LL, Rech MM, Ballotin VR, Bigarella LG, Tomé F, Moraes N, Balbinot RS, Rodriguez S, Brandão ABDM, Hochhegger B. Predicting major adverse cardiovascular events after orthotopic liver transplantation using a supervised machine learning model: A cohort study. World J Hepatol 2024; 16:193-210. [PMID: 38495288 PMCID: PMC10941741 DOI: 10.4254/wjh.v16.i2.193] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/27/2023] [Accepted: 02/04/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Liver transplant (LT) patients have become older and sicker. The rate of post-LT major adverse cardiovascular events (MACE) has increased, and this in turn raises 30-d post-LT mortality. Noninvasive cardiac stress testing loses accuracy when applied to pre-LT cirrhotic patients. AIM To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional cohort. METHODS This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic center. We developed a predictive model for post-LT MACE (defined as a composite outcome of stroke, new-onset heart failure, severe arrhythmia, and myocardial infarction) using the extreme gradient boosting (XGBoost) machine learning model. We addressed missing data (below 20%) for relevant variables using the k-nearest neighbor imputation method, calculating the mean from the ten nearest neighbors for each case. The modeling dataset included 83 features, encompassing patient and laboratory data, cirrhosis complications, and pre-LT cardiac assessments. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC). We also employed Shapley additive explanations (SHAP) to interpret feature impacts. The dataset was split into training (75%) and testing (25%) sets. Calibration was evaluated using the Brier score. We followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for reporting. Scikit-learn and SHAP in Python 3 were used for all analyses. The supplementary material includes code for model development and a user-friendly online MACE prediction calculator. RESULTS Of the 537 included patients, 23 (4.46%) developed in-hospital MACE, with a mean age at transplantation of 52.9 years. The majority, 66.1%, were male. The XGBoost model achieved an impressive AUROC of 0.89 during the training stage. This model exhibited accuracy, precision, recall, and F1-score values of 0.84, 0.85, 0.80, and 0.79, respectively. Calibration, as assessed by the Brier score, indicated excellent model calibration with a score of 0.07. Furthermore, SHAP values highlighted the significance of certain variables in predicting postoperative MACE, with negative noninvasive cardiac stress testing, use of nonselective beta-blockers, direct bilirubin levels, blood type O, and dynamic alterations on myocardial perfusion scintigraphy being the most influential factors at the cohort-wide level. These results highlight the predictive capability of our XGBoost model in assessing the risk of post-LT MACE, making it a valuable tool for clinical practice. CONCLUSION Our study successfully assessed the feasibility and accuracy of the XGBoost machine learning model in predicting post-LT MACE, using both cardiovascular and hepatic variables. The model demonstrated impressive performance, aligning with literature findings, and exhibited excellent calibration. Notably, our cautious approach to prevent overfitting and data leakage suggests the stability of results when applied to prospective data, reinforcing the model's value as a reliable tool for predicting post-LT MACE in clinical practice.
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Affiliation(s)
- Jonathan Soldera
- Post Graduate Program at Acute Medicine and Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
- Postgraduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil.
| | - Leandro Luis Corso
- Department of Engineering, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
| | - Matheus Machado Rech
- School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
| | | | | | - Fernanda Tomé
- Department of Engineering, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
| | - Nathalia Moraes
- Department of Engineering, Universidade de Caxias do Sul, Caxias do Sul 95070-560, Brazil
| | | | - Santiago Rodriguez
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Ajacio Bandeira de Mello Brandão
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Bruno Hochhegger
- Postgraduate Program in Pathology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
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Marchiori E, Hochhegger B, Zanetti G. Bullous emphysema in a cannabis user. J Bras Pneumol 2024; 50:e20230352. [PMID: 38422341 DOI: 10.36416/1806-3756/e20230352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Braithwaite D, Karanth SD, Divaker J, Schoenborn N, Lin K, Richman I, Hochhegger B, O'Neill S, Schonberg M. Evaluating ChatGPT's Accuracy in Providing Screening Mammography Recommendations among Older Women: Artificial Intelligence and Cancer Communication. Res Sq 2024:rs.3.rs-3911155. [PMID: 38352437 PMCID: PMC10862946 DOI: 10.21203/rs.3.rs-3911155/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Abstract Objective: The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography through age 74. Guidelines vary as to whether or not they recommended mammography screening to women aged 75 and older. This study aims to determine the ability of ChatGPT to provide appropriate recommendations for breast cancer screening in patients aged 75 years and older. Methods: 12 questions and 4 clinical vignettes addressing fundamental concepts about breast cancer screening and prevention in patients aged 75 years and older were created and asked to ChatGPT three consecutive times to generate 3 sets of responses. The responses were graded by a multi-disciplinary panel of experts in the intersection of breast cancer screening and aging . The responses were graded as 'appropriate', 'inappropriate', or 'unreliable' based on the reviewer's clinical judgment, content of the response, and whether the content was consistent across the three responses . Appropriateness was determined through a majority consensus. Results: The responses generated by ChatGPT were appropriate for 11/17 questions (64%). Three questions were graded as inappropriate (18%) and 2 questions were graded as unreliable (12%). A consensus was not reached on one question (6%) and was graded as no consensus. Conclusions: While recognizing the limitations of ChatGPT, it has potential to provide accurate health care information and could be utilized by healthcare professionals to assist in providing recommendations for breast cancer screening in patients age 75 years and older. Physician oversight will be necessary, due to the possibility of ChatGPT to provide inappropriate and unreliable responses, and the importance of accuracy in medicine.
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Marchiori E, Hochhegger B, Zanetti G. Paraseptal emphysema. J Bras Pneumol 2024; 49:e20230340. [PMID: 38198348 PMCID: PMC10760424 DOI: 10.36416/1806-3756/e20230340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Lam S, Wynes MW, Connolly C, Ashizawa K, Atkar-Khattra S, Belani CP, DiNatale D, Henschke CI, Hochhegger B, Jacomelli C, Jelitto M, Jirapatnakul A, Kelly KL, Krishnan K, Kobayashi T, Logan J, Mattos J, Mayo J, McWilliams A, Mitsudomi T, Pastorino U, Polańska J, Rzyman W, Sales Dos Santos R, Scagliotti GV, Wakelee H, Yankelevitz DF, Field JK, Mulshine JL, Avila R. The International Association for the Study of Lung Cancer Early Lung Imaging Confederation Open-Source Deep Learning and Quantitative Measurement Initiative. J Thorac Oncol 2024; 19:94-105. [PMID: 37595684 DOI: 10.1016/j.jtho.2023.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/20/2023] [Revised: 08/07/2023] [Accepted: 08/11/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION With global adoption of computed tomography (CT) lung cancer screening, there is increasing interest to use artificial intelligence (AI) deep learning methods to improve the clinical management process. To enable AI research using an open-source, cloud-based, globally distributed, screening CT imaging data set and computational environment that are compliant with the most stringent international privacy regulations that also protect the intellectual properties of researchers, the International Association for the Study of Lung Cancer sponsored development of the Early Lung Imaging Confederation (ELIC) resource in 2018. The objective of this report is to describe the updated capabilities of ELIC and illustrate how this resource can be used for clinically relevant AI research. METHODS In this second phase of the initiative, metadata and screening CT scans from two time points were collected from 100 screening participants in seven countries. An automated deep learning AI lung segmentation algorithm, automated quantitative emphysema metrics, and a quantitative lung nodule volume measurement algorithm were run on these scans. RESULTS A total of 1394 CTs were collected from 697 participants. The LAV950 quantitative emphysema metric was found to be potentially useful in distinguishing lung cancer from benign cases using a combined slice thickness more than or equal to 2.5 mm. Lung nodule volume change measurements had better sensitivity and specificity for classifying malignant from benign lung nodules when applied to solid lung nodules from high-quality CT scans. CONCLUSIONS These initial experiments revealed that ELIC can support deep learning AI and quantitative imaging analyses on diverse and globally distributed cloud-based data sets.
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Affiliation(s)
- Stephen Lam
- Department of Integrative Oncology, The British Columbia Cancer Research Institute and Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Murry W Wynes
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Casey Connolly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | - Kazuto Ashizawa
- Department of Clinical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Sukhinder Atkar-Khattra
- Department of Integrative Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Chandra P Belani
- Department of Medicine, Penn State College of Medicine, Hershey, Pennsylvania
| | | | - Claudia I Henschke
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, Gainesville, Florida
| | | | | | - Artit Jirapatnakul
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Karen L Kelly
- International Association for the Study of Lung Cancer, Denver, Colorado
| | | | - Takeshi Kobayashi
- Department of Diagnostic and Interventional Radiology, Ishikawa Prefectural Central Hospital, Kanazawa, Ishikawa, Japan
| | | | - Juliane Mattos
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - John Mayo
- Department of Radiology, Vancouver General Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Annette McWilliams
- Fiona Stanley Hospital, University of Western Australia, Perth, Western Australia, Australia
| | - Tetsuya Mitsudomi
- Department of Surgery, Division of Thoracic Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Ugo Pastorino
- Department of Surgery, Section of Thoracic Surgery, National Cancer Institute of Milan, Milan, Italy
| | - Joanna Polańska
- Department of Data Science and Engineering, Silesian University of Technology, Gliwice, Poland
| | - Witold Rzyman
- Department of Thoracic Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | | | | | - Heather Wakelee
- Stanford Cancer Institute, Stanford University, Stanford, California
| | - David F Yankelevitz
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John K Field
- Roy Castle Lung Cancer Research Programme, The University of Liverpool, Department of Molecular and Clinical Cancer Medicine, Liverpool, United Kingdom
| | - James L Mulshine
- Internal Medicine, Graduate College, Rush University Medical Center, Chicago, Illinois
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Altmayer S, Armelin LM, Pereira JS, Carvalho LV, Tse J, Balthazar P, Francisco MZ, Watte G, Hochhegger B. MRI with DWI improves detection of liver metastasis and selection of surgical candidates with pancreatic cancer: a systematic review and meta-analysis. Eur Radiol 2024; 34:106-114. [PMID: 37566274 DOI: 10.1007/s00330-023-10069-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 02/01/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To perform a systematic review and meta-analysis to evaluate if magnetic resonance imaging (MRI) with diffusion weighted imaging (DWI) adds value compared to contrast-enhanced computed tomography (CECT) alone in the preoperative evaluation of pancreatic cancer. METHODS MEDLINE, EMBASE, and Cochrane databases were searched for relevant published studies through October 2022. Studies met eligibility criteria if they evaluated the per-patient diagnostic performance of MRI with DWI in the preoperative evaluation of newly diagnosed pancreatic cancer compared to CECT. Our primary outcome was the number needed to treat (NNT) to prevent one futile surgery using MRI with DWI, defined as those in which CECT was negative and MRI with DWI was positive for liver metastasis (i.e., surgical intervention in metastatic disease missed by CECT). The secondary outcomes were to determine the diagnostic performance and the NNT of MRI with DWI to change management in pancreatic cancer. RESULTS Nine studies met the inclusion criteria with a total of 1121 patients, of whom 172 had liver metastasis (15.3%). The proportion of futile surgeries reduced by MRI with DWI was 6.0% (95% CI, 3.0-11.6%), yielding an NNT of 16.6. The proportion of cases that MRI with DWI changed management was 18.1% (95% CI, 9.9-30.7), corresponding to an NNT of 5.5. The per-patient sensitivity and specificity of MRI were 92.4% (95% CI, 87.4-95.6%) and 97.3% (95% CI, 96.0-98.1). CONCLUSION MRI with DWI may prevent futile surgeries in pancreatic cancer by improving the detection of occult liver metastasis on preoperative CECT with an NNT of 16.6. CLINICAL RELEVANCE STATEMENT MRI with DWI complements the standard preoperative CECT evaluation for liver metastasis in pancreatic cancer, improving the selection of surgical candidates and preventing unnecessary surgeries. KEY POINTS • The NNT of MRI with DWI to prevent potential futile surgeries due to occult liver metastasis on CECT, defined as those in which CECT was negative and MRI with DWI was positive for liver metastasis, in patients with pancreatic cancer was 16.6. • The higher performance of MRI with DWI to detect liver metastasis occult on CECT can be attributed to an increased detection of subcentimeter liver metastasis.
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Affiliation(s)
- Stephan Altmayer
- Department of Radiology, Stanford University, 300 Pasteur Drive, Suite H1330, Stanford, USA.
| | - Larissa Maria Armelin
- Faculdade de Medicina, Universidade Federal de Minas Gerais, 190 Prof Alfredo Balena Ave, Belo Horizonte, Brazil
| | | | - Lis Vitoria Carvalho
- Faculdade de Medicina, Universidade de São Paulo, 455 Dr Arnaldo Ave, São Paulo, Brazil
| | - Justin Tse
- Department of Radiology, Stanford University, 300 Pasteur Drive, Suite H1330, Stanford, USA
| | | | - Martina Zaguini Francisco
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Guilherme Watte
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, 1600 SW Archer Rd, Gainesville, USA
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Boanova LG, Altmayer S, Watte G, Raupp AA, Francisco MZ, De Oliveira GS, Hochhegger B, Andrade RGF. Detection of Liver Lesions in Colorectal Cancer Patients Using 18F-FDG PET/CT Dual-Time-Point Scan Imaging. Cancers (Basel) 2023; 15:5403. [PMID: 38001662 PMCID: PMC10670707 DOI: 10.3390/cancers15225403] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the diagnostic performance of dual-time-point fluorine-18-fluorodeoxyglucose positron emission computed tomography/computed tomography (18F-FDG PET/CT) compared to conventional early imaging for detecting colorectal liver metastases (CRLM) in colorectal cancer (CRC) patients. METHODS One hundred twenty-four consecutive CRC patients underwent dual-time-point imaging scans on a retrospective basis. Histopathological confirmation and/or clinical follow-up were accepted as the gold standard. Standard uptake values (SUV), signal-to-noise ratio (SNR), retention index (RI), tumor-to-normal liver ratio (TNR), and lesion sizes were measured for early and delayed PET scans. The diagnostic performance of early and delayed images was calculated on a per-patient basis and compared using McNemar's test. RESULTS Among the 124 patients, 57 (46%) had CRLM, 6 (4.8%) had benign lesions, and 61 (49.2%) had no concerning lesions detected. Smaller CRLM lesions (<5 cm3) showed significantly higher uptake in the delayed scans relative to early imaging (p < 0.001). The SUV and TNR increased significantly in delayed imaging of all metastatic lesions (p < 0.001). The retention index of all CRLM was high (40.8%), especially for small lesions (54.8%). A total of 177 lesions in delayed images and 124 in standard early images were identified. In a per-patient analysis, delayed imaging had significantly higher sensitivity (100% vs. 87.7%) and specificity (91.0% vs. 94.0%) compared to early imaging (p-value = 0.04). CONCLUSIONS The detection of liver lesions using dual-time-point PET/CT scan improves the sensitivity and specificity for the detection of colorectal liver metastasis.
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Affiliation(s)
- Luciane G. Boanova
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
- Department of Nuclear Medicine, Hospital Mae de Deus, Av. Jose de Alencar 286, Porto Alegre 90880-481, Brazil;
| | - Stephan Altmayer
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
| | - Guilherme Watte
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre 90050-170, Brazil; (G.W.); (M.Z.F.)
| | - Ana Amelia Raupp
- Department of Nuclear Medicine, Hospital Mae de Deus, Av. Jose de Alencar 286, Porto Alegre 90880-481, Brazil;
| | - Martina Zaguini Francisco
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, Rua Sarmento Leite 245, Porto Alegre 90050-170, Brazil; (G.W.); (M.Z.F.)
| | - Guilherme Strieder De Oliveira
- School of Medicine, Federal University of Rio Grande do Sul, R. Ramiro Barcelos, 2400—Santa Cecília, Porto Alegre 90035-003, Brazil;
| | - Bruno Hochhegger
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
| | - Rubens G. F. Andrade
- Faculty of Medicine, Pontificial Catholic University of Rio Grande do Sul, Av. Ipiranga 6690, Porto Alegre 90619-900, Brazil (B.H.)
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Traylor KS, Bastawrous S, Riedesel EL, Ballard DH, Hochhegger B, Ukeh I, Jaswal S, Agarwal M, Clarke JE, Lakhani DA, Balthazar P, Tomblinson CM, Bunch PM. A New (Digital) Era in Medical Journalism: Leveraging Social Media and Other Online Tools to Increase Reach and Engagement. Radiographics 2023; 43:e230103. [PMID: 37883299 DOI: 10.1148/rg.230103] [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: 10/28/2023]
Abstract
Social media is a popular communication and marketing tool in modern society, with the power to reach and engage large audiences. Many members of the medical and radiology communities have embraced social media platforms, particularly X (formerly known as Twitter), as an efficient and economic means for performing patient outreach, disseminating research and educational materials, building networks, and promoting diversity. Editors of medical journals with a clear vision and relevant expertise can leverage social media and other digital tools to advance the journal's mission, further their interests, and directly benefit journal authors and readers. For editors, social media offers a means to increase article visibility and downloads, expand awareness of volunteer opportunities, and use metrics and other feedback to inform future initiatives. Authors benefit from broader dissemination of their work, which aids establishment of a national or international reputation. Readers can receive high-quality high-yield content in a digestible format directly on their devices while actively engaging with journal editors and authors in the online community. The authors highlight the multifaceted benefits of social media engagement and digital tool implementation in the context of medical journalism and summarize the activities of the RadioGraphics Social Media and Digital Innovation Team. By enumerating the social media activities of RadioGraphics and describing the underlying rationale for each activity, the authors present a blueprint for other medical journals considering similar initiatives. ©RSNA, 2023.
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Affiliation(s)
- Katie S Traylor
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Sarah Bastawrous
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Erica L Riedesel
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - David H Ballard
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Bruno Hochhegger
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Ifechi Ukeh
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Shama Jaswal
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Mohit Agarwal
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Jamie E Clarke
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Dhairya A Lakhani
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Patricia Balthazar
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Courtney M Tomblinson
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
| | - Paul M Bunch
- From the Department of Radiology, University of Pittsburgh Medical Center Health System, 200 Lothrop St, South Tower 2nd Fl, Ste 200, Pittsburgh, PA 15213 (K.S.T.); Department of Radiology and Veterans Affairs, Puget Sound Health System, University of Washington School of Medicine, Seattle, Wash (S.B.); Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (E.L.R., P.B.); Pediatric Radiology, Children's Healthcare of Atlanta, Atlanta, Ga (E.L.R.); Department of Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Mo (D.H.B.); Department of Radiology, University of Florida, Gainesville, Fla (B.H.); Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (I.U.); Department of Radiology, New York Presbyterian/Weill Cornell Medicine, New York, NY (S.J.); Department of Neuroradiology, Medical College of Wisconsin, Milwaukee, Wis (M.A.); Department of Radiology, University of California Los Angeles, Los Angeles, Calif (J.E.C.); Department of Radiology, West Virginia University, Morgantown, WV (D.A.L.); Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tenn (C.M.T.); and Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC (P.M.B.)
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Marchiori E, Hochhegger B, Zanetti G. Pulmonary hypertension. J Bras Pneumol 2023; 49:e20230275. [PMID: 37909553 PMCID: PMC10759981 DOI: 10.36416/1806-3756/e20230275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Sousa C, Pasini RA, Pasqualotto A, Marchiori E, Altmayer S, Irion K, Mançano A, Hochhegger B. Imaging Findings in Aspergillosis: From Head to Toe. Mycopathologia 2023; 188:623-641. [PMID: 37380874 DOI: 10.1007/s11046-023-00766-6] [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: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Abstract
Aspergillosis is a mycotic infection induced by airborne fungi that are ubiquitous. Inhalation of Aspergillus conidia results in transmission through the respiratory tract. The clinical presentation is dependent on organism and host specifics, with immunodeficiency, allergies, and preexisting pulmonary disease constituting the most important risk factors. In recent decades, the incidence of fungal infections has increased dramatically, due in part to the increased number of transplants and the pervasive use of chemotherapy and immunosuppressive drugs. The spectrum of clinical manifestations can range from an asymptomatic or mild infection to a swiftly progressive, life-threatening illness. Additionally, invasive infections can migrate to extrapulmonary sites, causing infections in distant organs. Recognition and familiarity with the various radiological findings in the appropriate clinical context are essential for patient management and the prompt initiation of life-saving treatment. We discuss the radiological characteristics of chronic and invasive pulmonary aspergillosis, as well as some of the typically unexpected extrapulmonary manifestations of disseminated disease.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | | | - Alessandro Pasqualotto
- Radiology Department, Universidade Federal de Ciências da Saúde de Porto Alegre, Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
| | - Edson Marchiori
- Radiology Department, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | | | - Klaus Irion
- Radiology Department, University of Florida, Gainesville, FL, USA
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida, Gainesville, FL, USA.
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Campello CA, Castanha EB, Vilardo M, Staziaki PV, Francisco MZ, Mohajer B, Watte G, Moraes FY, Hochhegger B, Altmayer S. Machine learning for malignant versus benign focal liver lesions on US and CEUS: a meta-analysis. Abdom Radiol (NY) 2023; 48:3114-3126. [PMID: 37365266 DOI: 10.1007/s00261-023-03984-0] [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: 03/10/2023] [Revised: 06/10/2023] [Accepted: 06/12/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES To perform a meta-analysis of the diagnostic performance of learning (ML) algorithms (conventional and deep learning algorithms) for the classification of malignant versus benign focal liver lesions (FLLs) on US and CEUS. METHODS Available databases were searched for relevant published studies through September 2022. Studies met eligibility criteria if they evaluate the diagnostic performance of ML for the classification of malignant and benign focal liver lesions on US and CEUS. The pooled per-lesion sensitivities and specificities for each modality with 95% confidence intervals were calculated. RESULTS A total of 8 studies on US, 11 on CEUS, and 1 study evaluating both methods met the inclusion criteria with a total of 34,245 FLLs evaluated. The pooled sensitivity and specificity of ML for the malignancy classification of FLLs were 81.7% (95% CI, 77.2-85.4%) and 84.8% (95% CI, 76.0-90.8%) for US, compared to 87.1% (95% CI, 81.8-91.0%) and 87.0% (95% CI, 83.1-90.1%) for CEUS. In the subgroup analysis of studies that evaluated deep learning algorithms, the sensitivity and specificity of CEUS (n = 4) increased to 92.4% (95% CI, 88.5-95.0%) and 88.2% (95% CI, 81.1-92.9%). CONCLUSIONS The diagnostic performance of ML algorithms for the malignant classification of FLLs was high for both US and CEUS with overall similar sensitivity and specificity. The similar performance of US may be related to the higher prevalence of DL models in that group.
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Affiliation(s)
- Carlos Alberto Campello
- School of Medicine, Universidade Federal do Mato Grosso, 2367 Quarenta e Nove St, Cuiabá, Brazil
| | - Everton Bruno Castanha
- School of Medicine, Universidade Federal de Pelotas, 538 Prof. Dr. Araújo St. Pelotas, Pelotas, Brazil
| | - Marina Vilardo
- School of Medicine, Universidade Catolica de Brasilia, QS 07, Brasília, Brazil
| | - Pedro V Staziaki
- Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, USA
| | - Martina Zaguini Francisco
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Bahram Mohajer
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, Baltimore, USA
| | - Guilherme Watte
- Department of Radiology, Universidade Federal de Ciencias da Saude de Porto Alegre, 245 Sarmento Leite St, Porto Alegre, Brazil
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen's University, 76 Stuart St, Kingston, Canada
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, 1600 SW Archer Rd, Gainesville, USA
| | - Stephan Altmayer
- Department of Radiology, Stanford University, 300 Pasteur Drive, Suite H1330, Stanford, USA.
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Guedes Pinto E, Penha D, Ravara S, Monaghan C, Hochhegger B, Marchiori E, Taborda-Barata L, Irion K. Factors influencing the outcome of volumetry tools for pulmonary nodule analysis: a systematic review and attempted meta-analysis. Insights Imaging 2023; 14:152. [PMID: 37741928 PMCID: PMC10517915 DOI: 10.1186/s13244-023-01480-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/08/2023] [Indexed: 09/25/2023] Open
Abstract
Health systems worldwide are implementing lung cancer screening programmes to identify early-stage lung cancer and maximise patient survival. Volumetry is recommended for follow-up of pulmonary nodules and outperforms other measurement methods. However, volumetry is known to be influenced by multiple factors. The objectives of this systematic review (PROSPERO CRD42022370233) are to summarise the current knowledge regarding factors that influence volumetry tools used in the analysis of pulmonary nodules, assess for significant clinical impact, identify gaps in current knowledge and suggest future research. Five databases (Medline, Scopus, Journals@Ovid, Embase and Emcare) were searched on the 21st of September, 2022, and 137 original research studies were included, explicitly testing the potential impact of influencing factors on the outcome of volumetry tools. The summary of these studies is tabulated, and a narrative review is provided. A subset of studies (n = 16) reporting clinical significance were selected, and their results were combined, if appropriate, using meta-analysis. Factors with clinical significance include the segmentation algorithm, quality of the segmentation, slice thickness, the level of inspiration for solid nodules, and the reconstruction algorithm and kernel in subsolid nodules. Although there is a large body of evidence in this field, it is unclear how to apply the results from these studies in clinical practice as most studies do not test for clinical relevance. The meta-analysis did not improve our understanding due to the small number and heterogeneity of studies testing for clinical significance. CRITICAL RELEVANCE STATEMENT: Many studies have investigated the influencing factors of pulmonary nodule volumetry, but only 11% of these questioned their clinical relevance in their management. The heterogeneity among these studies presents a challenge in consolidating results and clinical application of the evidence. KEY POINTS: • Factors influencing the volumetry of pulmonary nodules have been extensively investigated. • Just 11% of studies test clinical significance (wrongly diagnosing growth). • Nodule size interacts with most other influencing factors (especially for smaller nodules). • Heterogeneity among studies makes comparison and consolidation of results challenging. • Future research should focus on clinical applicability, screening, and updated technology.
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Affiliation(s)
- Erique Guedes Pinto
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal.
| | - Diana Penha
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
| | - Sofia Ravara
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
| | - Colin Monaghan
- Liverpool Heart and Chest Hospital NHS Foundation Trust, Thomas Dr, Liverpool, L14 3PE, UK
| | | | - Edson Marchiori
- Faculdade de Medicina, Universidade Federal Do Rio de Janeiro, Bloco K - Av. Carlos Chagas Filho, 373 - 2º Andar, Sala 49 - Cidade Universitária da Universidade Federal Do Rio de Janeiro, Rio de Janeiro - RJ, 21044-020, Brasil
- Faculdade de Medicina, Universidade Federal Fluminense, Av. Marquês Do Paraná, 303 - Centro, Niterói - RJ, 24220-000, Brasil
| | - Luís Taborda-Barata
- R. Marquês de Ávila E Bolama, Universidade da Beira Interior Faculdade de Ciências da Saúde, 6201-001, Covilhã, Portugal
| | - Klaus Irion
- Manchester University NHS Foundation Trust, Manchester Royal Infirmary, Oxford Rd, Manchester, M13 9WL, UK
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Basilio R, Carvalho AR, Rodrigues R, Conrado M, Accorsi S, Forghani R, Machuca T, Zanon M, Altmayer S, Hochhegger B. Natural Language Processing for the Identification of Incidental Lung Nodules in Computed Tomography Reports: A Quality Control Tool. JCO Glob Oncol 2023; 9:e2300191. [PMID: 37769221 PMCID: PMC10581645 DOI: 10.1200/go.23.00191] [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] [Received: 06/12/2023] [Revised: 07/09/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE To evaluate the diagnostic performance of a natural language processing (NLP) model in detecting incidental lung nodules (ILNs) in unstructured chest computed tomography (CT) reports. METHODS All unstructured consecutive reports of chest CT scans performed at a tertiary hospital between 2020 and 2021 were retrospectively reviewed (n = 21,542) to train the NLP tool. Internal validation was performed using reference readings by two radiologists of both CT scans and reports, using a different external cohort of 300 chest CT scans. Second, external validation was performed in a cohort of all random unstructured chest CT reports from 57 different hospitals conducted in May 2022. A review by the same thoracic radiologists was used as the gold standard. The sensitivity, specificity, and accuracy were calculated. RESULTS Of 21,542 CT reports, 484 mentioned at least one ILN (mean age, 71 ± 17.6 [standard deviation] years; women, 52%) and were included in the training set. In the internal validation (n = 300), the NLP tool detected ILN with a sensitivity of 100.0% (95% CI, 97.6 to 100.0), a specificity of 95.9% (95% CI, 91.3 to 98.5), and an accuracy of 98.0% (95% CI, 95.7 to 99.3). In the external validation (n = 977), the NLP tool yielded a sensitivity of 98.4% (95% CI, 94.5 to 99.8), a specificity of 98.6% (95% CI, 97.5 to 99.3), and an accuracy of 98.6% (95% CI, 97.6 to 99.2). Twelve months after the initial reports, 8 (8.60%) patients had a final diagnosis of lung cancer, among which 2 (2.15%) would have been lost to follow-up without the NLP tool. CONCLUSION NLP can be used to identify ILNs in unstructured reports with high accuracy, allowing a timely recall of patients and a potential diagnosis of early-stage lung cancer that might have been lost to follow-up.
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Affiliation(s)
- Rodrigo Basilio
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | | | - Rosana Rodrigues
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Marco Conrado
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Sephania Accorsi
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Reza Forghani
- Radiomics and Augmented Intelligence Laboratory (RAIL), University of Florida, Gainesville, FL
| | - Tiago Machuca
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Matheus Zanon
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Stephan Altmayer
- Stanford Hospital, Stanford University Medical Center, Palo Alto, CA
| | - Bruno Hochhegger
- Radiomics and Augmented Intelligence Laboratory (RAIL), University of Florida, Gainesville, FL
- Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
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Hochhegger B, Braithwaite D. Beyond the AJR: Should Imaging-Based Risk Assessment Tools Be Used in Lung Cancer Screening? AJR Am J Roentgenol 2023; 221:390. [PMID: 36722762 PMCID: PMC10801696 DOI: 10.2214/ajr.23.29060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Bruno Hochhegger
- Department of Radiology, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32608
- University of Florida Health Cancer Center, Gainesville, FL
| | - Dejana Braithwaite
- University of Florida Health Cancer Center, Gainesville, FL
- Department of Surgery, University of Florida, Gainesville, FL
- Department of Epidemiology, University of Florida, Gainesville, FL
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18
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Marchiori E, Hochhegger B, Zanetti G. Bronchiectasis with tracheobronchial dilation. J Bras Pneumol 2023; 49:e20230235. [PMID: 37610963 PMCID: PMC10578933 DOI: 10.36416/1806-3756/e20230235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Marchiori E, Hochhegger B, Zanetti G. Transfusion-related acute lung injury: an uncommon cause of pulmonary edema. J Bras Pneumol 2023; 49:e20230175. [PMID: 37610961 PMCID: PMC10578943 DOI: 10.36416/1806-3756/e20230175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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20
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Marchiori E, Hochhegger B, Zanetti G. Multiple vascular nodules. J Bras Pneumol 2023; 49:e20230173. [PMID: 37493792 PMCID: PMC10578903 DOI: 10.36416/1806-3756/e20230173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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Silva JAM, Hochhegger B, Amorim VB, Zanetti G, Marchiori E. Computed tomography aspects of thoracic metastases from osteosarcoma: pictorial essay. Radiol Bras 2023; 56:215-219. [PMID: 37829585 PMCID: PMC10567086 DOI: 10.1590/0100-3984.2022.0107-en] [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] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/12/2022] [Accepted: 12/12/2022] [Indexed: 10/14/2023] Open
Abstract
Osteosarcoma is the most common primary bone tumor, with a higher incidence in the second decade of life, and it often leads to pulmonary metastases. The most common pattern seen on computed tomography is one of multiple well-defined nodules in the lung parenchyma, often with calcifications. Because of the variety of presentations of pulmonary metastases in osteosarcoma, including atypical forms, knowledge of the computed tomography aspects of these lesions is important for characterizing and evaluating the extent of the disease, as well as for distinguishing metastatic disease from other benign or malignant lung diseases. This essay discusses the main tomographic findings of pulmonary metastases from osteosarcoma.
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Affiliation(s)
| | | | | | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
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22
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Pierre K, Gupta M, Raviprasad A, Sadat Razavi SM, Patel A, Peters K, Hochhegger B, Mancuso A, Forghani R. Medical imaging and multimodal artificial intelligence models for streamlining and enhancing cancer care: opportunities and challenges. Expert Rev Anticancer Ther 2023; 23:1265-1279. [PMID: 38032181 DOI: 10.1080/14737140.2023.2286001] [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: 09/01/2023] [Accepted: 11/16/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION Artificial intelligence (AI) has the potential to transform oncologic care. There have been significant developments in AI applications in medical imaging and increasing interest in multimodal models. These are likely to enable improved oncologic care through more precise diagnosis, increasingly in a more personalized and less invasive manner. In this review, we provide an overview of the current state and challenges that clinicians, administrative personnel and policy makers need to be aware of and mitigate for the technology to reach its full potential. AREAS COVERED The article provides a brief targeted overview of AI, a high-level review of the current state and future potential AI applications in diagnostic radiology and to a lesser extent digital pathology, focusing on oncologic applications. This is followed by a discussion of emerging approaches, including multimodal models. The article concludes with a discussion of technical, regulatory challenges and infrastructure needs for AI to realize its full potential. EXPERT OPINION There is a large volume of promising research, and steadily increasing commercially available tools using AI. For the most advanced and promising precision diagnostic applications of AI to be used clinically, robust and comprehensive quality monitoring systems and informatics platforms will likely be required.
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Affiliation(s)
- Kevin Pierre
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Manas Gupta
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
| | - Abheek Raviprasad
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Seyedeh Mehrsa Sadat Razavi
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Anjali Patel
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
- University of Florida College of Medicine, Gainesville, FL, USA
| | - Keith Peters
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Bruno Hochhegger
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anthony Mancuso
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Reza Forghani
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Radiology, University of Florida College of Medicine, Gainesville, FL, USA
- Division of Medical Physics, University of Florida College of Medicine, Gainesville, FL, USA
- Department of Neurology, Division of Movement Disorders, University of Florida College of Medicine, Gainesville, FL, USA
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23
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Marchiori E, Hochhegger B, Zanetti G. Fat embolism syndrome causing a crazy-paving pattern on CT. J Bras Pneumol 2023; 49:e20230149. [PMID: 37283404 PMCID: PMC10578928 DOI: 10.36416/1806-3756/e20230149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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24
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Heuser GG, Medeiros TM, Heuser HG, Scopel KRO, Battisti IDE, Hochhegger B, Winkelmann ER. Diagnostic accuracy of pelvis multiparametric MRI against CT virtual hysterosalpingography: a prospective study of tubal patency through female infertility assessment. Br J Radiol 2023; 96:20220889. [PMID: 37066809 PMCID: PMC10230390 DOI: 10.1259/bjr.20220889] [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] [Received: 09/15/2022] [Revised: 03/03/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of MRI-hysterosalpingogram (HSG) with semiquantitative dynamic contrast-enhanced perfusion, against the virtual multislice CT hysterosalpingogram (VHSG) as a reference standard. METHODS AND MATERIALS In this prospective study, 26 women (age >18 years) searching for infertility causes and with VHSG physician request. Thereafter, the assessment performance of both techniques was determined by two reader analyses. k statistics were used for the assessment of tubal patency. Receiver operating characteristic (ROC) analysis was used to compare the capability for tubal patency assessment between both exams on a per-patient and per-tube basis. The McNemar test was used to compare the diagnostic accuracy measures. RESULTS Tubal patency, uterine morphological, ovarian, and extrauterine abnormalities were evaluated through both exams in all 26 women. There was no significant difference between diagnostic performance measurements between the methods. The ROC curve of VHSG was 0.852 for both per-patient and per-tube analyses, and one and 0.938 for MRI-HSG. Sensitivity and specificity for per-patient and per-tube for VHSG were 95.2 and 97.7, 80 and 87.5%, and for MRI-HSG 100% for both analyses and 100 and 87.5%, respectively. CONCLUSION This study demonstrates the feasibility of diagnosing tubal patency through MRI, using a semi-quantitative dynamic contrast-enhanced perfusion sequence, and the satisfactory diagnosing of the uterine morphology, ovarian abnormalities, and ovarian and deep endometriosis. ADVANCES IN KNOWLEDGE Multiparametric MRI with a perfusion real-time sequence as a HSG method can be used in the evaluation not only for uterine and ovarian abnormilities but also tubal patency.
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Affiliation(s)
| | | | | | | | - Iara Denise Endruweit Battisti
- Master's Program in Public Policy and Development and the Master's Program in Environment and Sustainable Technologies, Federal University of the Southern Frontier de Cerro Largo, Cerro Largo, RS, Brazil
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25
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Marchiori E, Hochhegger B, Zanetti G. Left upper lobe atelectasis. J Bras Pneumol 2023; 49:e20230064. [PMID: 37194819 DOI: 10.36416/1806-3756/e20230064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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26
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Marchiori E, Hochhegger B, Zanetti G. COVID-19 and infectious diseases: a frequent association. Clin Imaging 2023; 97:70-71. [PMID: 36905886 PMCID: PMC9991325 DOI: 10.1016/j.clinimag.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/09/2023]
Affiliation(s)
- Edson Marchiori
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
| | - Bruno Hochhegger
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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27
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Mango ALD, Gomes ACP, Hochhegger B, Zanetti G, Marchiori E. Computed tomography findings of pulmonary histoplasmosis: pictorial essay. Radiol Bras 2023; 56:162-167. [PMID: 37564080 PMCID: PMC10411766 DOI: 10.1590/0100-3984.2022.0106-en] [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] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/12/2022] [Indexed: 08/12/2023] Open
Abstract
Endemic systemic mycoses are prevalent in specific geographic areas of the world and are responsible for high rates of morbidity and mortality in the populations of such areas, as well as in immigrants and travelers returning from endemic regions. Pulmonary histoplasmosis is an infection caused by Histoplasma capsulatum, a dimorphic fungus. This infection has a worldwide distribution, being endemic in Brazil. Histoplasmosis can affect the lungs, and its diagnosis and management remain challenging, especially in non-endemic areas. Therefore, recognition of the various radiological manifestations of pulmonary histoplasmosis, together with the clinical and epidemiological history of the patient, is essential to narrowing the differential diagnosis. This essay discusses the main computed tomography findings of pulmonary histoplasmosis.
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Affiliation(s)
- Ana Luiza Di Mango
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
| | | | | | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
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28
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Pierre K, Haneberg AG, Kwak S, Peters KR, Hochhegger B, Sananmuang T, Tunlayadechanont P, Tighe PJ, Mancuso A, Forghani R. Applications of Artificial Intelligence in the Radiology Roundtrip: Process Streamlining, Workflow Optimization, and Beyond. Semin Roentgenol 2023; 58:158-169. [PMID: 37087136 DOI: 10.1053/j.ro.2023.02.003] [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] [Received: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 04/24/2023]
Abstract
There are many impactful applications of artificial intelligence (AI) in the electronic radiology roundtrip and the patient's journey through the healthcare system that go beyond diagnostic applications. These tools have the potential to improve quality and safety, optimize workflow, increase efficiency, and increase patient satisfaction. In this article, we review the role of AI for process improvement and workflow enhancement which includes applications beginning from the time of order entry, scan acquisition, applications supporting the image interpretation task, and applications supporting tasks after image interpretation such as result communication. These non-diagnostic workflow and process optimization tasks are an important part of the arsenal of potential AI tools that can streamline day to day clinical practice and patient care.
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Affiliation(s)
- Kevin Pierre
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL; Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Adam G Haneberg
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL; Division of Medical Physics, Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Sean Kwak
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL
| | - Keith R Peters
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL; Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Bruno Hochhegger
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL; Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Thiparom Sananmuang
- Department of Diagnostic and Therapeutic Radiology and Research, Faculty of Medicine Ramathibodi Hospital, Ratchathewi, Bangkok, Thailand
| | - Padcha Tunlayadechanont
- Department of Diagnostic and Therapeutic Radiology and Research, Faculty of Medicine Ramathibodi Hospital, Ratchathewi, Bangkok, Thailand
| | - Patrick J Tighe
- Departments of Anesthesiology & Orthopaedic Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Anthony Mancuso
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL; Department of Radiology, University of Florida College of Medicine, Gainesville, FL
| | - Reza Forghani
- Radiomics and Augmented Intelligence Laboratory (RAIL), Department of Radiology and the Norman Fixel Institute for Neurological Diseases, University of Florida College of Medicine, Gainesville, FL; Department of Radiology, University of Florida College of Medicine, Gainesville, FL; Division of Medical Physics, Department of Radiology, University of Florida College of Medicine, Gainesville, FL.
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29
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Marchiori E, Hochhegger B, Zanetti G. Hyperdensities within the pulmonary arteries. J Bras Pneumol 2023; 49:e20230048. [PMID: 36946822 PMCID: PMC10171279 DOI: 10.36416/1806-3756/e20230048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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de Godoy MF, Chatkin JM, Rodrigues RS, Forte GC, Marchiori E, Gavenski N, Barros RC, Hochhegger B. Artificial intelligence to predict the need for mechanical ventilation in cases of severe COVID-19. Radiol Bras 2023; 56:81-85. [PMID: 37168039 PMCID: PMC10165968 DOI: 10.1590/0100-3984.2022.0049] [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: 04/19/2022] [Accepted: 07/22/2022] [Indexed: 03/12/2023] Open
Abstract
Objective To determinate the accuracy of computed tomography (CT) imaging assessed by deep neural networks for predicting the need for mechanical ventilation (MV) in patients hospitalized with severe acute respiratory syndrome due to coronavirus disease 2019 (COVID-19). Materials and Methods This was a retrospective cohort study carried out at two hospitals in Brazil. We included CT scans from patients who were hospitalized due to severe acute respiratory syndrome and had COVID-19 confirmed by reverse transcription-polymerase chain reaction (RT-PCR). The training set consisted of chest CT examinations from 823 patients with COVID-19, of whom 93 required MV during hospitalization. We developed an artificial intelligence (AI) model based on convolutional neural networks. The performance of the AI model was evaluated by calculating its accuracy, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve. Results For predicting the need for MV, the AI model had a sensitivity of 0.417 and a specificity of 0.860. The corresponding area under the ROC curve for the test set was 0.68. Conclusion The high specificity of our AI model makes it able to reliably predict which patients will and will not need invasive ventilation. That makes this approach ideal for identifying high-risk patients and predicting the minimum number of ventilators and critical care beds that will be required.
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Affiliation(s)
| | - José Miguel Chatkin
- Pontifícia Universidade Católica do Rio Grande do Sul
(PUCRS), Porto Alegre, RS, Brazil
| | | | - Gabriele Carra Forte
- Pontifícia Universidade Católica do Rio Grande do Sul
(PUCRS), Porto Alegre, RS, Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Nathan Gavenski
- Pontifícia Universidade Católica do Rio Grande do Sul
(PUCRS), Porto Alegre, RS, Brazil
| | - Rodrigo Coelho Barros
- Pontifícia Universidade Católica do Rio Grande do Sul
(PUCRS), Porto Alegre, RS, Brazil
| | - Bruno Hochhegger
- Pontifícia Universidade Católica do Rio Grande do Sul
(PUCRS), Porto Alegre, RS, Brazil
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Haneberg AG, Pierre K, Winter-Reinhold E, Hochhegger B, Peters KR, Grajo J, Arreola M, Asadizanjani N, Bian J, Mancuso A, Forghani R. Introduction to Radiomics and Artificial Intelligence: A Primer for Radiologists. Semin Roentgenol 2023; 58:152-157. [PMID: 37087135 DOI: 10.1053/j.ro.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 04/03/2023]
Abstract
Health informatics and artificial intelligence (AI) are expected to transform the healthcare enterprise and the future practice of radiology. There is an increasing body of literature on radiomics and deep learning/AI applications in medical imaging. There are also a steadily increasing number of FDA cleared AI applications in radiology. It is therefore essential for radiologists to have a basic understanding of these approaches, whether in academia or private practice. In this article, we will provide an overview of the field and familiarize the readers with the fundamental concepts behind these approaches.
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Hochhegger B, Pasini R, Roncally Carvalho A, Rodrigues R, Altmayer S, Kayat Bittencourt L, Marchiori E, Forghani R. Artificial Intelligence for Cardiothoracic Imaging: Overview of Current and Emerging Applications. Semin Roentgenol 2023; 58:184-195. [PMID: 37087139 DOI: 10.1053/j.ro.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/07/2023]
Abstract
Artificial intelligence algorithms can learn by assimilating information from large datasets in order to decipher complex associations, identify previously undiscovered pathophysiological states, and construct prediction models. There has been tremendous interest and increased incorporation of artificial intelligence into various industries, including healthcare. As a result, there has been an exponential rise in the number of research articles and industry participants producing models intended for a variety of applications in medical imaging, which can be challenging to navigate for radiologists. In thoracic imaging, multiple applications are being evaluated for chest radiography and computed tomography and include applications for lung nodule evaluation and cancer imaging, quantifying diffuse lung disorders, and cardiac imaging, to name a few. This review aims to provide an overview of current clinical AI models, focusing on the most common clinical applications of AI in cardiothoracic imaging.
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Schambeck JPL, Forte GC, Gonçalves LM, Stuker G, Kotlinski JBF, Tramontin G, Altmayer S, Watte G, Hochhegger B. Diagnostic accuracy of magnetic resonance elastography and point-shear wave elastography for significant hepatic fibrosis screening: Systematic review and meta-analysis. PLoS One 2023; 18:e0271572. [PMID: 36730265 PMCID: PMC9894488 DOI: 10.1371/journal.pone.0271572] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 07/03/2022] [Indexed: 02/03/2023] Open
Abstract
The hepatic diseases are extremely common in clinical practice. The correct classification of liver fibrosis is extremely important, as it influences therapy and predicts disease outcomes. The purpose of this study is to compare the diagnostic performance of point-shear wave elastography (pSWE) and magnetic resonance elastography (MRE) in the hepatic fibrosis diagnostic. A meta-analysis was carried out based on articles published until October 2020. The articles are available at following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scientific Electronic Library Online, LILACS, Scopus, and CINAHL. Diagnostic performances were analyzed per METAVIR F2, using 3.5kPa as target fibrosis. Assessment of the methodological quality of the incorporated papers by the QUADAS-2 tool for pSWE and MRE. A total 2,153 studies articles were evaluated and 44 studies, comprising 6,081 patients with individual data, were included in the meta-analysis: 28 studies for pSWE and 16 studies for MRE. The pooled sensitivity and specificity were 0.86 (95%CI 0.80-0.90) and 0.88 (95%CI 0.85-0.91), respectively, for pSWE, compared with 0.94 (95%CI 0.89-0.97) and 0.95 (95%CI 0.89-0.98) respectively, for MRE. The pooled SROC curve for pSWE shows in the area under the curve (AUC) of 0.93 (95%CI 0.90-0.95), whereas the AUC for MRE was 0.98 (95%CI 0.96-0.99). The diagnostic odds ratio for pSWE and MRE were 41 (95%CI 24-72) and 293 (95%CI 86-1000), respectively. There was statistically significant heterogeneity for pSWE sensitivity (I² = 85.26, P<0.001) and specificity (I² = 89.46, P<0.001). The heterogeneity for MRE also was significant for sensitivity (I² = 73.28, P<0.001) and specificity (I² = 87.24, P<0.001). Therefore, both pSWE and MRE are suitable modalities for assessing liver fibrosis. In addition, MRE is a more accurate imaging technique than pSWE and can be used as alternative to invasive biopsy.
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Affiliation(s)
- João Paulo L. Schambeck
- Post-Graduate Program in Medicine and Health Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriele C. Forte
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- * E-mail:
| | - Luana M. Gonçalves
- Post-Graduate Program in Medicine and Health Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Stuker
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - João Bruno F. Kotlinski
- Faculty of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Giacomo Tramontin
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Stephan Altmayer
- Post-Graduate Program in Medicine and Health Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Watte
- Department of Radiology, Medical Imaging Research Lab, LABIMED, Porto Alegre, Rio Grande do Sul, Brazil
| | - Bruno Hochhegger
- Post-Graduate Program in Medicine and Health Science, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departament of Radiology, Hospital São Lucas/Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Radiology, Medical Imaging Research Lab, LABIMED, Porto Alegre, Rio Grande do Sul, Brazil
- Department of Diagnostic Methods, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
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Nunes TF, Inchingolo R, Kikuti CF, Faria BBD, Galhardo CAV, Tognini JRF, Marchiori E, Hochhegger B. Fluoroscopia por tomografia computadorizada - biópsia percutânea guiada de nódulos pulmonares ≤ 10 mm: análise retrospectiva de procedimentos realizados no período de pandemia de COVID-19. Radiol Bras 2023. [DOI: 10.1590/0100-3984.2022.0062] [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: 03/16/2023] Open
Abstract
Resumo Objetivo: Avaliar o desempenho diagnóstico da biópsia pulmonar percutânea transtorácica (BPPT) guiada por fluoroscopia associada a tomografia computadorizada (FTC) em nódulos pulmonares ≤ 10 mm no período de pandemia de COVID-19. Materiais e Métodos: No período de 1º de janeiro de 2020 a 30 de abril de 2022, 359 BPPTs guiadas por FTC foram realizadas em um centro terciário de radiologia intervencionista. As lesões pulmonares mediam entre 2 mm e 108 mm. Dessas 359 BPPTs, 27 (7,5%) foram realizadas com agulha 18G em nódulos de 2 mm a 10 mm. Resultados: Das 27 BPPTs realizadas nos nódulos ≤ 10 mm, quatro lesões tinham dimensões menores que 5 mm e 23 lesões mediam entre 5 e 10 mm. Sensibilidade e acurácia diagnóstica das BPPTs guiadas por FTC foram de 100% e 92,3%, respectivamente. A dose média de radiação ionizante para os pacientes durante o procedimento de BPPT guiada por FTC foi de 581,33 mGy*cm, variando de 303 a 1129 mGy*cm. A média de tempo dos procedimentos de biópsia foi de 6,6 minutos, variando de 2 a 12 minutos. Nas 27 BPPTs, nenhuma complicação maior foi descrita. Conclusão: A BBPT guiada por FTC resultou em alto rendimento diagnóstico e baixas taxas de complicações.
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Hochhegger B, Pelaez A, Machuca T, Mohammed TL, Patel P, Zanon M, Torres F, Altmayer S, Nascimento DZ. CT imaging findings in lung transplant recipients with COVID-19. Eur Radiol 2023; 33:2089-2095. [PMID: 36152040 PMCID: PMC9510464 DOI: 10.1007/s00330-022-09148-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our goal was to compare the chest computed tomography (CT) imaging findings of COVID-19 in lung transplant recipients (LTR) and a group of non-transplanted controls (NTC). METHODS This retrospective study included 51 consecutive LTR hospitalized with COVID-19 from two centers. A total of 75 NTC were included for comparison. Images were classified regarding the standardized RSNA category, main pattern of lung attenuation, and longitudinal and axial distribution. Quantitative CT (QCT) analysis was performed to evaluate percentage of high attenuation areas (%HAA, threshold -250 to -700 HU). CT scoring was used to measure severity of parenchymal abnormalities. RESULTS The imaging findings of COVID-19 in LTR were significantly different from controls regarding the RSNA classification and pattern of lung attenuation. LTR had a significantly higher proportion of patients with an indeterminate pattern on CT (0.31 vs. 0.11, p = 0.014). The most frequent pattern of attenuation in LTR was predominantly consolidation (0.39 vs. 0.22, p = 0.144) followed by a mixed pattern of ground-glass opacities (GGO) and consolidation (0.37 vs. 0.20, adjusted p = 0.102). On the other hand, the most common pattern in NTC was GGO predominant (0.58 vs. 0.24 of LTR, p = 0.001). LTR had significantly more severe parenchymal disease measured by CT score and %HAA by QCT (0.372 ± 0.08 vs. 0.148 ± 0.06, p < 0.001). CONCLUSION The most frequent finding of COVID-19 in LTR is a predominant pattern of consolidation. Compared to NTC, LTR more frequently demonstrated an indeterminate pattern according to the RSNA classification and more extensive lung abnormalities on QCT and semi-quantitative scoring. KEY POINTS • The most common CT finding of COVID-19 in LTR is a predominant pattern of consolidation followed by a mixed pattern of GGO and consolidation, while controls more often have a predominant pattern of GGO. • LTR more often presents with an indeterminate pattern of COVID-19 by RSNA classification than controls; therefore, molecular testing for COVID-19 is essential for LTR presenting with lower airway infection independently of imaging findings. • LTR had more extensive disease by semi-quantitative CT score and increased percentage areas of high attenuation on QCT.
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Affiliation(s)
- Bruno Hochhegger
- Department of Radiology, University of Florida, Gainesville, FL, USA.
| | - Andres Pelaez
- Department of Medicine, University of Florida, Gainesville, FL USA
| | - Tiago Machuca
- Department of Surgery, University of Florida, Gainesville, FL USA
| | | | - Pratik Patel
- Department of Radiology, University of Florida, Gainesville, FL USA
| | - Matheus Zanon
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Torres
- Department of Radiology, University of Toronto, Toronto, Canada
| | - Stephan Altmayer
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas Zaione Nascimento
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
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36
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Nunes TF, Inchingolo R, Kikuti CF, de Faria BB, Galhardo CAV, Tognini JRF, Marchiori E, Hochhegger B. Computed tomography fluoroscopy-guided percutaneous biopsy of pulmonary nodules ≤ 10 mm: retrospective analysis of procedures performed during the COVID-19 pandemic. Radiol Bras 2023; 56:1-7. [PMID: 36926361 PMCID: PMC10013188 DOI: 10.1590/0100-3984.2022.0062-en] [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: 06/07/2022] [Accepted: 08/24/2022] [Indexed: 03/15/2023] Open
Abstract
Objective To evaluate the diagnostic performance of computed tomography (CT) fluoroscopy-guided percutaneous transthoracic needle biopsy (PTNB) in pulmonary nodules ≤ 10 mm during the coronavirus disease 2019 pandemic. Materials and Methods Between January 1, 2020 and April 30, 2022, a total of 359 CT fluoroscopy-guided PTNBs were performed at an interventional radiology center. Lung lesions measured between 2 mm and 108 mm. Of the 359 PTNBs, 27 (7.5%) were performed with an 18G core needle on nodules ≤ 10 mm in diameter. Results Among the 27 biopsies performed on nodules ≤ 10 mm, the lesions measured < 5 mm in four and 5-10 mm in 23. The sensitivity and overall diagnostic accuracy of PTNB were 100% and 92.3%, respectively. The mean dose of ionizing radiation during PTNB was 581.33 mGy*cm (range, 303-1,129 mGy*cm), and the mean biopsy procedure time was 6.6 min (range, 2-12 min). There were no major postprocedural complications. Conclusion CT fluoroscopy-guided PTNB appears to provide a high diagnostic yield with low complication rates.
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Affiliation(s)
- Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian da Universidade
Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Riccardo Inchingolo
- Ospedale Generale Regionale Francesco Miulli, Acquaviva delle
Fonti, Puglia, Italy
| | - Cristina Faria Kikuti
- Hospital Universitário Maria Aparecida Pedrossian da Universidade
Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | | | | | - João Ricardo Filgueiras Tognini
- Universidade Federal de Mato Grosso do Sul (UFMS), Fundação de
Ensino e Pesquisa Miguel Couto da Unimed Campo Grande, Campo Grande, MS,
Brazil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ,
Brazil
| | - Bruno Hochhegger
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS),
Porto Alegre, RS, Brazil
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Hochhegger B, Patel PP, Zanon M, Müller E, Ferreira Correa L, Verma N, Mohammed TL, Quinto Dos Reis Hochhegger D, Irion K, Marchiori E. Narrowing the Differential Diagnosis of Cystic Lesions in Smokers with Expiratory CT Acquisition Using the Cyst-Airway Communication Hypothesis. Lung 2022; 200:817-820. [PMID: 36271930 DOI: 10.1007/s00408-022-00576-5] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 09/25/2022] [Indexed: 12/30/2022]
Abstract
The aim of this study was to assess percentage respiratory changes (δ) in the size of pulmonary cysts of different smoking-related etiologies. Retrospectively, we measured the cystic lesions due to histopathological-confirmed honeycombing from interstitial pulmonary fibrosis, pulmonary Langerhans cell histiocytosis (PLCH), and paraseptal emphysema, using paired inspiratory and expiratory CT scans. In a sample of 72 patients and 216 lesions, the mean diameter of PLCH and honeycombing decreased during expiration (PLCH, δ = 60.9%; p = 0.001; honeycombing, δ = 47.5%; p = 0.014). Conversely, paraseptal emphysema did not show any changes (δ = 5.2%; p = 0.34). In summary, our results demonstrated that cysts in smokers with PLCH and honeycombing fibrosis get smaller during expiratory CT scans, whereas the size of cystic-like lesions due to paraseptal emphysema and bullae tend to remain constant during respiratory cycles. These results support the hypothesis of cyst-airway communication in some cystic diseases, which could assist in the differential diagnosis in smoking-related lung diseases.
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Affiliation(s)
- Bruno Hochhegger
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd m509, Gainesville, FL, 32610, USA. .,Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619-900, Brazil. .,Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil.
| | - Pratik P Patel
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd m509, Gainesville, FL, 32610, USA
| | - Matheus Zanon
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619-900, Brazil.,Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil
| | - Enrico Müller
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619-900, Brazil
| | - Liana Ferreira Correa
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Av. Ipiranga, 6690, Porto Alegre, 90619-900, Brazil
| | - Nupur Verma
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil
| | - Tan-Lucien Mohammed
- Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil
| | - Daniela Quinto Dos Reis Hochhegger
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd m509, Gainesville, FL, 32610, USA.,Graduate Program in Pathology, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil
| | - Klaus Irion
- Department of Radiology, College of Medicine, University of Florida, 1600 SW Archer Rd m509, Gainesville, FL, 32610, USA.,Department of Radiology, Central Manchester University Hospitals, NHS Foundation Trust - Trust Headquarters, Cobbett House, Manchester Royal Infirmary, Oxford Road, Manchester, M139WL, UK
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro, Av. Carlos Chagas Filho, 373, Rio de Janeiro, 21941-902, Brazil
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Hochhegger B, Zanon M, Patel PP, Verma N, Eifer DA, Torres PPTES, Souza AS, Souza LVS, Mohammed TL, Marchiori E, Ackman JB. The diagnostic value of magnetic resonance imaging compared to computed tomography in the evaluation of fat-containing thoracic lesions. Br J Radiol 2022; 95:20220235. [PMID: 36125174 PMCID: PMC9733611 DOI: 10.1259/bjr.20220235] [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] [Received: 02/25/2022] [Revised: 08/09/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022] Open
Abstract
Intrathoracic fat-containing lesions may arise in the mediastinum, lungs, pleura, or chest wall. While CT can be helpful in the detection and diagnosis of these lesions, it can only do so if the lesions contain macroscopic fat. Furthermore, because CT cannot demonstrate microscopic or intravoxel fat, it can fail to identify and diagnose microscopic fat-containing lesions. MRI, employing spectral and chemical shift fat suppression techniques, can identify both macroscopic and microscopic fat, with resultant enhanced capability to diagnose these intrathoracic lesions non-invasively and without ionizing radiation. This paper aims to review the CT and MRI findings of fat-containing lesions of the chest and describes the fat-suppression techniques utilized in their assessment.
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Affiliation(s)
| | - Matheus Zanon
- Department of Radiology, Hospital São Lucas, Pontificia Universidade Catolica do Rio Grande do Sul - Av. Ipiranga, Porto Alegre, Brazil
| | - Pratik P Patel
- Department of Radiology, College of Medicine, University of Florida, Gainesville, United States
| | - Nupur Verma
- Department of Radiology, College of Medicine, University of Florida, Gainesville, United States
| | - Diego André Eifer
- Department of Radiology, Hospital São Lucas, Pontificia Universidade Catolica do Rio Grande do Sul - Av. Ipiranga, Porto Alegre, Brazil
| | | | - Arthur S Souza
- Department of Radiology, Rio Preto Radiodiagnostic Intitute – R. Cila, São José do Rio Preto, Brazil
| | | | - Tan-Lucien Mohammed
- Department of Radiology, College of Medicine, University of Florida, Gainesville, United States
| | - Edson Marchiori
- Department of Radiology, Federal University of Rio de Janeiro - Av. Carlos Chagas Filho, Rio de Janeiro, Brazil
| | - Jeanne B Ackman
- Department of Radiology, Division of Thoracic Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School - Founders House, Boston, United States
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Marchiori E, Hochhegger B, Zanetti G. Dense reticular pattern. J Bras Pneumol 2022; 48:e20220383. [PMID: 36449824 PMCID: PMC9747176 DOI: 10.36416/1806-3756/e20220383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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40
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Sousa C, Marchiori E, Youssef A, Mohammed TL, Patel P, Irion K, Pasini R, Mançano A, Souza A, Pasqualotto AC, Hochhegger B. Chest Imaging in Systemic Endemic Mycoses. J Fungi (Basel) 2022; 8:1132. [PMID: 36354899 PMCID: PMC9692403 DOI: 10.3390/jof8111132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 09/20/2023] Open
Abstract
Endemic fungal infections are responsible for high rates of morbidity and mortality in certain regions of the world. The diagnosis and management remain a challenge, and the reason could be explained by the lack of disease awareness, variability of symptoms, and insidious and often overlooked clinical presentation. Imaging findings are nonspecific and frequently misinterpreted as other more common infectious or malignant diseases. Patient demographics and clinical and travel history are important clues that may lead to a proper diagnosis. The purpose of this paper is to review the presentation and differential diagnosis of endemic mycoses based on the most common chest imaging findings.
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Affiliation(s)
- Célia Sousa
- Radiology Department, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
| | - Edson Marchiori
- Radiology Department, Universidade Federal de Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Ali Youssef
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Tan-Lucien Mohammed
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Pratik Patel
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Klaus Irion
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Romulo Pasini
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Alexandre Mançano
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
| | - Arthur Souza
- Radiology Department, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto 15090-000, Brazil
| | | | - Bruno Hochhegger
- Radiology Department, University of Florida Health Shands Hospital, Gainesville, FL 32608, USA
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Variability of pulmonary nodule volumetry on coronary CT angiograms. Medicine (Baltimore) 2022; 101:e30332. [PMID: 36107569 PMCID: PMC9439735 DOI: 10.1097/md.0000000000030332] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study aims to investigate the variability of pulmonary nodule (PN) volumetry on multiphase coronary CT angiograms (CCTA). Two radiologists reviewed 5973 CCTA scans in this cross-sectional study to detect incidental solid noncalcified PNs measuring between 5 and 8 mm. Each radiologist measured the nodules' diameters and volume, in systole and diastole, using 2 commercially available software packages to analyze PNs. Bland-Altman analysis was applied between different observers, software packages, and cardiac phases. Bland-Altman subanalysis for the systolic and diastolic datasets were also performed. A total of 195 PNs were detected within the inclusion criteria and measured in systole and diastole. Bland-Altman analysis was used to test the variability of volumetry between cardiac phases ([-47.0%; 52.3%]), software packages ([-50.2%; 68.2%]), and observers ([-14.5%; 27.8%]). The inter-observer variability of the systolic and diastolic subsets was [-13.6%; 31.4%] and [-13.9%; 19.7%], respectively. Using diastolic volume measurements, the variability of PN volumetry on CCTA scans is similar to the reported variability of volumetry on low-dose CT scans. Therefore, growth estimation of PNs on CCTA scans could be feasible.
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Affiliation(s)
- Erique Pinto
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- *Correspondence: Erique Pinto, MD, EBIR, Rua Luís DE Camões, nº 102, lt 8, 3º esq, 1300—356 Lisbon, Portugal. (e-mail: )
| | - Diana Penha
- Universidade da Beira Interior Faculdade de Ciências da Saúde, Covilha, Portugal
- Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Colin Monaghan
- Radiology Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro Faculdade de Medicina, Rio DE Janeiro, RJ, Brazil
- Universidade Federal Fluminense Faculdade de Medicina, Niteroi, RJ, Brazil
| | | | - Klaus Irion
- Imaging Department, Manchester University NHS Foundation Trust, Manchester, United Kingdom
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Santos R, Teles G, Chate R, Szarf G, Franceschini J, de Araújo Neto C, Ghefter M, Drokin I, Guimaraes M, Hochhegger B. MA11.09 Artificial Intelligence in Lung Cancer Screening: Accuracy and Predictive Value. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.142] [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: 11/25/2022]
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Avila R, Krishnan K, Wynes M, Connolly C, McWilliams A, Logan J, Henschke C, Yankelevitz D, Pastorino U, Santos R, Hochhegger B, Ashizawa K, Kobayashi T, Rzyman W, Jelitto-Gorska M, Field J, Mulshine J, Lam S. EP01.04-005 Quantitative Characteristics in Global CT Lung Cancer Screening Populations Using the ELIC Distributed Database and Computation Environment. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.300] [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: 10/14/2022]
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Avila R, Krishnan K, Wynes M, Connolly C, McWilliams A, Logan J, Henschke C, Yankelevitz D, Pastorino U, Santos R, Hochhegger B, Ashizawa K, Kobayashi T, Rzyman W, Jelitto-Gorska M, Field J, Mulshine J, Lam S. MA11.07 The ELIC Distributed Database and Computation Environment for Analyses of Lung Cancer Screening LDCTs Across the World. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.140] [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: 11/30/2022]
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45
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Marchiori E, Hochhegger B, Zanetti G. Diffuse thickening of the tracheal wall, with calcifications. J Bras Pneumol 2022; 48:e20220223. [PMID: 35894417 PMCID: PMC9496260 DOI: 10.36416/1806-3756/e20220223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS), Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ), Brasil
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Barros MC, Hochhegger B, Altmayer S, Zanon M, Sartori G, Watte G, do Nascimento MHS, Chatkin JM. The Normal Lung Index From Quantitative Computed Tomography for the Evaluation of Obstructive and Restrictive Lung Disease. J Thorac Imaging 2022; 37:246-252. [PMID: 35749622 DOI: 10.1097/rti.0000000000000629] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective was to evaluate whether the normal lung index (NLI) from quantitative computed tomography (QCT) analysis can be used to predict mortality as well as pulmonary function tests (PFTs) in patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). MATERIALS AND METHODS Normal subjects (n=20) and patients with COPD (n=172) and ILD (n=114) who underwent PFTs and chest CT were enrolled retrospectively in this study. QCT measures included the NLI, defined as the ratio of the lung with attenuation between -950 and -700 Hounsfield units (HU) over the total lung volume (-1024 to -250 HU, mL), high-attenuation area (-700 to -250 HU, %), emphysema index (>6% of pixels < -950 HU), skewness, kurtosis, and mean lung attenuation. Coefficients of correlation between QCT measurements and PFT results in all subjects were calculated. Univariate and multivariate survival analyses were performed to assess mortality prediction by disease. RESULTS The Pearson correlation analysis showed that the NLI correlated moderately with the forced expiratory volume in 1 second in subjects with COPD (r=0.490, P<0.001) and the forced vital capacity in subjects with ILD (r=0.452, P<0.001). Multivariate analysis revealed that the NLI of <70% was a significant independent predictor of mortality in subjects with COPD (hazard ratio=3.14, P=0.034) and ILD (hazard ratio=2.72, P=0.005). CONCLUSION QCT analysis, specifically the NLI, can also be used to predict mortality in individuals with COPD and ILD.
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Affiliation(s)
| | | | | | - Matheus Zanon
- Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre
| | - Gabriel Sartori
- Irmandade Santa Casa de Misericordia de Porto Alegre, Porto Alegre
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Hochhegger B, Altmayer S. Traumatic sternal fractures. Radiol Bras 2022; 55:IX. [PMID: 35983348 PMCID: PMC9380610 DOI: 10.1590/0100-3984.2022.55.4e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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Braithwaite D, Karanth SD, Slatore CG, Zhang D, Bian J, Meza R, Jeon J, Tammemagi M, Schabath M, Wheeler M, Guo Y, Hochhegger B, Kaye FJ, Silvestri GA, Gould MK. Personalised Lung Cancer Screening (PLuS) study to assess the importance of coexisting chronic conditions to clinical practice and policy: protocol for a multicentre observational study. BMJ Open 2022; 12:e064142. [PMID: 35732383 PMCID: PMC9226937 DOI: 10.1136/bmjopen-2022-064142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/30/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Lung cancer is the leading cause of cancer death in the USA and worldwide, and lung cancer screening (LCS) with low-dose CT (LDCT) has the potential to improve lung cancer outcomes. A critical question is whether the ratio of potential benefits to harms found in prior LCS trials applies to an older and potentially sicker population. The Personalised Lung Cancer Screening (PLuS) study will help close this knowledge gap by leveraging real-world data to fully characterise LCS recipients. The principal goal of the PLuS study is to characterise the comorbidity burden of individuals undergoing LCS and quantify the benefits and harms of LCS to enable informed decision-making. METHODS AND ANALYSIS PLuS is a multicentre observational study designed to assemble an LCS cohort from the electronic health records of ~40 000 individuals undergoing annual LCS with LDCT from 2016 to 2022. Data will be integrated into a unified repository to (1) examine the burden of multimorbidity by race/ethnicity, socioeconomic status and age; (2) quantify potential benefits and harms; and (3) use the observational data with validated simulation models in the Cancer Intervention and Surveillance Modeling Network (CISNET) to provide LCS outcomes in the real-world US population. We will fit a multivariable logistic regression model to estimate the adjusted ORs of comorbidity, functional limitations and impaired pulmonary function adjusted for relevant covariates. We will also estimate the cumulative risk of LCS outcomes using discrete-time survival models. To our knowledge, this is the first study to combine observational data and simulation models to estimate the long-term impact of LCS with LDCT. ETHICS AND DISSEMINATION The study was approved by the Kaiser Permanente Southern California Institutional Review Board and VA Portland Health Care System. The results will be disseminated through publications and presentations at national and international conferences. Safety considerations include protection of patient confidentiality.
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Affiliation(s)
- Dejana Braithwaite
- Department of Surgery, University of Florida, Gainesville, Florida, USA
- Cancer Center, UF Health, Gainesville, Florida, USA
| | - Shama D Karanth
- Cancer Center, UF Health, Gainesville, Florida, USA
- Institute on Aging, University of Florida, Gainesville, Florida, USA
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, Portland VA Medical Center, Portland, Oregon, USA
| | - Dongyu Zhang
- Cancer Center, UF Health, Gainesville, Florida, USA
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Jiang Bian
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Tammemagi
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Mattthew Schabath
- Department of Cancer Epidemiology, H Lee Moffitt Cancer Center and Research Center Inc, Tampa, Florida, USA
| | - Meghann Wheeler
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Yi Guo
- Department of Health Outcomes & Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Bruno Hochhegger
- Department of Radiology, University of Florida, Gainesville, Florida, USA
| | - Frederic J Kaye
- Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Gerard A Silvestri
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Michael K Gould
- Department of Health Systems Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, California, USA
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Marchiori E, Hochhegger B, Zanetti G. Widening of the mediastinum. J Bras Pneumol 2022; 48:e20220158. [PMID: 35703621 PMCID: PMC9262426 DOI: 10.36416/1806-3756/e20220158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Edson Marchiori
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Bruno Hochhegger
- . Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre (RS) Brasil
| | - Gláucia Zanetti
- . Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
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50
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Pinto E, Penha D, Hochhegger B, Monaghan C, Marchiori E, Taborda-Barata L, Irion K. Incidental chest findings on coronary CT angiography: a pictorial essay and management proposal. J Bras Pneumol 2022; 48:e20220015. [PMID: 35584528 PMCID: PMC9064655 DOI: 10.36416/1806-3756/e20220015] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/07/2022] [Indexed: 11/17/2022]
Abstract
Many health systems have been using coronary CT angiography (CCTA) as a first-line examination for ischaemic heart disease patients in various countries. The rising number of CCTA examinations has led to a significant increase in the number of reported incidental extracardiac findings, mainly in the chest. Pulmonary nodules are the most common incidental findings on CCTA scans, as there is a substantial overlap of risk factors between the population seeking to exclude ischaemic heart disease and those at risk of developing lung cancer (i.e., advanced age and smoking habits). However, most incidental findings are clinically insignificant and actively pursuing them could be cost-prohibitive and submit the patient to unnecessary and potentially harmful examinations. Furthermore, there is little consensus regarding when to report or actively exclude these findings and how to manage them, that is, when to trigger an alert or to immediately refer the patient to a pulmonologist, a thoracic surgeon or a multidisciplinary team. This pictorial essay discusses the current literature on this topic and is illustrated with a review of CCTA scans. We also propose a checklist organised by organ and system, recommending actions to raise awareness of pulmonologists, thoracic surgeons, cardiologists and radiologists regarding the most significant and actionable incidental findings on CCTA scans.
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Affiliation(s)
- Erique Pinto
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Diana Penha
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,. Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Bruno Hochhegger
- . Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre (RS) Brasil
| | - Colin Monaghan
- . Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
| | - Edson Marchiori
- . Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil.,. Faculdade de Medicina, Universidade Federal Fluminense, Niterói (RJ) Brasil
| | - Luís Taborda-Barata
- . Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
| | - Klaus Irion
- . Imaging Department, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, United Kingdom
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