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Lakhman Y, Aherne EA, Jayaprakasam VS, Nougaret S, Reinhold C. Staging of Cervical Cancer: A Practical Approach Using MRI and FDG PET. AJR Am J Roentgenol 2023; 221:633-648. [PMID: 37459457 DOI: 10.2214/ajr.23.29003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
This review provides a practical approach to the imaging evaluation of patients with cervical cancer (CC), from initial diagnosis to restaging of recurrence, focusing on MRI and FDG PET. The primary updates to the International Federation of Gynecology and Obstetrics (FIGO) CC staging system, as well as these updates' relevance to clinical management, are discussed. The recent literature investigating the role of MRI and FDG PET in CC staging and image-guided brachytherapy is summarized. The utility of MRI and FDG PET in response assessment and posttreatment surveillance is described. Important findings on MRI and FDG PET that interpreting radiologists should recognize and report are illustrated. The essential elements of structured reports during various phases of CC management are outlined. Special considerations, including the role of imaging in patients desiring fertility-sparing management, differentiation of CC and endometrial cancer, and unusual CC histologies, are also described. Finally, future research directions including PET/MRI, novel PET tracers, and artificial intelligence applications are highlighted.
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Affiliation(s)
- Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Emily A Aherne
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Vetri Sudar Jayaprakasam
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Stephanie Nougaret
- Department of Radiology, Montpellier Cancer Institute, Montpellier, France
- Pinkcc Lab, IRCM, Montpellier, France
| | - Caroline Reinhold
- Department of Radiology, McGill University Health Centre, McGill University, Montreal, QC, Canada
- Augmented Intelligence & Precision Health Laboratory, Research Institute of McGill University Health Centre, Montreal, QC, Canada
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2
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Boehm KM, Aherne EA, Ellenson L, Nikolovski I, Alghamdi M, Vázquez-García I, Zamarin D, Long Roche K, Liu Y, Patel D, Aukerman A, Pasha A, Rose D, Selenica P, Causa Andrieu PI, Fong C, Capanu M, Reis-Filho JS, Vanguri R, Veeraraghavan H, Gangai N, Sosa R, Leung S, McPherson A, Gao J, Lakhman Y, Shah SP. Multimodal data integration using machine learning improves risk stratification of high-grade serous ovarian cancer. Nat Cancer 2022; 3:723-733. [PMID: 35764743 PMCID: PMC9239907 DOI: 10.1038/s43018-022-00388-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 04/27/2022] [Indexed: 04/25/2023]
Abstract
Patients with high-grade serous ovarian cancer suffer poor prognosis and variable response to treatment. Known prognostic factors for this disease include homologous recombination deficiency status, age, pathological stage and residual disease status after debulking surgery. Recent work has highlighted important prognostic information captured in computed tomography and histopathological specimens, which can be exploited through machine learning. However, little is known about the capacity of combining features from these disparate sources to improve prediction of treatment response. Here, we assembled a multimodal dataset of 444 patients with primarily late-stage high-grade serous ovarian cancer and discovered quantitative features, such as tumor nuclear size on staining with hematoxylin and eosin and omental texture on contrast-enhanced computed tomography, associated with prognosis. We found that these features contributed complementary prognostic information relative to one another and clinicogenomic features. By fusing histopathological, radiologic and clinicogenomic machine-learning models, we demonstrate a promising path toward improved risk stratification of patients with cancer through multimodal data integration.
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Affiliation(s)
- Kevin M Boehm
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, New York, NY, USA
| | - Emily A Aherne
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lora Ellenson
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ines Nikolovski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mohammed Alghamdi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ignacio Vázquez-García
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Irving Institute for Cancer Dynamics, Columbia University, New York, NY, USA
| | - Dmitriy Zamarin
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Kara Long Roche
- Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ying Liu
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Druv Patel
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Aukerman
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arfath Pasha
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Doori Rose
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pier Selenica
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Chris Fong
- Computational Oncology, Department of Epidemiology and Biostatistics, 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
| | - Jorge S Reis-Filho
- Human Oncology and Pathogenesis Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rami Vanguri
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Harini Veeraraghavan
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ramon Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samantha Leung
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew McPherson
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - JianJiong Gao
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Sohrab P Shah
- Computational Oncology, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Kaye EA, Aherne EA, Duzgol C, Häggström I, Kobler E, Mazaheri Y, Fung MM, Zhang Z, Otazo R, Vargas HA, Akin O. Accelerating Prostate Diffusion-weighted MRI Using a Guided Denoising Convolutional Neural Network: Retrospective Feasibility Study. Radiol Artif Intell 2020; 2:e200007. [PMID: 33033804 DOI: 10.1148/ryai.2020200007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/29/2020] [Accepted: 05/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the feasibility of accelerating prostate diffusion-weighted imaging (DWI) by reducing the number of acquired averages and denoising the resulting image using a proposed guided denoising convolutional neural network (DnCNN). MATERIALS AND METHODS Raw data from the prostate DWI scans were retrospectively gathered between July 2018 and July 2019 from six single-vendor MRI scanners. There were 103 datasets used for training (median age, 64 years; interquartile range [IQR], 11), 15 for validation (median age, 68 years; IQR, 12), and 37 for testing (median age, 64 years; IQR, 12). High b-value diffusion-weighted (hb DW) data were reconstructed into noisy images using two averages and reference images using all 16 averages. A conventional DnCNN was modified into a guided DnCNN, which uses the low b-value DW image as a guidance input. Quantitative and qualitative reader evaluations were performed on the denoised hb DW images. A cumulative link mixed regression model was used to compare the readers' scores. The agreement between the apparent diffusion coefficient (ADC) maps (denoised vs reference) was analyzed using Bland-Altman analysis. RESULTS Compared with the original DnCNN, the guided DnCNN produced denoised hb DW images with higher peak signal-to-noise ratio (32.79 ± 3.64 [standard deviation] vs 33.74 ± 3.64), higher structural similarity index (0.92 ± 0.05 vs 0.93 ± 0.04), and lower normalized mean square error (3.9% ± 10 vs 1.6% ± 1.5) (P < .001 for all). Compared with the reference images, the denoised images received higher image quality scores from the readers (P < .0001). The ADC values based on the denoised hb DW images were in good agreement with the reference ADC values (mean ADC difference ranged from -0.04 to 0.02 × 10-3 mm2/sec). CONCLUSION Accelerating prostate DWI by reducing the number of acquired averages and denoising the resulting image using the proposed guided DnCNN is technically feasible. Supplemental material is available for this article. © RSNA, 2020.
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Affiliation(s)
- Elena A Kaye
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Emily A Aherne
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Cihan Duzgol
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Ida Häggström
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Erich Kobler
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Yousef Mazaheri
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Maggie M Fung
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Zhigang Zhang
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Ricardo Otazo
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Hebert A Vargas
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
| | - Oguz Akin
- Departments of Medical Physics (E.A.K., I.H., Y.M., R.O.), Radiology (E.A.A., C.D., R.O., H.A.V., O.A.), and Epidemiology and Biostatistics (Z.Z.), Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room S1212B, New York, NY 10065; Institute of Computer Graphics and Vision, Graz University of Technology, Graz, Austria (E.K.); and MR Applications & Workflow Team, GE Healthcare, Chicago, Ill (M.M.F.)
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Koktzoglou I, Huang R, Ong AL, Aouad PJ, Aherne EA, Edelman RR. Feasibility of a sub-3-minute imaging strategy for ungated quiescent interval slice-selective MRA of the extracranial carotid arteries using radial k-space sampling and deep learning-based image processing. Magn Reson Med 2020; 84:825-837. [PMID: 31975432 DOI: 10.1002/mrm.28179] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 12/09/2019] [Accepted: 12/30/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE To develop and test the feasibility of a sub-3-minute imaging strategy for non-contrast evaluation of the extracranial carotid arteries using ungated quiescent interval slice-selective (QISS) MRA, combining single-shot radial sampling with deep neural network-based image processing to optimize image quality. METHODS The extracranial carotid arteries of 12 human subjects were imaged at 3 T using ungated QISS MRA. In 7 healthy volunteers, the effects of radial and Cartesian k-space sampling, single-shot and multishot image acquisition (1.1-3.3 seconds/slice, 141-423 seconds/volume), and deep learning-based image processing were evaluated using segmental image quality scoring, arterial temporal SNR, arterial-to-background contrast and apparent contrast-to-noise ratio, and structural similarity index. Comparison of deep learning-based image processing was made with block matching and 3D filtering denoising. RESULTS Compared with Cartesian sampling, radial k-space sampling increased arterial temporal SNR 107% (P < .001) and improved image quality during 1-shot imaging (P < .05). The carotid arteries were depicted with similar image quality on the rapid 1-shot and much lengthier 3-shot radial QISS protocols (P = not significant), which was corroborated in patient studies. Deep learning-based image processing outperformed block matching and 3D filtering denoising in terms of structural similarity index (P < .001). Compared with original QISS source images, deep learning image processing provided 24% and 195% increases in arterial-to-background contrast (P < .001) and apparent contrast-to-noise ratio (P < .001), and provided source images that were preferred by radiologists (P < .001). CONCLUSION Rapid, sub-3-minute evaluation of the extracranial carotid arteries is feasible with ungated single-shot radial QISS, and benefits from the use of deep learning-based image processing to enhance source image quality.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois.,Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Rong Huang
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois
| | - Archie L Ong
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois.,Department of Neurology, NorthShore University HealthSystem, Evanston, Illinois
| | - Pascale J Aouad
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Emily A Aherne
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois.,Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Aherne EA, Koktzoglou I, Lind BB, Edelman RR. Dynamic quantitative nonenhanced magnetic resonance angiography of the abdominal aorta and lower extremities using cine fast interrupted steady-state in combination with arterial spin labeling: a feasibility study. J Cardiovasc Magn Reson 2019; 21:55. [PMID: 31474219 PMCID: PMC6717984 DOI: 10.1186/s12968-019-0562-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cine fast interrupted steady-state in combination with arterial spin labeling is a recently described nonenhanced magnetic resonance angiography (MRA) technique that relies on bolus tracking for time-resolved digital subtraction angiography-like displays of blood flow patterns. We evaluated the feasibility of applying this technique to display in-plane flow patterns in two regions: the abdominal aorta and lower extremity peripheral arteries. METHODS We performed an institutional review board-approved study in healthy subjects and patients. In 7 healthy subjects, in-plane flow was imaged at 4 stations ranging from the lower legs to the aorto-iliac bifurcation (junction of the distal thigh and upper calf, mid-thigh, junction of the upper thigh and pelvis, upper pelvis). In 5 healthy subjects and 6 patients without abdominal aortopathy, images were acquired through the suprarenal abdominal aorta. Ten patients with known peripheral arterial disease and two patients with stable disease of the abdominal aorta were also evaluated. Peak velocity was compared at each of the 4 stations for cine fast interrupted steady-state in combination with arterial spin labeling and two-dimensional cine phase contrast in patients with normal vessels. RESULTS In-plane flow patterns were well visualized in all peripheral arterial stations and in the abdominal aorta, providing a high quality display of hemodynamic patterns along extensive lengths of the vessels. There was very strong positive correlation (r = 0.952, P < 0.05) and excellent agreement (intraclass correlation coefficient, 0.935; 95% confidence interval, 0.812-0.972) between peak flow velocities measured by cine fast interrupted steady-state in combination with arterial spin labeling and two-dimensional cine phase contrast. In 10 patients with peripheral artery disease and 2 patients with aortic pathology, cine fast interrupted steady-state in combination with arterial spin labeling provided a visual demonstration of abnormal hemodynamics. CONCLUSION This feasibility study suggests that cine fast interrupted steady-state in combination with arterial spin labeling provides an efficient, high quality and physiologically accurate display of in-plane flow patterns over extensive lengths of the lower extremity peripheral arteries, which can be difficult to achieve using other MRA techniques.
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Affiliation(s)
- Emily A. Aherne
- Department of Radiology, NorthShore University HealthSystem, Walgreen Building, G507 2650 Ridge Ave, Evanston, USA
- McGaw Medical Center of Northwestern University, 2650 Ridge Ave Evanston, Chicago, IL 60201 USA
| | - Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Walgreen Building, G507 2650 Ridge Ave, Evanston, USA
- University of Chicago Pritzker School of Medicine, Chicago, USA
| | - Benjamin B. Lind
- Department of Surgery, NorthShore University HealthSystem, 9650 Gross Point Rd Ste 4900, Skokie, Evanston, IL 60076 USA
| | - Robert R. Edelman
- Department of Radiology, NorthShore University HealthSystem, Walgreen Building, G507 2650 Ridge Ave, Evanston, USA
- Northwestern University Feinberg School of Medicine, Chicago, USA
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Koktzoglou I, Aherne EA, Walker MT, Meyer JR, Edelman RR. Ungated nonenhanced radial quiescent interval slice-selective (QISS) magnetic resonance angiography of the neck: Evaluation of image quality. J Magn Reson Imaging 2019; 50:1798-1807. [PMID: 31077477 DOI: 10.1002/jmri.26781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Standard-of-care time-of-flight (TOF) techniques for nonenhanced magnetic resonance angiography (NEMRA) of the carotid bifurcation and other cervical arteries often provide nondiagnostic image quality due to motion and flow artifacts. PURPOSE To perform an initial evaluation of an ungated radial quiescent-interval slice-selective (QISS) technique for NEMRA of the neck, in comparison with 2D TOF and contrast-enhanced magnetic resonance angiography (CEMRA). STUDY TYPE Retrospective. POPULATION Sixty patients referred for neck MR angiography. FIELD STRENGTH/SEQUENCE Ungated radial QISS at 3T. ASSESSMENT Three radiologists scored image quality of 18 arterial segments using a 4-point scale (1, nondiagnostic; 2, fair; 3, good; 4, excellent), and two radiologists graded proximal internal carotid stenosis using five categories (<50%, 50-69%, 70-99%, occlusion, nondiagnostic). STATISTICAL TESTS Friedman tests with post-hoc Wilcoxon signed-rank tests; unweighted Gwet's AC1 statistic; tests for equality of proportions. RESULTS Ungated radial QISS provided image quality that significantly exceeded 2D TOF (mean scores of 2.7 vs. 2.0, 2.7 vs. 2.2, and 2.9 vs. 2.3; P < 0.001, all comparisons), while CEMRA provided the best image quality (mean scores of 3.6, 3.7, and 3.5 for the three reviewers). Interrater agreement of image quality scores was substantial for CEMRA (AC1 = 0.70, P < 0.001), and moderate for QISS (AC1 = 0.43, P < 0.001) and TOF (AC1 = 0.41, P < 0.001). Compared with TOF, QISS NEMRA provided a significantly higher percentage of diagnostic segments for all three reviewers (91.0% vs. 71.7%, 93.5% vs. 72.9%, 95.5% vs. 85.2%; P < 0.0001) and demonstrated better agreement with CEMRA for grading of proximal internal carotid stenosis (AC1 = 0.94 vs. 0.73 for reviewer 1, P < 0.05; AC1 = 0.89 vs. 0.68 for reviewer 2, P < 0.05). DATA CONCLUSION In this initial study, ungated radial QISS significantly outperformed 2D TOF for the evaluation of the neck arteries, with overall better image quality and more diagnostic arterial segments, and improved agreement with CEMRA for grading stenosis of the proximal internal carotid artery. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:1798-1807.
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Affiliation(s)
- Ioannis Koktzoglou
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Emily A Aherne
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew T Walker
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Joel R Meyer
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Robert R Edelman
- Department of Radiology, NorthShore University HealthSystem, Evanston, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Aherne EA, Plodkowski AJ, Montecalvo J, Hayan S, Zheng J, Capanu M, Adusumilli PS, Travis WD, Ginsberg MS. What CT characteristics of lepidic predominant pattern lung adenocarcinomas correlate with invasiveness on pathology? Lung Cancer 2018; 118:83-89. [PMID: 29572008 DOI: 10.1016/j.lungcan.2018.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 09/30/2017] [Revised: 01/15/2018] [Accepted: 01/18/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES The International Association for the Study of Lung Cancer, American Thoracic Society and European Respiratory Society lung adenocarcinoma classification in 2011 defined three lepidic predominant patterns including adenocarcinoma in situ, minimally invasive adenocarcinoma and lepidic predominant adenocarcinoma. We sought to correlate the radiology and pathology findings and identify any computed tomography (CT) features which can be associated with invasive growth. MATERIALS AND METHODS An institutional review board approved, retrospective study was conducted evaluating 63 patients with resected, pathologically confirmed, adenocarcinomas with predominant lepidic patterns. Preoperative CT images of the nodules were assessed using quantitative and qualitative radiographic descriptors while blinded to pathologic sub-classification and size. Maximum diameter was measured after evaluation of the axial, sagittal and coronal planes. Radiologic - pathologic associations were examined using Fisher's exact test, the Kruskal-Wallis test and the Spearman correlation coefficient (ρ). RESULTS AND CONCLUSION Increasing maximum diameter of the whole lesion (ground glass and solid component) on CT was significantly associated with invasiveness (p = .003), as was the maximum pathologic specimen diameter (p = .008). Larger diameter of the solid component on CT was also found in lepidic predominant adenocarcinoma compared to minimally invasive adenocarcinoma (median 10.5 vs 2 mm, p = .005). More invasive tumors had higher visual estimated percentage solid component compared to whole lesion measurement on CT (p = .014). CT and pathologic measurements were positively correlated, although only moderately (ρ = .66) for the maximum whole lesion size and fair (ρ = .49) for solid/invasive component maximum measurements. Larger whole lesion size and solid component size of lepidic predominant pattern adenocarcinomas are associated with lesion invasiveness, although radiologic and pathologic lesion measurements are only fair-moderately positively correlated.
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Affiliation(s)
- Emily A Aherne
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States.
| | - Andrew J Plodkowski
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Joseph Montecalvo
- Department of Histopathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Sumar Hayan
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Junting Zheng
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Marinela Capanu
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Prasad S Adusumilli
- Department of Cardiothoracic Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - William D Travis
- Department of Histopathology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States
| | - Michelle S Ginsberg
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065, United States.
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Smyth AE, Healy CF, Aherne EA, MacMathuna P, Morrin MM, Fenlon HM. National Survey of CT Colonography Practice in Ireland. Ir Med J 2016; 109:419. [PMID: 27814436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
CT Colonography was first introduced to Ireland in 1999. Our aim of this study is to review current CT Colonography practices in the Republic of Ireland. A questionnaire on CT Colonography practice was sent to all non-maternity adult radiology departments in the Republic of Ireland with a CT scanner. The results are interpreted in the context of the recommendations on CT Colonography quality standards as published by the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus statement in the journal of European Radiology in 2013. Thirty centres provide CT Colonography; 21 of which responded (70%). Each centre performs median 90 studies per year; the majority follow accepted patient preparation and image acquisition protocols. Seventy-six percent of the centres repsonded that the majority of patients imaged are symptomatic. Of the 51 consultant radiologists reading CT Colonography, 37 (73%) have attended a CT Colonography course. In 17 (81%) of the centres the studies are single read although 81% of the centres have access to a second radiologist's opinion. Fourteen (67%) of the centres reported limited access to CT scanner time as the major limiting factor to expanding their service. CT Colonography is widely available in Ireland and is largely performed in accordance with European recommendations.
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Affiliation(s)
- A E Smyth
- Department of Gastroenterology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - C F Healy
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - E A Aherne
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - P MacMathuna
- Department of Gastroenterology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
| | - M M Morrin
- Department of Radiology, Beaumont Hospital, Beaumont Road, Dublin 9
| | - H M Fenlon
- Department of Radiology, Mater Misericordiae University Hospital, Eccles St, Dublin 7
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