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Chang KJ, Kim DH, Lalani TK, Paroder V, Pickhardt PJ, Shaish H, Bates DDB. Radiologic T staging of colon cancer: renewed interest for clinical practice. Abdom Radiol (NY) 2023; 48:2874-2887. [PMID: 37277570 DOI: 10.1007/s00261-023-03904-2] [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: 01/09/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 06/07/2023]
Abstract
Radiologic imaging, especially MRI, has long been the mainstay for rectal cancer staging and patient selection for neoadjuvant therapy prior to surgical resection. In contrast, colonoscopy and CT have been the standard for colon cancer diagnosis and metastasis staging with T and N staging often performed at the time of surgical resection. With recent clinical trials exploring the expansion of the use of neoadjuvant therapy beyond the anorectum to the remainder of the colon, the current and future state of colon cancer treatment is evolving with a renewed interest in evaluating the role radiology may play in the primary T staging of colon cancer. The performance of CT, CT colonography, MRI, and FDG PET-CT for colon cancer staging will be reviewed. N staging will also be briefly discussed. It is expected that accurate radiologic T staging will significantly impact future clinical decisions regarding the neoadjuvant versus surgical management of colon cancer.
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Affiliation(s)
- Kevin J Chang
- Department of Radiology, Boston University Medical Center, Radiology- FGH 4001, 820 Harrison Ave, Boston, MA, 02118, USA.
| | - David H Kim
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tasneem K Lalani
- Diagnostic Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Perry J Pickhardt
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hiram Shaish
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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2
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Golia Pernicka JS, Rauch GM, Gangai N, Bates DDB, Ernst R, Hope TA, Horvat N, Sheedy SP, Gollub MJ. Imaging of Anal Squamous Cell Carcinoma: Survey Results and Expert Opinion from the Rectal and Anal Cancer Disease-Focused Panel of the Society of Abdominal Radiology. Abdom Radiol (NY) 2023; 48:3022-3032. [PMID: 36932225 PMCID: PMC10929685 DOI: 10.1007/s00261-023-03863-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/19/2023]
Abstract
The role and method of image-based staging of anal cancer has evolved with the rapid development of newer imaging modalities and the need to address the rising incidence of this rare cancer. In 2014, the European Society of Medical Oncology mandated pelvic magnetic resonance imaging (MRI) for anal cancer and subsequently other societies such as the National Comprehensive Cancer Network followed suit with similar recommendations. Nevertheless, great variability exists from center to center and even within individual centers. Notably, this is in stark contrast to the imaging of the anatomically nearby rectal cancer. As participating team members for this malignancy, we embarked on a comprehensive literature review of anal cancer imaging to understand the relative merits of these new technologies which developed after computed tomography (CT), e.g., MRI and positron emission tomography/computed tomography (PET/CT). The results of this literature review helped to inform our next stage: questionnaire development regarding the imaging of anal cancer. Next, we distributed the questionnaire to members of the Society of Abdominal Radiology (SAR) Rectal and Anal Disease-Focused Panel, a group of abdominal radiologists with special interest, experience, and expertise in rectal and anal cancer, to provide expert radiologist opinion on the appropriate anal cancer imaging strategy. In our expert opinion survey, experts advocated the use of MRI in general (65% overall and 91-100% for primary staging clinical scenarios) and acknowledged the superiority of PET/CT for nodal assessment (52-56% agreement for using PET/CT in primary staging clinical scenarios compared to 30% for using MRI). We therefore support the use of MRI and PET and suggest further exploration of PET/MRI as an optimal combined evaluation. Our questionnaire responses emphasized the heterogeneity in imaging practice as performed at numerous academic cancer centers across the United States and underscore the need for further reconciliation and establishment of best imaging practice guidelines for optimized patient care in anal cancer.
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Affiliation(s)
- Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA.
- , 530 E 74th St, Room 07118, New York, NY, 10021, USA.
| | - Gaiane M Rauch
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Randy Ernst
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Thomas A Hope
- Departments of Radiology and Biomedical Imaging and Pharmaceutical Chemistry, University of California San Francisco, San Francisco, CA, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | | | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
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Kim TH, Firat C, Thompson HM, Gangai N, Zheng J, Capanu M, Bates DDB, Paroder V, García-Aguilar J, Shia J, Gollub MJ, Horvat N. Extramural Venous Invasion and Tumor Deposit at Diffusion-weighted MRI in Patients after Neoadjuvant Treatment for Rectal Cancer. Radiology 2023; 308:e230079. [PMID: 37581503 PMCID: PMC10478788 DOI: 10.1148/radiol.230079] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 08/16/2023]
Abstract
Background Diffusion-weighted (DW) imaging is useful in detecting tumor in the primary tumor bed in locally advanced rectal cancer (LARC) after neoadjuvant therapy, but its value in detecting extramural venous invasion (EMVI) and tumor deposit is not well validated. Purpose To evaluate diagnostic accuracy and association with patient prognosis of viable EMVI and tumor deposit on DW images in patients with LARC after neoadjuvant therapy using whole-mount pathology specimens. Materials and Methods This retrospective study included patients who underwent neoadjuvant therapy and surgery from 2018 to 2021. Innovative five-point Likert scale was used by two radiologists to independently evaluate the likelihood of viable EMVI and tumor deposit on restaging DW MRI scans in four axial quadrants (12 to 3 o'clock, 3 to 6 o'clock, 6 to 9 o'clock, and 9 to 12 o'clock). Diagnostic accuracy was assessed at both the per-quadrant and per-patient level, with whole-mount pathology as the reference standard. Weighted κ values for interreader agreement and Cox regression models for disease-free survival and overall survival analyses were used. Results A total of 117 patients (mean age, 56 years ± 12 [SD]; 70 male, 47 female) were included. Pathologically proven viable EMVI and tumor deposit was detected in 29 of 117 patients (25%) and in 44 of 468 quadrants (9.4%). Per-quadrant analyses showed an area under the receiver operating characteristics curve of 0.75 (95% CI: 0.68, 0.83), with sensitivity and specificity of 55% and 96%, respectively. Good interreader agreement was observed between the radiologists (κ = 0.62). Per-patient analysis showed sensitivity and specificity of 62% and 93%, respectively. The presence of EMVI and tumor deposit on restaging DW MRI scans was associated with worse disease-free survival (hazard ratio [HR], 5.6; 95% CI: 2.4, 13.3) and overall survival (HR, 8.9; 95% CI: 1.6, 48.5). Conclusion DW imaging using the five-point Likert scale showed high specificity and moderate sensitivity in the detection of viable extramural venous invasion and tumor deposits in LARC after neoadjuvant therapy, and its presence on restaging DW MRI scans is associated with worse prognosis. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Méndez and Ayuso in this issue.
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Affiliation(s)
| | | | - Hannah M. Thompson
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Natalie Gangai
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Junting Zheng
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Marinela Capanu
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - David D. B. Bates
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Viktoriya Paroder
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Julio García-Aguilar
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Jinru Shia
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Marc J. Gollub
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Natally Horvat
- From the Departments of Radiology (T.H.K., N.G., D.D.B.B., V.P.,
M.J.G., N.H.), Pathology (C.F., J.S.), Surgery (H.M.T., J.G.A.), and
Epidemiology and Biostatistics (J.Z., M.C.), Memorial Sloan-Kettering Cancer
Center, 1275 York Ave, Box 29, New York, NY 10065
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Thompson HM, Bates DDB, Pernicka JG, Park SJ, Nourbakhsh M, Fuqua JL, Fiasconaro M, Lavery JA, Wei IH, Pappou EP, Smith JJ, Nash GM, Weiser MR, Paty PB, Garcia-Aguilar J, Widmar M. ASO Visual Abstract: MRI Assessment of Extramural Venous Invasion Before and After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer and its Association with Disease-Free and Overall Survival. Ann Surg Oncol 2023; 30:3967-3968. [PMID: 37085657 DOI: 10.1245/s10434-023-13290-0] [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: 04/23/2023]
Affiliation(s)
- Hannah M Thompson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | | | - Sun Jin Park
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Mahra Nourbakhsh
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - James L Fuqua
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Megan Fiasconaro
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jessica A Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Iris H Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanouil P Pappou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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5
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Thompson HM, Bates DDB, Pernicka JG, Park SJ, Nourbakhsh M, Fuqua JL, Fiasconaro M, Lavery JA, Wei IH, Pappou EP, Smith JJ, Nash GM, Weiser MR, Paty PB, Garcia-Aguilar J, Widmar M. MRI Assessment of Extramural Venous Invasion Before and After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer and Its Association with Disease-Free and Overall Survival. Ann Surg Oncol 2023; 30:3957-3965. [PMID: 36964328 PMCID: PMC10394736 DOI: 10.1245/s10434-023-13225-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 01/27/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Extramural venous invasion (EMVI) on baseline MRI is associated with poor prognosis in patients with locally advanced rectal cancer. This study investigated the association of persistent EMVI after total neoadjuvant therapy (TNT) (chemoradiotherapy and systemic chemotherapy) with survival. METHODS Baseline MRI, post-TNT MRI, and surgical pathology data from 175 patients with locally advanced rectal cancer who underwent TNT and total mesorectal excision between 2010 and 2017 were retrospectively analyzed for evidence of EMVI. Two radiologists assessed EMVI status with disagreement adjudicated by a third. Pathologic EMVI status was assessed per departmental standards. Cox regression models evaluated the associations between EMVI and disease-free and overall survival. RESULTS EMVI regression on both post-TNT MRI and surgical pathology was associated with disease-free survival (hazard ratio, 0.17; 95% confidence interval (CI), 0.04-0.64) and overall survival (hazard ratio, 0.11; 95% CI, 0.02-0.68). In an exploratory analysis of 35 patients with EMVI on baseline MRI, only six had EMVI on pathology compared with 18 on post-TNT MRI; these findings were not associated (p = 0.2). Longer disease-free survival was seen with regression on both modalities compared with remaining positive. Regression on pathology alone, independent of MRI EMVI status, was associated with similar improvements in survival. CONCLUSIONS Baseline EMVI is associated with poor prognosis even after TNT. EMVI regression on surgical pathology is common even with persistent EMVI on post-TNT MRI. EMVI regression on surgical pathology is associated with improved DFS, while the utility of post-TNT MRI EMVI persistence for decision-making and prognosis remains unclear.
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Affiliation(s)
- Hannah M Thompson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Sun Jin Park
- Department of Surgery, Kyung Hee University College of Medicine, Seoul, Korea
| | - Mahra Nourbakhsh
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James L Fuqua
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Megan Fiasconaro
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jessica A Lavery
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iris H Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanouil P Pappou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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El Homsi M, Bates DDB, Mazaheri Y, Sosa R, Gangai N, Petkovska I. Multiplexed sensitivity-encoding diffusion-weighted imaging (MUSE) in diffusion-weighted imaging for rectal MRI: a quantitative and qualitative analysis at multiple b-values. Abdom Radiol (NY) 2023; 48:448-457. [PMID: 36307596 PMCID: PMC9905276 DOI: 10.1007/s00261-022-03710-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 01/19/2023]
Abstract
PURPOSE To compare four diffusion-weighted imaging (DWI) sequences for image quality, rectal contour, and lesion conspicuity, and to assess the difference in their signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR), and apparent diffusion coefficient (ADC). METHODS In this retrospective study of 36 consecutive patients who underwent 3.0 T rectal MRI from January-June 2020, DWI was performed with single-shot echo planar imaging (ss-EPI) (b800 s/mm2), multiplexed sensitivity encoding (MUSE) (b800 s/mm2), MUSE (b1500 s/mm2), and field-of-view optimized and constrained undistorted single-shot (FOCUS) (b1500 s/mm2). Two radiologists independently scored image quality using a 5-point Likert scale. Inter-reader agreement was assessed using the weighted Cohen's к. SNR, CNR, and ADC measurements were compared using the paired t-test. RESULTS For both readers, MUSE b800 scored significantly higher for image quality, rectal contour, and lesion conspicuity compared to ss-EPI; MUSE b800 also scored significantly higher for image quality and rectal contour compared to all other sequences. Lesion conspicuity was equally superior for MUSE b800 and MUSE b1500 compared to the other two sequences. There was good to excellent inter-reader agreement for all qualitative features (к = 0.72-0.88). MUSE b800 had the highest SNR; MUSE b1500 had the highest CNR. A significant difference in ADC was observed between ss-EPI compared to the other sequences (p < 0.001) and between MUSE b800 and FOCUS. No significant difference in ADC was found between MUSE b1500 and FOCUS b1500. CONCLUSION MUSE b800 improved image quality over ss-EPI and both MUSE b800 and b1500 showed better tumor conspicuity compared to conventional ss-EPI.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ramon Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Kassam Z, Lang R, Bates DDB, Chang KJ, Fraum TJ, Friedman KA, Golia Pernicka JS, Gollub MJ, Harisinghani M, Khatri G, Lall C, Lee S, Magnetta M, Nougaret S, Paspulati RM, Paroder V, Shaish H, Kim DH. SAR user guide to the rectal MR synoptic report (primary staging). Abdom Radiol (NY) 2023; 48:186-199. [PMID: 35754053 DOI: 10.1007/s00261-022-03578-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023]
Abstract
Rectal MR is the key diagnostic exam at initial presentation for rectal cancer patients. It is the primary determinant in establishing clinical stage for the patient and greatly impacts the clinical decision-making process. Consequently, structured reporting for MR is critically important to ensure that all required information is provided to the clinical care team. The SAR initial staging reporting template has been constructed to address these important items, including locoregional extent and factors impacting the surgical approach and management of the patient. Potential outputs to each item are defined, requiring the radiologist to commit to a result. This provides essential information to the surgeon or oncologist to make specific treatment deisions for the patient. The SAR Initial Staging MR reporting template has now been officially adopted by the NAPRC (National Accreditation Program for Rectal Cancer) under the American College of Surgery. With the recent revisions to the reporting template, this user guide has been revamped to improve its practicality and support to the radiologist to complete the structured report. Each line item of the report is supplemented with clinical perspectives, images, and illustrations to help the radiologist understand the potential implications for a given finding. Common errors and pitfalls to avoid are highlighted. Ideally, rectal MR interpretation should not occur in a vacuum but in the context of a multi-disciplinary tumor board to ensure that healthcare providers use common terminology and share a solid understanding of the strengths and weaknesses of MR.
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Affiliation(s)
- Z Kassam
- Western University, London, Canada
| | - R Lang
- Western University, London, Canada
| | | | | | - T J Fraum
- Mallinckrodt Institute of Radiology, St. Louis, USA
| | - K A Friedman
- University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | | | | | - G Khatri
- University of Texas Southwestern, Dallas, USA
| | - C Lall
- University of Florida-Jacksonville, Jacksonville, USA
| | - S Lee
- University of California, Irvine, USA
| | | | - S Nougaret
- Montpellier Cancer Institute, U1194, Montpellier University, Montpellier, France
| | - R M Paspulati
- University Hospital, Case Western Reserve University, Cleveland, USA
| | - V Paroder
- Memorial Sloan Kettering, New York, USA
| | - H Shaish
- Columbia University Medical Center, New York, USA
| | - D H Kim
- Department of Radiology, University of Wisconsin Medical School, University of Wisconsin, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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Kassam Z, Lang R, Bates DDB, Chang KJ, Fraum TJ, Friedman KA, Golia Pernicka JS, Gollub MJ, Harisinghani M, Khatri G, Lall C, Lee S, Magnetta M, Nougaret S, Paspulati RM, Paroder V, Shaish H, Kim DH, Baheti A, Beets-Tan R, dePrisco G, Ernst R, Ganeshan D, Hope T, Horvat N, Jhaveri K, Kaur H, Korngold E, Lalwani N, Moreno C, Petkovska I, Pickhardt PJ, Rauche G, Sheedy S. Correction: SAR user guide to the rectal MR synoptic report (primary staging). Abdom Radiol (NY) 2023; 48:200. [PMID: 36114288 DOI: 10.1007/s00261-022-03656-5] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Z Kassam
- Western University, London, Canada
| | - R Lang
- Western University, London, Canada
| | | | | | - T J Fraum
- Mallinckrodt Institute of Radiology, St. Louis, USA
| | - K A Friedman
- University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | | | | | - G Khatri
- University of Texas Southwestern, Dallas, USA
| | - C Lall
- University of Florida-Jacksonville, Jacksonville, USA
| | - S Lee
- University of California, Irvine, USA
| | | | - S Nougaret
- Montpellier Cancer Institute, U1194, Montpellier University, Montpellier, France
| | - R M Paspulati
- University Hospital, Case Western Reserve University, Cleveland, USA
| | - V Paroder
- Memorial Sloan Kettering, New York, USA
| | - H Shaish
- Columbia University Medical Center, New York, USA
| | - D H Kim
- Department of Radiology, University of Wisconsin Medical School, University of Wisconsin, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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Galgano SJ, Morani AC, Gopireddy DR, Sharbidre K, Bates DDB, Goenka AH, Arif-Tiwari H, Itani M, Iravani A, Javadi S, Faria S, Lall C, Bergsland E, Verma S, Francis IR, Halperin DM, Chatterjee D, Bhosale P, Yano M. Pancreatic neuroendocrine neoplasms: a 2022 update for radiologists. Abdom Radiol (NY) 2022; 47:3962-3970. [PMID: 35244755 DOI: 10.1007/s00261-022-03466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 01/18/2023]
Abstract
Pancreatic neuroendocrine neoplasms (PaNENs) are a unique group of pancreatic neoplasms with a wide range of clinical presentations and behaviors. Given their heterogeneous appearance and increasing detection on cross-sectional imaging, it is essential that radiologists understand the variable presentation and distinctions PaNENs display compared to other pancreatic neoplasms. Additionally, some of these neoplasms may be hormonally functional, and it is imperative that radiologists be aware of the common clinical presentations of hormonally active PaNENs. Knowledge of PaNEN pathology and treatments may influence which imaging modality is optimal for each patient. Each imaging modality used for PaNENs has distinct advantages and disadvantages, particularly in different treatment settings. Thus, the focus of this manuscript is to provide an update for the radiologist on PaNEN pathology, imaging, and treatments.
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Affiliation(s)
- Samuel J Galgano
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | - Dheeraj R Gopireddy
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, FL, USA
| | - Kedar Sharbidre
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ajit H Goenka
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Hina Arif-Tiwari
- Department of Radiology, University of Arizona-Tuscon, Tuscon, AZ, USA
| | - Malak Itani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Amir Iravani
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Sanaz Javadi
- Department of Radiology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Silvana Faria
- Department of Radiology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Chandana Lall
- Department of Radiology, University of Florida-Jacksonville, Jacksonville, FL, USA
| | - Emily Bergsland
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Sadhna Verma
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
| | - Isaac R Francis
- Department of Radiology, Michigan Medicine, Ann Arbor, MI, USA
| | - Daniel M Halperin
- Department of Gastrointestinal Medical Oncology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Deyali Chatterjee
- Department of Pathology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Priya Bhosale
- Department of Radiology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Motoyo Yano
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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10
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Chang H, Bates DDB, Gupta A, LeBedis CA. Use of MR in Pancreaticobiliary Emergencies. Magn Reson Imaging Clin N Am 2022; 30:479-499. [PMID: 35995475 DOI: 10.1016/j.mric.2022.04.009] [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: 11/17/2022]
Abstract
This article presents the MR protocols, imaging features, diagnostic criteria, and complications of commonly encountered emergencies in pancreaticobiliary imaging, which include pancreatic trauma, bile leak, acute cholecystitis, biliary obstruction, and pancreatitis. Various classifications and complications that can arise with these conditions, as well as artifacts that may mimic pathology, are also included. Finally, the emerging utility of abbreviated MR protocols is discussed.
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Affiliation(s)
- Hailey Chang
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA.
| | - David D B Bates
- Department of Radiology, Cornell University, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Avneesh Gupta
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
| | - Christina A LeBedis
- Department of Radiology, Boston Medical Center, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA 02118, USA
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11
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El Homsi M, Horvat N, Woodlock DP, Araji A, Vargas HA, Bates DDB. CT Imaging Findings in Patients with Ovarian Cancer and Acute Abdominal Symptoms: Experience at a Tertiary Cancer Center. Emerg Radiol 2022; 29:947-952. [PMID: 35809140 DOI: 10.1007/s10140-022-02075-9] [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: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate computed tomography (CT) findings in patients with ovarian cancer presenting to a comprehensive cancer center's urgent care unit with acute abdominal symptoms. METHODS This retrospective study included consecutive patients with ovarian cancer who underwent abdominal CT at a comprehensive cancer center's urgent care unit between January 1, 2018, and January 14, 2020, due to acute abdominal symptoms. Two abdominal radiologists reviewed the abdominal CT reports, categorizing imaging findings as follows: (a) no new or acute finding, (b) new or increased bowel or gastric obstruction, (c) new or increased ascites, (d) new or increased peritoneal carcinomatosis, (e) new or increased nonperitoneal metastases, (f) new inflammatory or infectious changes, (g) new or increased hydronephrosis, (h) new or increased biliary dilatation, (i) new vascular complications, or (j) new bowel perforation. RESULTS A total of 200 patients (mean age, 59 years; range, 22-87) underwent a total of 259 abdominal CT scans, of which 217/259 (83.8%) scans were found to have new or increased findings. A total of 115/259 (44.4%) scans had only one finding while 102/259 (39.4%) scans had 2 or more findings. Altogether, 382 new or increased findings were detected: findings were most commonly related to bowel or gastric obstruction (92/382, 24.1%) with small bowel obstruction being the most common finding (80/382, 20.9%); ascites (78/382, 20.4%); peritoneal carcinomatosis (62/382, 16.2%); and nonperitoneal metastases (62/382, 16.2%). Inflammatory or infectious findings accounted for 30/382 (7.9%) findings. CONCLUSION Most patients with ovarian cancer presenting with acute abdominal had relevant positive findings on abdominal CT, with small bowel obstruction being the most common finding.
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Affiliation(s)
- Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - David P Woodlock
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Abdallah Araji
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - H Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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12
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Mazaheri Y, Thakur SB, Bitencourt AGV, Lo Gullo R, Hötker AM, Bates DDB, Akin O. Evaluation of cancer outcome assessment using MRI: A review of deep-learning methods. BJR Open 2022; 4:20210072. [PMID: 36105425 PMCID: PMC9459949 DOI: 10.1259/bjro.20210072] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Accurate evaluation of tumor response to treatment is critical to allow personalized treatment regimens according to the predicted response and to support clinical trials investigating new therapeutic agents by providing them with an accurate response indicator. Recent advances in medical imaging, computer hardware, and machine-learning algorithms have resulted in the increased use of these tools in the field of medicine as a whole and specifically in cancer imaging for detection and characterization of malignant lesions, prognosis, and assessment of treatment response. Among the currently available imaging techniques, magnetic resonance imaging (MRI) plays an important role in the evaluation of treatment assessment of many cancers, given its superior soft-tissue contrast and its ability to allow multiplanar imaging and functional evaluation. In recent years, deep learning (DL) has become an active area of research, paving the way for computer-assisted clinical and radiological decision support. DL can uncover associations between imaging features that cannot be visually identified by the naked eye and pertinent clinical outcomes. The aim of this review is to highlight the use of DL in the evaluation of tumor response assessed on MRI. In this review, we will first provide an overview of common DL architectures used in medical imaging research in general. Then, we will review the studies to date that have applied DL to magnetic resonance imaging for the task of treatment response assessment. Finally, we will discuss the challenges and opportunities of using DL within the clinical workflow.
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Affiliation(s)
| | | | | | - Roberto Lo Gullo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Andreas M. Hötker
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
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13
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Gollub MJ, Lobaugh S, Golia Pernicka JS, Simmers CDA, Bates DDB, Fuqua JL, Paroder V, Petkovska I, Weiser MR, Capanu M. Occurrence of peritoneal carcinomatosis in patients with rectal cancer undergoing staging pelvic MRI: clinical observations. Eur Radiol 2022; 32:5097-5105. [PMID: 35319077 PMCID: PMC9283216 DOI: 10.1007/s00330-022-08694-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 01/14/2022] [Accepted: 02/25/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Describe the cumulative incidence (CUIN) of peritoneal carcinomatosis (PC) and survival in patients presenting with advanced rectal cancer at staging pelvic MRI. METHODS From 2013 to 2018, clinicopathologic records of patients with pretreatment rectal MRI clinical (c)T3c, cT3d, cT4a, and cT4b primary rectal adenocarcinoma were retrospectively reviewed by two radiologists. Standard MRI descriptors and pathologic stages were recorded. Recurrence-free (RFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Development of PC was explored using competing risk analysis. Differences in survival were compared using the log-rank test. Gray's test was used to test for differences in CUIN of PC. RESULTS Three hundred forty-three patients (147 women; median age, 56 years) had MRI stages cT3cd, n = 170; cT4a, n = 40; and cT4b, n = 133. Median follow-up among survivors was 27 months (0.36-70 months). For M1 patients, OS differed only by cT stage (2-year OS: cT3 88.1%, cT4a 79.1%, cT4b 64.7%, p = 0.045). For M0 patients, OS and RFS differed only by pathological (p)T stage. We observed a statistically significant difference in the cumulative incidence of PC by cT stage (2-year CUIN: cT3 3.2%, cT4a 8.5%, cT4b 1.6%, p = 0.01), but not by pT stage. Seventy-nine patients (23%) presented with metastatic disease (M1), eight with PC (2.3%). Overall, eight patients presented with PC (cT4a: n = 4, other stages: n = 4) and 22 developed PC (cT4a: n = 5, other stages: n = 17). CONCLUSIONS PC is uncommon in rectal cancer. MRI-based T stage exhibited an overall association with the cumulative incidence of PC, and descriptively, cT4a stage appears to have the highest CUIN. KEY POINTS • In a retrospective study of 343 patients with rectal cancer undergoing baseline MRI and clinical follow-up, we found that peritoneal carcinomatosis was rare. • We observed a significant overall association between PC at presentation and cT stage that appeared to be driven by the higher proportion of cT4a patients presenting with PC. • Among patients that did not present with PC, we observed a significant overall association between time to PC and cT stage that may be driven by the higher cumulative incidence of PC in cT4a patients.
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Affiliation(s)
- Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Room H722, 1275 York Avenue, New York, NY, 10065, USA.
| | - Stephanie Lobaugh
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Room H722, 1275 York Avenue, New York, NY, 10065, USA
| | | | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Room H722, 1275 York Avenue, New York, NY, 10065, USA
| | - J Louis Fuqua
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Room H722, 1275 York Avenue, New York, NY, 10065, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Room H722, 1275 York Avenue, New York, NY, 10065, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, Room H722, 1275 York Avenue, New York, NY, 10065, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Jayaprakasam VS, Paroder V, Gibbs P, Bajwa R, Gangai N, Sosa RE, Petkovska I, Golia Pernicka JS, Fuqua JL, Bates DDB, Weiser MR, Cercek A, Gollub MJ. MRI radiomics features of mesorectal fat can predict response to neoadjuvant chemoradiation therapy and tumor recurrence in patients with locally advanced rectal cancer. Eur Radiol 2022; 32:971-980. [PMID: 34327580 PMCID: PMC9018044 DOI: 10.1007/s00330-021-08144-w] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/11/2021] [Accepted: 06/02/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To interrogate the mesorectal fat using MRI radiomics feature analysis in order to predict clinical outcomes in patients with locally advanced rectal cancer. METHODS This retrospective study included patients who underwent neoadjuvant chemoradiotherapy for locally advanced rectal cancer from 2009 to 2015. Three radiologists independently segmented mesorectal fat on baseline T2-weighted axial MRI. Radiomics features were extracted from segmented volumes and calculated using CERR software, with adaptive synthetic sampling being employed to combat large class imbalances. Outcome variables included pathologic complete response (pCR), local recurrence, distant recurrence, clinical T-category (cT), post-treatment T category (ypT), and post-treatment N category (ypN). A maximum of eight most important features were selected for model development using support vector machines and fivefold cross-validation to predict each outcome parameter via elastic net regularization. Diagnostic metrics of the final models were calculated, including sensitivity, specificity, PPV, NPV, accuracy, and AUC. RESULTS The study included 236 patients (54 ± 12 years, 135 men). The AUC, sensitivity, specificity, PPV, NPV, and accuracy for each clinical outcome were as follows: for pCR, 0.89, 78.0%, 85.1%, 52.5%, 94.9%, 83.9%; for local recurrence, 0.79, 68.3%, 80.7%, 46.7%, 91.2%, 78.3%; for distant recurrence, 0.87, 80.0%, 88.4%, 58.3%, 95.6%, 87.0%; for cT, 0.80, 85.8%, 56.5%, 89.1%, 49.1%, 80.1%; for ypN, 0.74, 65.0%, 80.1%, 52.7%, 87.0%, 76.3%; and for ypT, 0.86, 81.3%, 84.2%, 96.4%, 46.4%, 81.8%. CONCLUSION Radiomics features of mesorectal fat can predict pathological complete response and local and distant recurrence, as well as post-treatment T and N categories. KEY POINTS • Mesorectal fat contains important prognostic information in patients with locally advanced rectal cancer (LARC). • Radiomics features of mesorectal fat were significantly different between those who achieved complete vs incomplete pathologic response (accuracy 83.9%, 95% CI: 78.6-88.4%). • Radiomics features of mesorectal fat were significantly different between those who did vs did not develop local or distant recurrence (accuracy 78.3%, 95% CI: 72.0-83.7% and 87.0%, 95% CI: 81.6-91.2% respectively).
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Affiliation(s)
- Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA.
| | - Peter Gibbs
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - Raazi Bajwa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - James Louis Fuqua
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - Martin R Weiser
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Andrea Cercek
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
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15
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Golia Pernicka JS, Bates DDB, Fuqua JL, Knezevic A, Yoon J, Nardo L, Petkovska I, Paroder V, Nash GM, Markowitz AJ, Gollub MJ. Meaningful words in rectal MRI synoptic reports: How "polypoid" may be prognostic. Clin Imaging 2021; 80:371-376. [PMID: 34517303 DOI: 10.1016/j.clinimag.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/02/2021] [Accepted: 08/18/2021] [Indexed: 01/13/2023]
Abstract
PURPOSE This study explored the clinicopathologic outcomes of rectal tumor morphological descriptors used in a synoptic rectal MRI reporting template and determined that prognostic differences were observed. METHODS This retrospective study was conducted at a comprehensive cancer center. Fifty patients with rectal tumors for whom the synoptic descriptor "polypoid" was chosen by three experienced radiologists were compared with ninety comparator patients with "partially circumferential" and "circumferential" rectal tumors. Two radiologists re-evaluated all cases. The outcome measures were agreement among two re-interpreting radiologists, clinical T staging with MRI (mrT) and descriptive nodal features, and degrees of wall attachment of tumors (on MRI) compared with pathological (p) T and N stage when available. RESULTS Re-evaluation by two radiologists showed moderate to excellent agreement in tumor morphology, presence of a pedicle, and degree of wall attachment (k = 0.41-0.76) and excellent agreement on lymph node presence and size (ICC = 0.83-0.91). Statistically significant lower mrT stage was noted for polypoid morphology, wherein 98% were mrT1/2, while only 7% and 2% of partially circumferential and circumferential tumors respectively were mrT1/2. Pathologic T and N stages among the three morphologies also differed significantly, with only 14% of polypoid cases higher than stage pT2 compared to 48% of partially circumferential cases and 60% of circumferential cases. CONCLUSION Using a "polypoid" morphology in rectal cancer MRI synoptic reports revealed a seemingly distinct phenotype with lower clinical and pathologic T and N stages when compared with alternative available descriptors. PRECIS "Polypoid" morphology in rectal cancer confers a lower clinical and pathologic T and N stage and may be useful in determining whether to proceed with surgery versus neoadjuvant treatment.
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Affiliation(s)
- Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10065, USA.
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10065, USA
| | - James L Fuqua
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10065, USA
| | - Andrea Knezevic
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Joongchul Yoon
- Department of Radiology, Hôpital Saint-Eustache, 520 Boulevard Arthur-Sauvé, Saint-Eustache, QC J7R 5B1, Canada
| | - Lorenzo Nardo
- Department of Radiology, University of California-Davis, 4860 Y Street, Sacramento, CA 95817, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10065, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10065, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Arnold J Markowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 530 East 74th Street, New York, NY 10065, USA
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16
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Mahmood U, Shrestha R, Bates DDB, Mannelli L, Corrias G, Erdi YE, Kanan C. Detecting Spurious Correlations With Sanity Tests for Artificial Intelligence Guided Radiology Systems. Front Digit Health 2021; 3:671015. [PMID: 34713144 PMCID: PMC8521929 DOI: 10.3389/fdgth.2021.671015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/29/2021] [Indexed: 11/23/2022] Open
Abstract
Artificial intelligence (AI) has been successful at solving numerous problems in machine perception. In radiology, AI systems are rapidly evolving and show progress in guiding treatment decisions, diagnosing, localizing disease on medical images, and improving radiologists' efficiency. A critical component to deploying AI in radiology is to gain confidence in a developed system's efficacy and safety. The current gold standard approach is to conduct an analytical validation of performance on a generalization dataset from one or more institutions, followed by a clinical validation study of the system's efficacy during deployment. Clinical validation studies are time-consuming, and best practices dictate limited re-use of analytical validation data, so it is ideal to know ahead of time if a system is likely to fail analytical or clinical validation. In this paper, we describe a series of sanity tests to identify when a system performs well on development data for the wrong reasons. We illustrate the sanity tests' value by designing a deep learning system to classify pancreatic cancer seen in computed tomography scans.
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Affiliation(s)
- Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Robik Shrestha
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, NY, United States
| | - David D. B. Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Lorenzo Mannelli
- Institute of Research and Medical Care (IRCCS) SDN, Institute of Diagnostic and Nuclear Research, Naples, Italy
| | - Giuseppe Corrias
- Department of Radiology, University of Cagliari, Cagliari, Italy
| | - Yusuf Emre Erdi
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Christopher Kanan
- Chester F. Carlson Center for Imaging Science, Rochester Institute of Technology, Rochester, NY, United States
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17
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Mahmood U, Apte A, Kanan C, Bates DDB, Corrias G, Manneli L, Oh JH, Erdi YE, Nguyen J, O'Deasy J, Shukla-Dave A. Quality control of radiomic features using 3D-printed CT phantoms. J Med Imaging (Bellingham) 2021; 8:033505. [PMID: 34222557 PMCID: PMC8240751 DOI: 10.1117/1.jmi.8.3.033505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 06/04/2021] [Indexed: 01/01/2023] Open
Abstract
Purpose: The lack of standardization in quantitative radiomic measures of tumors seen on computed tomography (CT) scans is generally recognized as an unresolved issue. To develop reliable clinical applications, radiomics must be robust across different CT scan modes, protocols, software, and systems. We demonstrate how custom-designed phantoms, imprinted with human-derived patterns, can provide a straightforward approach to validating longitudinally stable radiomic signature values in a clinical setting. Approach: Described herein is a prototype process to design an anatomically informed 3D-printed radiomic phantom. We used a multimaterial, ultra-high-resolution 3D printer with voxel printing capabilities. Multiple tissue regions of interest (ROIs), from four pancreas tumors, one lung tumor, and a liver background, were extracted from digital imaging and communication in medicine (DICOM) CT exam files and were merged together to develop a multipurpose, circular radiomic phantom (18 cm diameter and 4 cm width). The phantom was scanned 30 times using standard clinical CT protocols to test repeatability. Features that have been found to be prognostic for various diseases were then investigated for their repeatability and reproducibility across different CT scan modes. Results: The structural similarity index between the segment used from the patients' DICOM image and the phantom CT scan was 0.71. The coefficient variation for all assessed radiomic features was < 1.0 % across 30 repeat scans of the phantom. The percent deviation (pDV) from the baseline value, which was the mean feature value determined from repeat scans, increased with the application of the lung convolution kernel, changes to the voxel size, and increases in the image noise. Gray level co-occurrence features, contrast, dissimilarity, and entropy were particularly affected by different scan modes, presenting with pDV > ± 15 % . Conclusions: Previously discovered prognostic and popular radiomic features are variable in practice and need to be interpreted with caution or excluded from clinical implementation. Voxel-based 3D printing can reproduce tissue morphology seen on CT exams. We believe that this is a flexible, yet practical, way to design custom phantoms to validate and compare radiomic metrics longitudinally, over time, and across systems.
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Affiliation(s)
- Usman Mahmood
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Aditya Apte
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Christopher Kanan
- Rochester Institute of Technology, Department of Imaging Science, Rochester, New York, United States
| | - David D B Bates
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
| | - Giuseppe Corrias
- Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
| | | | - Jung Hun Oh
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Yusuf Emre Erdi
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | | | - Joseph O'Deasy
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States
| | - Amita Shukla-Dave
- Memorial Sloan Kettering Cancer Center, Department of Medical Physics, New York, United States.,Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, United States
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Levine J, Petkovska I, Landa J, Bates DDB, Capanu M, Fuqua JL, Paroder V, Zheng J, Gollub MJ, Pernicka JSG. Bone lesions on baseline staging rectal MRI: prevalence and significance in patients with rectal adenocarcinoma. Abdom Radiol (NY) 2021; 46:2423-2431. [PMID: 33543320 DOI: 10.1007/s00261-020-02923-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 12/24/2022]
Abstract
A T1 sequence on routine baseline staging rectal magnetic resonance imaging (MRI) is thought to help detect bone lesions. Our primary aim was to evaluate the incidence of bone lesions encountered on baseline staging rectal MRI, particularly the prevalence of bone metastases. This retrospective study included patients with rectal adenocarcinoma who underwent baseline rectal MRI at our institution between January 2010 and December 2017. The MRI report was reviewed for presence of bone lesions. When found, lesion type, presence of axial T1 non-fat-suppressed sequence, primary tumor T-stage, and presence of other organ metastases were recorded. In the absence of bone biopsy, the reference standard was follow-up imaging via computed tomography (CT), MRI, and/or positron emission tomography/CT (PET/CT) ≥ 1 year after the baseline MRI. The Wilcoxon rank-sum test and Fisher's exact test were used to compare clinicopathologic data of patients with malignant or benign bone lesions. A total of 1197 patients were included. 62/1197 patients (mean age 56.8 years (SD: 13.8), with 39 men) had bone lesions on baseline imaging, with 6 being bone metastases (0.5%, 95% CI 0.2%-1.1%). Of the 6 patients with bone metastases, 5/6 had other metastases (i.e., liver, lung) at baseline. Bone metastases on baseline rectal MRI performed for rectal adenocarcinoma are extremely rare. Furthermore, bone metastases without other organ (i.e., liver, lung) involvement is extremely rare.
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Affiliation(s)
- Jeffrey Levine
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
- Department of Radiology, Lenox Hill Hospital, 100 E 77th Street, New York, NY, 10075, USA.
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Jonathan Landa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - J Louis Fuqua
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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Cruz-Hernández E, Mahmood U, Golia Pernicka JS, Paroder V, Petkovska I, Gollub MJ, Shia J, Ganesh K, Bates DDB. Initial evaluation of dual-energy computed tomography as an imaging biomarker for hepatic metastases from neuroendocrine tumor of the gastrointestinal tract. Quant Imaging Med Surg 2021; 11:2085-2092. [PMID: 33936989 DOI: 10.21037/qims-20-917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background To evaluate quantitative iodine parameters from the arterial phase dual-energy computed tomography (DECT) scans as an imaging biomarker for tumor grade (TG), mitotic index (MI), and Ki-67 proliferation index of hepatic metastases from neuroendocrine tumors (NETs) of the gastrointestinal (GI) tract. Imaging biomarkers have the potential to provide relevant clinical information about pathologic processes beyond lesion morphology. NETs are a group of rare, heterogeneous neoplasms classified by World Health Organization (WHO) TG, which is derived from MI and Ki-67 proliferation index. Imaging biomarkers for these pathologic features and TG may be useful. Methods Between January 2014 and April 2019, 73 unique patients with hepatic metastases from NET of the GI tract underwent DECT of the abdomen with an arterial phase were analyzed after exclusions. Using GSIViewer software (GE Healthcare, Madison, Wisconsin), elliptical regions of interest (ROIs) were placed over selected hepatic metastases by a fellowship trained abdominal radiologist. Quantitative iodine concentration (IC) data was extracted from the lesion ROIs, and the normalized IC (lesion IC/aorta IC) and relative IC (lesion IC/liver IC) for each liver were calculated. Spearman correlation was calculated for lesion mean IC, normalized IC, and relative IC to both Ki-67 proliferation and mitotic indices. Student's t-test was performed to compare lesion mean IC, normalized IC and relative IC between WHO TGs. Results There was very weak correlation between both normalized IC and relative IC for both Ki-67 proliferation and mitotic indices. A significant difference was not observed between normalized IC and relative IC to distinguish metastases from G1 and G2/3 tumors. Conclusions Our study finds limited potential for quantitative parameters from DECT to distinguish neuroendocrine hepatic metastases by WHO TG, as well as limited potential as an imaging biomarker for Ki-67 proliferation and mitotic indices in this setting. Our findings of a lack of correlation between Ki-67 and quantitative iodine parameters stands in contrast to existing literature that reports positive correlations for these parameters in the rectum and stomach.
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Affiliation(s)
| | - Usman Mahmood
- Department of Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karuna Ganesh
- Molecular Pharmacology Program and Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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20
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Jayaprakasam VS, Javed-Tayyab S, Gangai N, Zheng J, Capanu M, Bates DDB, Fuqua JL, Paroder V, Golia-Pernicka J, Gollub MJ, Petkovska I. Does microenema administration improve the quality of DWI sequences in rectal MRI? Abdom Radiol (NY) 2021; 46:858-866. [PMID: 32926212 DOI: 10.1007/s00261-020-02718-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/13/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine whether the administration of a microenema immediately prior to rectal magnetic resonance imaging (MRI) decreases the level of gas-related artifacts on diffusion-weighted imaging (DWI) sequences. METHODS This retrospective analysis included 492 (183 baseline and 309 post-total neoadjuvant treatment [TNT]) consecutive MRI scans for rectal cancer from January 2019 to January 2020. Scan-related factors were identified including microenema use (yes or no), field of view (FOV) in DWI (b = 800 or b = 1500), and magnet strength (1.5 T or 3 T). Two readers scored DWI studies for gas-related artifacts and T2-weighted sequences for the amount of intraluminal gas on a 5-point scale. Fisher's exact test and the Rao-Scott Chi-squared test were used to examine associations between microenema use and other factors. Generalized estimating equation and multivariable regression models were performed to examine the effect of microenema use in subgroups of scans for each reader. Cohen's κ was used to assess inter-reader agreement. RESULTS Gas-related artifact levels decreased in scans with microenema overall (P < 0.001) as well as when scans were stratified by FOV (P ≤ 0.003). For both readers, post-TNT scans with microenema showed lower artifact levels overall (P < 0.014 and P < 0.001) and in post-TNT subgroups of axial DWI scans (P ≤ 0.006 and P < 0.001) and scans acquired with a 3 T magnet (P ≤ 0.001 for both FOV). No evidence of decreased artifact level was found for baseline studies. Decreased gas was seen with microenema use (P < 0.001 for both readers). Inter-reader agreement on artifact-level and gas-level assessments ranged from slight to substantial (κ = 0.273-0.685). CONCLUSION Microenema use prior to rectal MRI reduces gas-related artifacts on DWI, including both large and small FOV sequences and particularly on post-TNT scans performed at 3 T, and offers a viable solution to improve DWI quality.
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21
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Bates DDB, Fuqua JL, Zheng J, Capanu M, Golia Pernicka JS, Javed-Tayyab S, Paroder V, Petkovska I, Gollub MJ. Measurement of rectal tumor height from the anal verge on MRI: a comparison of internal versus external anal sphincter. Abdom Radiol (NY) 2021; 46:867-872. [PMID: 32940753 DOI: 10.1007/s00261-020-02757-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the most accurate measurement technique to assess rectal tumor height on MRI using two different anatomic landmarks for the anal verge. INTRODUCTION Accurate measurements and standardized reporting of MRI for rectal cancer staging is essential. It is not known whether measurements starting from the internal anal sphincter (IAS) or external anal sphincter (EAS) more closely correlate with tumor height from the anal verge on endoscopy. METHODS This retrospective study included baseline staging MRI examinations for 85 patients after exclusions. Two radiologists blinded to endoscopic results measured the distance of rectal tumors from the internal anal sphincter and external anal sphincter on sagittal T2 images. The reference standard was endoscopic measurement of tumor height; descriptive statistics were performed. RESULTS For reader 1, the mean difference in measurement of tumor height between MRI and endoscopy was - 0.45 cm (SD ± 1.76 cm, range - 6.0 to 3.9 cm) for the IAS and 0.51 cm (SD ± 1.75 cm range - 4.7 to 4.8 cm) for the EAS. For reader 2, the mean difference in measurement of tumor height between MRI and endoscopy was - 0.57 (STD ± 1.81, range - 5.9 to 4.8 cm) for the IAS and 0.52 cm (STD ± 1.85, range - 4.3 to 5.6 cm) for the EAS. Interobserver ICC was excellent between reader 1 and reader 2 for measurements from both the IAS (0.955 95% CI 0.931-0.97) and EAS (0.952, 95% CI 0.928, 0.969). CONCLUSION Measurement of tumor height on MRI was highly reproducible between readers; beginning measurements from the EAS tends to slightly overestimate tumor height on average and from the IAS tends to slightly underestimate tumor height on average.
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Affiliation(s)
- David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - James L Fuqua
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Junting Zheng
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Golia Pernicka
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Sidra Javed-Tayyab
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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22
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Bates DDB, Firat C, Shia J, Widmar M. Concept of Complete Mesocolic Excision and the Role of Computed Tomography Imaging. Semin Roentgenol 2020; 56:201-205. [PMID: 33858646 DOI: 10.1053/j.ro.2020.07.011] [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: 11/11/2022]
Affiliation(s)
- David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Canan Firat
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
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Abstract
As therapeutic options to treat rectal cancers have advanced over the last several decades, MRI has become the standard of care for baseline local tumor and nodal staging of rectal cancers. An understanding of the technique, anatomy, tumor appearance, and elements of staging on MRI is essential to provide prognostic information and to guide neoadjuvant chemoradiation and surgical treatment. We provide a framework for imaging the rectum on MRI followed by a practical case-based approach to interpretation of pre-treatment MRI of the rectum in evaluation of rectal cancers, with examples and illustrations of the range of local tumor (T) stage and nodal (N) disease involvement. This approach can be paired with standardized reporting templates to support clear, accurate and clinically relevant imaging assessment of rectal cancers.
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Affiliation(s)
- Neeraj Lalwani
- Virginia Commonwealth University School of Medicine and VCU Health, Richmond, VA.
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Mark Lockhart
- The University of Alabama at Birmingham, Department of Radiology, Birmingham, AL
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24
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Yaeger R, Paroder V, Bates DDB, Capanu M, Chou J, Tang L, Chatila W, Schultz N, Hersch J, Kelsen D. Systemic Chemotherapy for Metastatic Colitis-Associated Cancer Has a Worse Outcome Than Sporadic Colorectal Cancer: Matched Case Cohort Analysis. Clin Colorectal Cancer 2020; 19:e151-e156. [PMID: 32798155 DOI: 10.1016/j.clcc.2020.02.008] [Citation(s) in RCA: 4] [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: 07/11/2019] [Revised: 11/29/2019] [Accepted: 02/02/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Colitis-associated cancers (CAC) are a catastrophic complication of inflammatory bowel disease; at diagnosis, CAC is frequently at an advanced stage. Although the genomic alterations (GA) in CAC are different from sporadic colorectal cancer (CRC), the same systemic therapies are used. We compared clinically relevant outcomes using standard care systemic chemotherapy of stage IV CAC versus a matched patient control cohort of stage IV CRC patients. PATIENTS AND METHODS A retrospective matched cohort design was used. Eighteen cases of stage IV CAC (7 ulcerative colitis, 11 Crohn disease) and 18 CRC were identified. GA analysis was available for all patients. Outcome endpoints included response rate and response duration, progression-free survival, and OS. RESULTS Although the response rates were similar (CAC 35.7% vs. CRC 57.1%, P = .45), the median duration of response for CAC was significantly shorter (1.4 months, vs. CRC 11.8 months, P = .006). There was no difference in dose density of first-line therapy between cohorts, suggesting that shorter response duration was due to more rapid development of chemotherapy resistance. Median OS was significantly shorter for CAC patients (13 vs. 27.6 months, P = .034). As expected, there was a difference in the spectrum of GA between CAC and CRC cohorts. However, GA associated with poor prognosis (eg, B-Raf) were no more frequent in the CAC cohort. CONCLUSION Clinically meaningful outcomes of duration of response and OS are worse for CAC versus sporadic CRC patients treated with FOLFOX or FOLFIRI as first therapy for metastatic disease.
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Affiliation(s)
| | | | | | | | - Joanne Chou
- Department of Epidemiology and Biostatistics
| | | | - Walid Chatila
- Department of Computational Oncology, Memorial Sloan-Kettering Cancer Center and Weil-Cornell Medical College, New York, NY
| | - Nikolaus Schultz
- Department of Computational Oncology, Memorial Sloan-Kettering Cancer Center and Weil-Cornell Medical College, New York, NY
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25
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Bates DDB, Golia Pernicka JS, Fuqua JL, Paroder V, Petkovska I, Zheng J, Capanu M, Schilsky J, Gollub MJ. Diagnostic accuracy of b800 and b1500 DWI-MRI of the pelvis to detect residual rectal adenocarcinoma: a multi-reader study. Abdom Radiol (NY) 2020; 45:293-300. [PMID: 31690966 DOI: 10.1007/s00261-019-02283-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To compare the sensitivity, specificity and intra-observer and inter-observer agreement of pelvic magnetic resonance imaging (MRI) b800 and b1500 s/mm2 sequences in the detection of residual adenocarcinoma after neoadjuvant chemoradiation (CRT) for locally advanced rectal cancer (LARC). INTRODUCTION Detection of residual adenocarcinoma after neoadjuvant CRT for LARC has become increasingly important and relies on both MRI and endoscopic surveillance. Optimal MRI diffusion b values have yet to be established for this clinical purpose. METHODS From our MRI database between 2018 and 2019, we identified a cohort of 28 patients after exclusions who underwent MRI of the rectum before and after neoadjuvant chemoradiation with a protocol that included both b800 and b1500 s/mm2 diffusion sequences. Four radiologists experienced in rectal MRI interpreted the post-CRT MRI studies with either b800 DWI or b1500 DWI, and a minimum of 2 weeks later re-interpreted the same studies using the other b value sequence. Surgical pathology or endoscopic follow-up for 1 year without tumor re-growth was used as the reference standard. Descriptive statistics compared accuracy for each reader and for all readers combined between b values. Inter-observer agreement was assessed using kappa statistics. A p value of 0.05 or less was considered significant. RESULTS Within the cohort, 19/28 (67.9%) had residual tumor, while 9/28 (32.1%) had a complete response. Among four readers, one reader had increased sensitivity for detection of residual tumor at b1500 s/mm2 (0.737 vs. 0.526, p = 0.046). There was no significant difference between detection of residual tumor at b800 and at b1500 for the rest of the readers. With all readers combined, the pooled sensitivity was 0.724 at b1500 versus 0.605 at b800, but this was not significant (p = 0.119). There was no difference in agreement between readers at the two b value settings (67.8% at b800 vs. 72.0% at b1500), or for any combination of individual readers. CONCLUSION Aside from one reader demonstrating increased sensitivity, no significant difference in accuracy parameters or inter-observer agreement was found between MR using b800 and b1500 for the detection of residual tumor after neoadjuvant CRT for LARC. However, there was a suggestion of a trend towards increased sensitivity with b1500, and further studies using larger cohorts may be needed to further investigate this topic.
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Bates DDB, de Paula MCF, Horvat N, Sheedy S, Lall C, Kassam Z, Pickhardt P, Lalwani N, Ganeshan D, Petkovska I. Beyond adenocarcinoma: MRI of uncommon rectal neoplasms and mimickers. Abdom Radiol (NY) 2019; 44:3581-3594. [PMID: 31069482 DOI: 10.1007/s00261-019-02045-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To provide a review of rare rectal tumors beyond adenocarcinoma. RESULTS Rectal cancer is a common malignancy, both in the United States and abroad. In addition to adenocarcinoma, abdominal radiologists will encounter a variety of other less common rectal masses, both benign and malignant neoplasms as well as non-neoplastic mimickers. Familiarity with these conditions and their characteristic features on MRI is useful in clinical practice. In this article, a number of such conditions are discussed, with an emphasis on distinguishing features on MRI of the rectum. CONCLUSION Familiarity with the MRI features of rare rectal tumors beyond adenocarcinoma, as well as a small number of non-neoplastic mimics, is important for abdominal imagers to make diagnostic differentials and to assist in treatment planning.
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Hope TA, Gollub MJ, Arya S, Bates DDB, Ganeshan D, Harisinghani M, Jhaveri KS, Kassam Z, Kim DH, Korngold E, Lalwani N, Moreno CC, Nougaret S, Paroder V, Paspulati RM, Golia Pernicka JS, Petkovska I, Pickhardt PJ, Rauch GM, Rosenthal MH, Sheedy SP, Horvat N. Rectal cancer lexicon: consensus statement from the society of abdominal radiology rectal & anal cancer disease-focused panel. Abdom Radiol (NY) 2019; 44:3508-3517. [PMID: 31388697 DOI: 10.1007/s00261-019-02170-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Standardized terminology is critical to providing consistent reports to referring clinicians. This lexicon aims to provide a reference for terminology frequently used in rectal cancer and reflects the consensus of the Society of Abdominal Radiology Disease Focused Panel in Rectal cancer. This lexicon divided the terms into the following categories: primary tumor staging, nodal staging, treatment response, anal canal anatomy, general anatomy, and treatments.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143, USA.
- Department of Radiology, San Francisco VA Medical Center, San Francisco, CA, USA.
- UCSF Helen, Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA, USA.
| | - Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Kartik S Jhaveri
- University of Toronto University Health Network, Toronto, ON, Canada
| | - Zahra Kassam
- Schulich School of Medicine, Western University, London, ON, Canada
| | - David H Kim
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Neeraj Lalwani
- Department of Radiology, Section of Abdominal Imaging, Wake Forest University and Baptist Medical Center, Winston-Salem, NC, USA
| | | | - Stephanie Nougaret
- Montpellier Cancer Research Institute, Montpellier, France
- Department of Radiology, Montpellier Cancer Institute, INSERM, U1194, University of Montpellier, Montpellier, France
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Raj M Paspulati
- Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, OH, USA
| | | | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Perry J Pickhardt
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Gaiane M Rauch
- Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael H Rosenthal
- Harvard Medical School, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Natally Horvat
- Department of Radiology, Hospital Sirio-Libanes, São Paulo, São Paulo, Brazil
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Abstract
INTRODUCTION As computational capabilities have advanced, radiologists and their collaborators have looked for novel ways to analyze diagnostic images. This has resulted in the development of radiomics and radiogenomics as new fields in medical imaging. Radiomics and radiogenomics may change the practice of medicine, particularly for patients with colorectal cancer. Radiomics corresponds to the extraction and analysis of numerous quantitative imaging features from conventional imaging modalities in correlation with several endpoints, including the prediction of pathology, genomics, therapeutic response, and clinical outcome. In radiogenomics, qualitative and/or quantitative imaging features are extracted and correlated with genetic profiles of the imaged tissue. Thus far, several studies have evaluated the use of radiomics and radiogenomics in patients with colorectal cancer; however, there are challenges to be overcome before its routine implementation including challenges related to sample size, model design and interpretability, and the lack of robust multicenter validation set. MATERIAL AND METHODS In this article, we will review the concepts of radiomics and radiogenomics and their potential applications in rectal cancer. CONCLUSION Radiologists should be aware of the basic concepts, benefits, pitfalls, and limitations of new radiomic and radiogenomics techniques to achieve a balanced interpretation of the results.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Hospital Sirio-Libanes, Sao Paulo, SP, Brazil
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA
| | - Iva Petkovska
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY, 10065, USA.
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29
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Bates DDB, Mazaheri Y, Lobaugh S, Golia Pernicka JS, Paroder V, Shia J, Zheng J, Capanu M, Petkovska I, Gollub MJ. Evaluation of diffusion kurtosis and diffusivity from baseline staging MRI as predictive biomarkers for response to neoadjuvant chemoradiation in locally advanced rectal cancer. Abdom Radiol (NY) 2019; 44:3701-3708. [PMID: 31154482 DOI: 10.1007/s00261-019-02073-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the role of diffusion kurtosis and diffusivity as potential imaging biomarkers to predict response to neoadjuvant chemoradiation therapy (CRT) from baseline staging magnetic resonance imaging (MRI) in locally advanced rectal cancer (LARC). MATERIALS AND METHODS This retrospective study included 45 consecutive patients (31 male/14 female) who underwent baseline MRI with high b-value sequences (up to 1500 mm/s2) for LARC followed by neoadjuvant chemoradiation and surgical resection. The mean age was 57.4 years (range 34.2-72.9). An abdominal radiologist using open source software manually segmented T2-weighted images. Segmentations were used to derive diffusion kurtosis and diffusivity from diffusion-weighted images as well as volumetric data. These data were analyzed with regard to tumor regression grade (TRG) using the four-tier American Joint Committee on Cancer (AJCC) classification, TRG 0-3. Proportional odds regression was used to analyze the four-level ordinal outcome. A sensitivity analysis was performed using univariable logistic regression for binary TRG groups, TRG 0/1 (> 90% response), or TRG 2/3 (< 90% response). p < 0.05 was considered significant throughout. RESULTS In the univariable proportional odds regression analysis, higher diffusivity summary (Dsum) values were observed to be significantly associated with higher odds of being in one or more favorable TRG group (TRG 0 or 1). In other words, on average, patients with higher Dsum values were more likely to be in a more favorable TRG group. These results are mostly consistent with the sensitivity analysis, in which higher values for most Dsum values [all but region of interest (ROI)-max D median (p = 0.08)] were observed to be significantly associated with higher odds of being TRG 0 or 1. Tumor volume of interest (VOI) and ROI volume, ROI kurtosis mean and median, and VOI kurtosis mean and median were not significantly associated with TRG. CONCLUSION Diffusivity derived from the baseline staging MRI, but not diffusion kurtosis or volumetric data, is associated with TRG and therefore shows promise as a potential imaging biomarker to predict the response to neoadjuvant chemotherapy in LARC. CLINICAL RELEVANCE STATEMENT Diffusivity shows promise as a potential imaging biomarker to predict AJCC TRG following neoadjuvant CRT, which has implications for risk stratification. Patients with TRG 0/1 have 5-year disease-free survival (DFS) of 90-98%, as opposed to those who are TRG 2/3 with 5-year DFS of 68-73%.
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Affiliation(s)
- David D B Bates
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Yousef Mazaheri
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Stephanie Lobaugh
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jennifer S Golia Pernicka
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Viktoriya Paroder
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Junting Zheng
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marinela Capanu
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iva Petkovska
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Marc J Gollub
- Body Imaging Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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Golia Pernicka JS, Gagniere J, Chakraborty J, Yamashita R, Nardo L, Creasy JM, Petkovska I, Do RRK, Bates DDB, Paroder V, Gonen M, Weiser MR, Simpson AL, Gollub MJ. Radiomics-based prediction of microsatellite instability in colorectal cancer at initial computed tomography evaluation. Abdom Radiol (NY) 2019; 44:3755-3763. [PMID: 31250180 PMCID: PMC6824954 DOI: 10.1007/s00261-019-02117-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To predict microsatellite instability (MSI) status of colon cancer on preoperative CT imaging using radiomic analysis. METHODS This retrospective study involved radiomic analysis of preoperative CT imaging of patients who underwent resection of stage II-III colon cancer from 2004 to 2012. A radiologist blinded to MSI status manually segmented the tumor region on CT images. 254 Intensity-based radiomic features were extracted from the tumor region. Three prediction models were developed with (1) only clinical features, (2) only radiomic features, and (3) "combined" clinical and radiomic features. Patients were randomly separated into training (n = 139) and test (n = 59) sets. The model was constructed from training data only; the test set was reserved for validation only. Model performance was evaluated using AUC, sensitivity, specificity, PPV, and NPV. RESULTS Of the total 198 patients, 134 (68%) patients had microsatellite stable tumors and 64 (32%) patients had MSI tumors. The combined model performed slightly better than the other models, predicting MSI with an AUC of 0.80 for the training set and 0.79 for the test set (specificity = 96.8% and 92.5%, respectively), whereas the model with only clinical features achieved an AUC of 0.74 and the model with only radiomic features achieved an AUC of 0.76. The model with clinical features alone had the lowest specificity (70%) compared with the model with radiomic features alone (95%) and the combined model (92.5%). CONCLUSIONS Preoperative prediction of MSI status via radiomic analysis of preoperative CT adds specificity to clinical assessment and could contribute to personalized treatment selection.
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Affiliation(s)
- Jennifer S Golia Pernicka
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA.
| | - Johan Gagniere
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Digestive and Hepatobiliary Surgery, U1071 INSERM / Clermont-Auvergne University, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Jayasree Chakraborty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rikiya Yamashita
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Lorenzo Nardo
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - John M Creasy
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iva Petkovska
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Richard R K Do
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - David D B Bates
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Viktoriya Paroder
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
| | - Mithat Gonen
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Amber L Simpson
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J Gollub
- Body Imaging Service, Department of Radiology, Evelyn H. Lauder Breast Center, Memorial Sloan Kettering Cancer Center, 300 East 66th St., Suite 757, New York, NY, 10065, USA
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Braman N, Prasanna P, Whitney J, Singh S, Beig N, Etesami M, Bates DDB, Gallagher K, Bloch BN, Vulchi M, Turk P, Bera K, Abraham J, Sikov WM, Somlo G, Harris LN, Gilmore H, Plecha D, Varadan V, Madabhushi A. Association of Peritumoral Radiomics With Tumor Biology and Pathologic Response to Preoperative Targeted Therapy for HER2 (ERBB2)-Positive Breast Cancer. JAMA Netw Open 2019; 2:e192561. [PMID: 31002322 PMCID: PMC6481453 DOI: 10.1001/jamanetworkopen.2019.2561] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE There has been significant recent interest in understanding the utility of quantitative imaging to delineate breast cancer intrinsic biological factors and therapeutic response. No clinically accepted biomarkers are as yet available for estimation of response to human epidermal growth factor receptor 2 (currently known as ERBB2, but referred to as HER2 in this study)-targeted therapy in breast cancer. OBJECTIVE To determine whether imaging signatures on clinical breast magnetic resonance imaging (MRI) could noninvasively characterize HER2-positive tumor biological factors and estimate response to HER2-targeted neoadjuvant therapy. DESIGN, SETTING, AND PARTICIPANTS In a retrospective diagnostic study encompassing 209 patients with breast cancer, textural imaging features extracted within the tumor and annular peritumoral tissue regions on MRI were examined as a means to identify increasingly granular breast cancer subgroups relevant to therapeutic approach and response. First, among a cohort of 117 patients who received an MRI prior to neoadjuvant chemotherapy (NAC) at a single institution from April 27, 2012, through September 4, 2015, imaging features that distinguished HER2+ tumors from other receptor subtypes were identified. Next, among a cohort of 42 patients with HER2+ breast cancers with available MRI and RNaseq data accumulated from a multicenter, preoperative clinical trial (BrUOG 211B), a signature of the response-associated HER2-enriched (HER2-E) molecular subtype within HER2+ tumors (n = 42) was identified. The association of this signature with pathologic complete response was explored in 2 patient cohorts from different institutions, where all patients received HER2-targeted NAC (n = 28, n = 50). Finally, the association between significant peritumoral features and lymphocyte distribution was explored in patients within the BrUOG 211B trial who had corresponding biopsy hematoxylin-eosin-stained slide images. Data analysis was conducted from January 15, 2017, to February 14, 2019. MAIN OUTCOMES AND MEASURES Evaluation of imaging signatures by the area under the receiver operating characteristic curve (AUC) in identifying HER2+ molecular subtypes and distinguishing pathologic complete response (ypT0/is) to NAC with HER2-targeting. RESULTS In the 209 patients included (mean [SD] age, 51.1 [11.7] years), features from the peritumoral regions better discriminated HER2-E tumors (maximum AUC, 0.85; 95% CI, 0.79-0.90; 9-12 mm from the tumor) compared with intratumoral features (AUC, 0.76; 95% CI, 0.69-0.84). A classifier combining peritumoral and intratumoral features identified the HER2-E subtype (AUC, 0.89; 95% CI, 0.84-0.93) and was significantly associated with response to HER2-targeted therapy in both validation cohorts (AUC, 0.80; 95% CI, 0.61-0.98 and AUC, 0.69; 95% CI, 0.53-0.84). Features from the 0- to 3-mm peritumoral region were significantly associated with the density of tumor-infiltrating lymphocytes (R2 = 0.57; 95% CI, 0.39-0.75; P = .002). CONCLUSIONS AND RELEVANCE A combination of peritumoral and intratumoral characteristics appears to identify intrinsic molecular subtypes of HER2+ breast cancers from imaging, offering insights into immune response within the peritumoral environment and suggesting potential benefit for treatment guidance.
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Affiliation(s)
- Nathaniel Braman
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Prateek Prasanna
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Jon Whitney
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Salendra Singh
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Niha Beig
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Maryam Etesami
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - David D. B. Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Katherine Gallagher
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - B. Nicolas Bloch
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
| | - Manasa Vulchi
- Department of Hematology and Medical Oncology, The Cleveland Clinic, Cleveland, Ohio
| | - Paulette Turk
- Department of Diagnostic Radiology, The Cleveland Clinic, Cleveland, Ohio
| | - Kaustav Bera
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
| | - Jame Abraham
- Department of Hematology and Medical Oncology, The Cleveland Clinic, Cleveland, Ohio
| | - William M. Sikov
- Program in Women’s Oncology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - George Somlo
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, California
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California
| | - Lyndsay N. Harris
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Hannah Gilmore
- Department of Pathology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Donna Plecha
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Vinay Varadan
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio
- Louis Stokes Cleveland Veterans Administration Medical Center, Cleveland, Ohio
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Middha S, Yaeger R, Shia J, Stadler ZK, King S, Guercio S, Paroder V, Bates DDB, Rana S, Diaz LA, Saltz L, Segal N, Ladanyi M, Zehir A, Hechtman JF. Majority of B2M-Mutant and -Deficient Colorectal Carcinomas Achieve Clinical Benefit From Immune Checkpoint Inhibitor Therapy and Are Microsatellite Instability-High. JCO Precis Oncol 2019; 3. [PMID: 31008436 DOI: 10.1200/po.18.00321] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
PURPOSE Microsatellite instability-high (MSI-H) colorectal carcinomas (CRCs) show high rates of response to immune checkpoint inhibitors (IOs). B2M mutations and protein loss have been proposed as causes of resistance to IOs, yet they are enriched in MSI-H CRC. We aimed to characterize B2M-mutant, IO-naive CRC. PATIENTS AND METHODS All CRCs with results for Memorial Sloan Kettering Integrated Mutation Profiling of Actionable Cancer Targets, a next-generation sequencing assay that interrogates > 400 genes for mutations as well as MSI status, were surveyed for B2M mutations. All B2M-mutant CRCs were assessed for expression of B2M, major histocompatibility complex class I, and programmed death-1 ligand (PD-L1) via immunohistochemistry and average CD3+ and CD8+ tumor-infiltrating lymphocyte counts against a control group of MSI-H B2M wild-type CRCs. RESULTS Fifty-nine (3.4%) of 1,751 patients with CRC harbored B2M mutations, with 84% (77 of 92) of the mutations predicted to be truncating. B2M mutations were significantly enriched in MSI-H CRCs, with 44 (24%) of 182 MSI-H CRCs harboring B2M mutations (P < .001). Thirty-two of 44 B2M-mutant CRCs with available material (73%) had complete loss of B2M expression, whereas all 26 CRCs with wild-type B2M retained expression (P < .001). B2M mutation status was not associated with major histocompatibility complex class I expression, KRAS or BRAF mutation, tumor-infiltrating lymphocyte level, or PD-L1 expression after adjustment for MSI status. Of 13 patients with B2M-mutant CRC who received programmed death-1 or PD-L1 IOs, 11 (85%) achieved clinical benefit, defined as stable disease or partial response using Response Evaluation Criteria in Solid Tumors criteria. CONCLUSION B2M mutations occur in approximately 24% of MSI-H CRCs and are usually associated with loss of B2M expression. Most patients with B2M-mutant MSI-H CRC with loss of protein expression obtain clinical benefit from IOs.
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Affiliation(s)
- Sumit Middha
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rona Yaeger
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jinru Shia
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Sarah King
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Satshil Rana
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Luis A Diaz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Leonard Saltz
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Neil Segal
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marc Ladanyi
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ahmet Zehir
- Memorial Sloan Kettering Cancer Center, New York, NY
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Gollub MJ, Blazic I, Bates DDB, Campbell N, Knezevic A, Gonen M, Lynn P, Weiser MR, Garcia-Aguilar J, Hötker AM, Cercek A, Saltz L. Pelvic MRI after induction chemotherapy and before long-course chemoradiation therapy for rectal cancer: What are the imaging findings? Eur Radiol 2018; 29:1733-1742. [PMID: 30280248 DOI: 10.1007/s00330-018-5726-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 06/25/2018] [Revised: 07/31/2018] [Accepted: 08/27/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To determine the appearance of rectal cancer on MRI after oxaliplatin-based chemotherapy (ICT) and make a preliminary assessment of MRI's value in predicting response to total neoadjuvant treatment (TNT). METHODS In this IRB-approved, HIPAA-compliant, retrospective study between 1 January 2010-20 October 2014, pre- and post-ICT tumour T2 volume, relative T2 signal intensity (rT2SI), node size, signal intensity and border characteristics were assessed in 63 patients (65 tumours) by three readers. The strength of association between the reference standard of histopathological percent tumour response and tumour volume change, rT2SI and lymph node characteristics was assessed with Spearman's correlation coefficient and Wilcoxon's rank sum test. Cox regression was used to assess association between DFS and radiological measures. RESULTS Change in T2 volume was not associated with TNT response. Change in rT2SI showed correlation with TNT response for one reader only using selective regions of interest (ROIs) and borderline correlation with response using total volume ROI. There was a significant negative correlation between baseline and post-ICT node size and TNT response (r = -0.25, p = 0.05; r = -0.35, p = 0.005, readers 1 and 2, respectively). Both baseline and post-induction median node sizes were significantly smaller in complete responders (p = 0.03, 0.001; readers 1 and 2, respectively). Change in largest baseline node size and decrease in post-ICT node signal heterogeneity were associated with 100% tumour response (p = 0.04). Nodal sizes at baseline and post-ICT MRI correlated with DFS. CONCLUSION In patients undergoing post-ICT MRI, tumour volume did not correlate with TNT response, but decreased lymph node sizes were significantly associated with complete response to TNT as well as DFS. Relative T2SI showed borderline correlation with TNT response. KEY POINTS • MRI-based tumour volume after induction chemotherapy and before chemoradiotherapy did not correlate with overall tumour response at the end of all treatment. • Lymph node size after induction chemotherapy and before chemoradiotherapy was strongly associated with complete pathological response after all treatment. • Lymph node sizes at baseline and post-induction chemotherapy MRI correlated with disease-free survival.
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Affiliation(s)
- Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Ivana Blazic
- Department of Radiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, 11080, Serbia
| | - David D B Bates
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Naomi Campbell
- IMED Radiology Network, Level 3, 104 Breakfast Creek Road, Newstead, QLD, 4006, Australia
| | - Andrea Knezevic
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricio Lynn
- Department of Surgery, New York University Medical Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andreas M Hötker
- Department of Diagnostic and Interventional Radiology, Johannes Gutenberg-University Medical Centre, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Andrea Cercek
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Leonard Saltz
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bates DDB, Gallagher K, Yu H, Uyeda J, Murakami AM, Setty BN, Anderson SW, Clement MO. Acute Radiologic Manifestations of America’s Opioid Epidemic. Radiographics 2018; 38:109-123. [DOI: 10.1148/rg.2018170114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David D. B. Bates
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Katherine Gallagher
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - HeiShun Yu
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Jennifer Uyeda
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Akira M. Murakami
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Bindu N. Setty
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Stephan W. Anderson
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
| | - Mariza O. Clement
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114 (D.D.B.B., H.Y.); Department of Radiology, Boston University Medical Center, Boston, Mass (D.D.B.B., K.G., H.Y., A.M.M., B.N.S., S.W.A., M.O.C.); and Department of Radiology, Brigham and Women’s Hospital, Boston, Mass (J.U.)
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Jain A, Khalid M, Qureshi MM, Georgian-Smith D, Kaplan JA, Buch K, Grinstaff MW, Hirsch AE, Hines NL, Anderson SW, Gallagher KM, Bates DDB, Bloch BN. Stereotactic core needle breast biopsy marker migration: An analysis of factors contributing to immediate marker migration. Eur Radiol 2017; 27:4797-4803. [DOI: 10.1007/s00330-017-4851-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 01/09/2017] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
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Bates DDB, Wasserman M, Malek A, Gorantla V, Anderson SW, Soto JA, LeBedis CA. Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury. Radiographics 2017; 37:613-625. [DOI: 10.1148/rg.2017160092] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- David D. B. Bates
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Michael Wasserman
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Anita Malek
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Varun Gorantla
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Stephan W. Anderson
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Jorge A. Soto
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
| | - Christina A. LeBedis
- From the Departments of Radiology (D.D.B.B., M.W., V.G., S.W.A., J.A.S., C.A.L.) and Pathology (A.M.), Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118
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Bates DDB, Tamayo-Murillo D, Kussman S, Luce A, LeBedis CA, Soto JA, Anderson SW. Biliary and pancreatic ductal dilation in patients on methadone maintenance therapy. Abdom Radiol (NY) 2017; 42:884-889. [PMID: 27770163 DOI: 10.1007/s00261-016-0946-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/30/2022]
Abstract
PURPOSE To determine whether the diameter of intrahepatic and extrahepatic bile ducts and pancreatic ducts in patients on methadone maintenance therapy is increased when compared with control subjects. METHODS Between January 1, 2000 and March 15, 2013, a total of 97 patients (mean age 49.9, range 22-79, 65 male, 32 female) were identified who were receiving chronic methadone maintenance therapy (MMT) when they underwent imaging with abdominal MRI or a contrast-enhanced abdominopelvic CT. A group of 97 consecutive non-MMT control patients (mean age 51.4, range 21-86, 45 male, 52 female) who underwent imaging with abdominal MRI or contrast-enhanced abdominopelvic CT were identified. Patients with known pancreaticobiliary pathology that may confound biliary ductal measurements were excluded. Blinded interpretation was performed, documenting the diameters of the intrahepatic and extrahepatic bile ducts and pancreatic ducts. Descriptive statistics were performed. RESULTS Patients on MMT demonstrated increased bile duct diameter, with an average increase in duct diameter of 2.39 mm for the common bile duct (p < 0.001; 95% CI 1.88-2.90 mm), 1.43 mm for the intrahepatic bile ducts (p < 0.001; 95% CI 1.12-1.74 mm), and 0.90 mm for the pancreatic duct (p < 0.001; 95% CI 0.64-1.16 mm). No statistically significant correlation was found between ductal diameters and the daily dose of methadone. CONCLUSION Patients on methadone maintenance therapy demonstrate significantly increased intra- and extrahepatic bile duct and pancreatic duct diameter when compared with controls. There was no correlation between the dose of methadone and ductal diameter.
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Affiliation(s)
- David D B Bates
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
| | - Dorathy Tamayo-Murillo
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Steven Kussman
- Renaissance Imaging Medical Associates, 18436 Roscoe Boulevard, Northridge, CA, 91325, USA
| | - Adam Luce
- Department of Radiology, Stanford University Medical Center, 300 Pasteur Drive, 5621, Stanford, CA, 94305-5105, USA
| | - Christina A LeBedis
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Jorge A Soto
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Stephan W Anderson
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
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Abstract
Iatrogenic and traumatic bile leaks are uncommon. However, given the overall increase in number of hepatobiliary surgeries and the paradigm shift toward nonoperative management of patients with liver trauma, they have become more prevalent in recent years. Imaging is essential to establishing early diagnosis and guiding treatment as the clinical signs and symptoms of bile leaks are nonspecific, and a delay in recognition of bile leaks portends a high morbidity and mortality rate. Findings suspicious for a bile leak at computed tomography or ultrasonography include free or contained peri- or intrahepatic low density fluid in the setting of recent trauma or hepatobiliary surgery. Hepatobiliary scintigraphy and magnetic resonance cholangiopancreatography (MRCP) with hepatobiliary contrast agents can be used to detect active or contained bile leak. MRCP with hepatobiliary contrast agents has the unique ability to reveal the exact location of bile leak, which often governs whether endoscopic management or surgical management is warranted. Percutaneous transhepatic cholangiography and fluoroscopy via an indwelling catheter that is placed either percutaneously or surgically are useful modalities to guide percutaneous transhepatic biliary drain placement which can provide biliary drainage and/or diversion in the setting of traumatic biliary injury. Surgical treatment of a bile duct injury with Roux-en-Y hepaticojejunostomy is warranted if definitive treatment cannot be accomplished through percutaneous or endoscopic means.
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Bates DDB, Tkacz JN, LeBedis CA, Holalkere N. Suboptimal CT pulmonary angiography in the emergency department: a retrospective analysis of outcomes in a large academic medical center. Emerg Radiol 2016; 23:603-607. [DOI: 10.1007/s10140-016-1425-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 07/14/2016] [Indexed: 10/21/2022]
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Ramalingam V, Bates DDB, Buch K, Uyeda J, Zhao KM, Storer LA, Roberts MB, Lebedis CA, Soto JA, Anderson SW. Diagnosing acute appendicitis using a nonoral contrast CT protocol in patients with a BMI of less than 25. Emerg Radiol 2016; 23:455-62. [PMID: 27392572 DOI: 10.1007/s10140-016-1421-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/01/2016] [Indexed: 12/14/2022]
Abstract
The objective of this study was to compare the accuracy for the diagnosis of appendicitis in patients presenting to the emergency department (ED) with acute, nontraumatic abdominal pain and a body mass index (BMI) of less than 25 before and after the implementation of a nonoral contrast computed tomography (CT) protocol with intravenous contrast. The IRB approved this HIPAA-compliant retrospective study; informed consent was waived. This study included 736 adult patients with a BMI of less than 25 presenting to our ED with acute, nontraumatic abdominal pain over two distinct 6-month time periods. An oral and intravenous contrast-enhanced protocol was utilized in the first cohort (group A), and an intravenous contrast-enhanced protocol without oral contrast was utilized in the second cohort (group B). Three abdominal fellowship-trained readers retrospectively reviewed all CT studies and electronic medical records, including surgical/pathology reports that served as reference standards. Group A consisted of 359 patients; 41 patients had surgically proven appendicitis. The sensitivity and specificity of the readers for diagnosing appendicitis in group A ranged from 95.2-100 and 98.1-99.5 %, respectively. Group B consisted of 372 patients; 39 had surgically proven appendicitis. The sensitivity and specificity of the readers in group B ranged from 92.0-100 and 98.6-100 %, respectively. There were no statistically significant differences in sensitivity or specificity for CT scans performed in groups A and B. In patients with a BMI of less than 25, an intravenous contrast-enhanced CT protocol without oral contrast demonstrates similar accuracy to an intravenous contrast-enhanced protocol with oral contrast for diagnosing acute appendicitis.
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Affiliation(s)
- Vijay Ramalingam
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - David D B Bates
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA.
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Jennifer Uyeda
- Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA
| | - Kathy M Zhao
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Lindsey A Storer
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Marisa B Roberts
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christina A Lebedis
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Jorge A Soto
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
| | - Stephan W Anderson
- Department of Radiology, Boston University Medical Center, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA, 02118, USA
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