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Tejani A, Dowling T, Sanampudi S, Yazdani R, Canan A, Malja E, Xi Y, Abbara S, Peshock RM, Kay FU. Deep Learning for Detection of Pneumothorax and Pleural Effusion on Chest Radiographs: Validation Against Computed Tomography, Impact on Resident Reading Time, and Interreader Concordance. J Thorac Imaging 2024; 39:185-193. [PMID: 37884394 DOI: 10.1097/rti.0000000000000746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
PURPOSE To study the performance of artificial intelligence (AI) for detecting pleural pathology on chest radiographs (CXRs) using computed tomography as ground truth. PATIENTS AND METHODS Retrospective study of subjects undergoing CXR in various clinical settings. Computed tomography obtained within 24 hours of the CXR was used to volumetrically quantify pleural effusions (PEfs) and pneumothoraxes (Ptxs). CXR was evaluated by AI software (INSIGHT CXR; Lunit) and by 3 second-year radiology residents, followed by AI-assisted reassessment after a 3-month washout period. We used the area under the receiver operating characteristics curve (AUROC) to assess AI versus residents' performance and mixed-model analyses to investigate differences in reading time and interreader concordance. RESULTS There were 96 control subjects, 165 with PEf, and 101 with Ptx. AI-AUROC was noninferior to aggregate resident-AUROC for PEf (0.82 vs 0.86, P < 0.001) and Ptx (0.80 vs 0.84, P = 0.001) detection. AI-assisted resident-AUROC was higher but not significantly different from the baseline. AI-assisted reading time was reduced by 49% (157 vs 80 s per case, P = 0.009), and Fleiss kappa for Ptx detection increased from 0.70 to 0.78 ( P = 0.003). AI decreased detection error for PEf (odds ratio = 0.74, P = 0.024) and Ptx (odds ratio = 0.39, P < 0.001). CONCLUSION Current AI technology for the detection of PEf and Ptx on CXR was noninferior to second-year resident performance and could help decrease reading time and detection error.
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Affiliation(s)
- Ali Tejani
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX
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Kay FU, Madhuranthakam AJ. MR Perfusion Imaging of the Lung. Magn Reson Imaging Clin N Am 2024; 32:111-123. [PMID: 38007274 DOI: 10.1016/j.mric.2023.09.006] [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: 11/27/2023]
Abstract
Lung perfusion assessment is critical for diagnosing and monitoring a variety of respiratory conditions. MRI perfusion provides a radiation-free technique, making it an ideal choice for longitudinal imaging in younger populations. This review focuses on the techniques and applications of MRI perfusion, including contrast-enhanced (CE) MRI and non-CE methods such as arterial spin labeling (ASL), fourier decomposition (FD), and hyperpolarized 129-Xenon (129-Xe) MRI. ASL leverages endogenous water protons as tracers for a non-invasive measure of lung perfusion, while FD offers simultaneous measurements of lung perfusion and ventilation, enabling the generation of ventilation/perfusion mapsHyperpolarized 129-Xe MRI emerges as a novel tool for assessing regional gas exchange in the lungs. Despite the promise of MRI perfusion techniques, challenges persist, including competition with other imaging techniques and the need for additional validation and standardization. In conditions such as cystic fibrosis and lung cancer, MRI has displayed encouraging results, whereas in diseases like chronic obstructive pulmonary disease, further validation remains necessary. In conclusion, while MRI perfusion techniques hold immense potential for a comprehensive, non-invasive assessment of lung function and perfusion, their broader clinical adoption hinges on technological advancements, collaborative research, and rigorous validation.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
| | - Ananth J Madhuranthakam
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; Advanced Imaging Research Center, University of Texas Southwestern Medical Center, North Campus 2201 Inwood Road, Dallas, TX 75390-8568, USA
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Kay FU, Lumby C, Tanabe Y, Abbara S, Rajiah P. Detection of Low Blood Hemoglobin Levels on Pulmonary CT Angiography: A Feasibility Study Combining Dual-Energy CT and Machine Learning. Tomography 2023; 9:1538-1550. [PMID: 37624116 PMCID: PMC10459752 DOI: 10.3390/tomography9040123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVES To evaluate if dual-energy CT (DECT) pulmonary angiography (CTPA) can detect anemia with the aid of machine learning. METHODS Inclusion of 100 patients (mean age ± SD, 51.3 ± 14.8 years; male-to-female ratio, 42/58) who underwent DECT CTPA and hemoglobin (Hb) analysis within 24 h, including 50 cases with Hb below and 50 controls with Hb ≥ 12 g/dL. Blood pool attenuation was assessed on virtual noncontrast (VNC) images at eight locations. A classification model using extreme gradient-boosted trees was developed on a training set (n = 76) for differentiating cases from controls. The best model was evaluated in a separate test set (n = 24). RESULTS Blood pool attenuation was significantly lower in cases than controls (p-values < 0.01), except in the right atrium (p = 0.06). The machine learning model had sensitivity, specificity, and accuracy of 83%, 92%, and 88%, respectively. Measurements at the descending aorta had the highest relative importance among all features; a threshold of 43 HU yielded sensitivity, specificity, and accuracy of 68%, 76%, and 72%, respectively. CONCLUSION VNC imaging and machine learning shows good diagnostic performance for detecting anemia on DECT CTPA.
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Affiliation(s)
- Fernando U. Kay
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
| | - Cynthia Lumby
- Veterans Affairs North Texas Health Care System, Dallas, TX 75216, USA;
| | - Yuki Tanabe
- Department of Radiology, Ehime University, Matsuyama 790-0825, Japan;
| | - Suhny Abbara
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA;
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Barbosa MF, Canan A, Xi Y, Litt H, Diercks DB, Abbara S, Kay FU. Comparative Effectiveness of Coronary CT Angiography and Standard of Care for Evaluating Acute Chest Pain: A Living Systematic Review and Meta-Analysis. Radiol Cardiothorac Imaging 2023; 5:e230022. [PMID: 37693194 PMCID: PMC10483255 DOI: 10.1148/ryct.230022] [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: 01/21/2023] [Revised: 06/26/2023] [Accepted: 07/03/2023] [Indexed: 09/12/2023]
Abstract
Purpose To perform a living systematic review and meta-analysis of randomized controlled trials comparing the effectiveness of coronary CT angiography (CCTA) and standard of care (SOC) in the evaluation of acute chest pain (ACP). Materials and Methods Multiple electronic databases were systematically searched, with the most recent search conducted on October 31, 2022. Studies were stratified into two groups according to the pretest probability for acute coronary syndrome (group 1 with predominantly low-to-intermediate risk vs group 2 with high risk). A meta-regression analysis was also conducted using participant risk, type of SOC used, and the use or nonuse of high-sensitivity troponins as independent variables. Results The final analysis included 22 randomized controlled trials (9379 total participants; 4956 assigned to CCTA arms and 4423 to SOC arms). There was a 14% reduction in the length of stay and a 17% reduction in immediate costs for the CCTA arm compared with the SOC arm. In group 1, the length of stay was 17% shorter and costs were 21% lower using CCTA. There was no evidence of differences in referrals to invasive coronary angiography, myocardial infarction, mortality, rate of hospitalization, further stress testing, or readmissions between CCTA and SOC arms. There were more revascularizations (relative risk, 1.45) and medication changes (relative risk, 1.33) in participants with low-to-intermediate acute coronary syndrome risk and increased radiation exposure in high-risk participants (mean difference, 7.24 mSv) in the CCTA arm compared with the SOC arm. The meta-regression analysis found significant differences between CCTA and SOC arms for rate of hospitalization, further stress testing, and medication changes depending on the type of SOC (P < .05). Conclusion The results support the use of CCTA as a safe, rapid, and less expensive in the short term strategy to exclude acute coronary syndrome in low- to intermediate-risk patients presenting with acute chest pain.Keywords: Acute Coronary Syndrome, Chest Pain, Emergency Department, Coronary Computed Tomography, Usual Care Supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Maurício F. Barbosa
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Arzu Canan
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Yin Xi
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Harold Litt
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Deborah B. Diercks
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Suhny Abbara
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
| | - Fernando U. Kay
- From the Department of Radiology, Cardiothoracic Division (M.F.B.,
A.C., S.A., F.U.K.), Department of Radiology (Y.X.), and Department of Emergency
Medicine (D.B.D.), UT Southwestern Medical Center at Dallas, 5323 Harry Hines
Blvd, Dallas, TX 75390; and Department of Radiology, University of Pennsylvania,
Philadelphia, Pa (H.L.)
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Abdellatif W, Vasan V, Kay FU, Kohli A, Abbara S, Brewington C. Know your way around acute unenhanced CT during global iodinated contrast crisis: a refresher to ED radiologists. Emerg Radiol 2022; 29:1019-1031. [PMID: 35945464 PMCID: PMC9363271 DOI: 10.1007/s10140-022-02085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Due to a contrast shortage crisis resulting from the decreased supply of iodinated contrast agents, the American College of Radiology (ACR) has issued a guidance statement followed by memoranda from various hospitals to preserve and prioritize the limited supply of contrast. The vast majority of iodinated contrast is used by CT, with a minority used by vascular and intervention radiology, fluoroscopy, and other services. A direct consequence is a paradigm shift to large volume unenhanced CT scans being utilized for acute and post traumatic patients in EDs, an uncharted territory for most radiologists and trainees. This article provides radiological diagnostic guidance and a pictorial example through systematic review of common unenhanced CT findings in the acute setting.
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Affiliation(s)
- Waleed Abdellatif
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA.
| | - Vasantha Vasan
- Abdominal Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Fernando U Kay
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Ajay Kohli
- Departments of Radiology and Orthopedic Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Suhny Abbara
- Cardiothoracic Imaging Division, Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
| | - Cecelia Brewington
- Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8896, USA
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Ananthakrishnan L, Kay FU, Zeikus EA, Chu ES, Chang J, Barr JD, Rofsky NM, Abbara S. What the Baby Formula and Medical Contrast Material Shortages Have in Common: Insights and Recommendations for Managing the Iodinated Contrast Media Shortage. Radiol Cardiothorac Imaging 2022; 4:e220101. [PMID: 35833167 PMCID: PMC9274312 DOI: 10.1148/ryct.220101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 05/21/2022] [Accepted: 05/21/2022] [Indexed: 05/25/2023]
Abstract
The impact of supply chain and supply chain logistics, including personnel directly and indirectly related to the movement of supplies, has come to light in a variety of industries since the global COVID-19 pandemic. Acutely, the experience with baby formula and iodinated contrast material exposes key vulnerabilities to supply chains. The rather sudden diminished availability of iodinated contrast material has forced health care systems to engage in more judicious use of product through catalyzing the adoption of behaviors that had been recommended and deemed reasonable prior to the shortage. The authors describe efforts at a large, academic safety net county health system to conserve iodinated contrast media by optimizing contrast media use in the CT department and changing ordering patterns of referring providers. Special attention is given to opportunities to conserve contrast material in cardiothoracic imaging, including low kV and dual-energy CT techniques. A values-based leadership philosophy and collaboration with key stakeholders facilitate effective response to the critical shortage and rapid deployment of iodinated contrast media conservation strategies. Last, while the single-supplier model is efficient and cost-effective, its application to critically necessary services such as health care must be questioned considering disruptions related to the COVID-19 pandemic. Keywords: CT, Intravenous Contrast Agents, CT-Spectral Imaging (Dual Energy) ©RSNA, 2022.
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Kligerman SJ, Kay FU, Raptis CA, Henry TS, Sechrist JW, Walker CM, Vargas DB, Filev PD, Chung MS, Digumarthy SR, Ropp AM, Mohammed TL, Pope KW, Marquis KM, Chung JH, Kanne JP. CT Findings and Patterns of E-Cigarette or Vaping Product Use-Associated Lung Injury: A Multicenter Cohort of 160 Cases. Chest 2021; 160:1492-1511. [PMID: 33957099 PMCID: PMC8546241 DOI: 10.1016/j.chest.2021.04.054] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/15/2021] [Accepted: 04/18/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND E-cigarette and vaping-induced lung injury (EVALI) causes a spectrum of CT lung injury patterns. Relative frequencies and associations with vaping behavior are unknown. RESEARCH QUESTION What are the frequencies of imaging findings and CT patterns in EVALI and what is the relationship to vaping behavior? STUDY DESIGN AND METHODS CT scans of 160 subjects with EVALI from 15 institutions were retrospectively reviewed. CT findings and patterns were defined and agreed on via consensus. The parenchymal organizing pneumonia (OP) pattern was defined as regional or diffuse ground-glass opacity (GGO) ± consolidation without centrilobular nodules (CNs). An airway-centered OP pattern was defined as diffuse CNs with little or no GGO, whereas a mixed OP pattern was a combination of the two. Other patterns included diffuse alveolar damage (DAD), acute eosinophilic-like pneumonia, and pulmonary hemorrhage. Cases were classified as atypical if they did not fit into a pattern. Imaging findings, pattern frequencies, and injury severity were correlated with substance vaped (marijuana derives [tetrahydrocannabinol] [THC] only, nicotine derivates only, and both), vaping frequency, regional geography, and state recreational THC legality. One-way analysis of variance, χ2 test, and multivariable analyses were used for statistical analysis. RESULTS A total of 160 patients (79.4% men) with a mean age of 28.2 years (range, 15-68 years) with EVALI underwent CT scan. Seventy-seven (48.1%), 15 (9.4%), and 68 (42.5%) patients admitted to vaping THC, nicotine, or both, respectively. Common findings included diffuse or lower lobe GGO with subpleural (78.1%), lobular (59.4%), or peribronchovascular (PBV) sparing (40%). Septal thickening (50.6%), lymphadenopathy (63.1%), and CNs (36.3%) were common. PBV sparing was associated with younger age (P = .02). Of 160 subjects, 156 (97.5%) had one of six defined patterns. Parenchymal, airway-centered, and mixed OP patterns were seen in 89 (55.6%), 14 (8.8%), and 32 (20%) patients, respectively. Acute eosinophilic-like pneumonia (six of 160, 3.8%), DAD (nine of 160, 5.6%), pulmonary hemorrhage (six of 160, 3.8%), and atypical (four of 160, 2.5%) patterns were less common. Increased vaping frequency was associated with more severe injury (P = .008). Multivariable analysis showed a negative association between vaping for > 6 months and DAD pattern (P = .03). Two subjects (1.25%) with DAD pattern died. There was no relation between pattern and injury severity, geographic location, and state legality of recreational use of THC. INTERPRETATION EVALI typically causes an OP pattern but exists on a spectrum of acute lung injury. Vaping habits do not correlate with CT patterns except for negative correlation between vaping > 6 months and DAD pattern. PBV sparing, not previously described in acute lung injury, is a common finding.
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Affiliation(s)
- Seth J Kligerman
- Department of Radiology, University of California, San Diego, San Diego, CA.
| | - Fernando U Kay
- Department of Radiology, University of Texas Southwestern Medical Center, TX
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology/Washington University School of Medicine, St. Louis, MO
| | - Travis S Henry
- Department of Radiology, University of California, San Francisco, San Francisco, CA
| | - Jacob W Sechrist
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Peter D Filev
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA
| | | | | | - Alan M Ropp
- Department of Radiology, University of Virginia, VA
| | | | - Kristen W Pope
- Department of Radiology, University of Kansas Medical Center, KS
| | - Kaitlin M Marquis
- Mallinckrodt Institute of Radiology/Washington University School of Medicine, St. Louis, MO
| | | | - Jeffrey P Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, WI
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Colak E, Kitamura FC, Hobbs SB, Wu CC, Lungren MP, Prevedello LM, Kalpathy-Cramer J, Ball RL, Shih G, Stein A, Halabi SS, Altinmakas E, Law M, Kumar P, Manzalawi KA, Nelson Rubio DC, Sechrist JW, Germaine P, Lopez EC, Amerio T, Gupta P, Jain M, Kay FU, Lin CT, Sen S, Revels JW, Brussaard CC, Mongan J. The RSNA Pulmonary Embolism CT Dataset. Radiol Artif Intell 2021; 3:e200254. [PMID: 33937862 PMCID: PMC8043364 DOI: 10.1148/ryai.2021200254] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 01/11/2023]
Abstract
Supplemental material is available for this article.
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Kay FU, Ho V, Dosunmu EB, Chhabra A, Brown K, Duan X, Öz OK. Quantitative CT Detects Undiagnosed Low Bone Mineral Density in Oncologic Patients Imaged With 18F-FDG PET/CT. Clin Nucl Med 2021; 46:8-15. [PMID: 33234926 PMCID: PMC8931857 DOI: 10.1097/rlu.0000000000003416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE We assessed the prevalence of low bone mineral density (BMD) in oncologic patients undergoing F-FDG PET/CT. PATIENTS AND METHODS This is a retrospective analysis of 100 patients who underwent F-FDG PET/CT at a single center from October 2015 till May 2016. Quantitative CT (QCT) was used to assess BMD at the lumbar spine (BMDQCT) and femoral necks (BMDCTXA). SUVmax was used to evaluate metabolic activity of the bone marrow. Risk of osteoporosis-related fractures was calculated with femoral neck BMDCTXA and the FRAX algorithm, which was compared against measurements of CT attenuation of the trabecular bone at L1 (L1HU). RESULTS Osteoporosis and osteopenia were respectively present in 16% and 46% of patients 50 years and older. Bone marrow SUVmax was correlated with BMD at the lumbar spine (ρ = 0.36, P < 0.001). Increased age and low marrow SUVmax were associated with low BMDQCT at the lumbar spine (both P < 0.001), whereas increased age, female sex, and low marrow SUVmax were associated with low BMDCTXA at the femoral necks (P < 0.001, P < 0.001, P = 0.01, respectively). L1HU had an area under the curve of 0.95 (95% confidence interval [CI], 0.90-0.99) for detecting increased risk for osteoporosis-related fracture, with best threshold of 125.8 HU (95% CI, 115.7-144.9) yielding sensitivity of 100% (95% CI, 0.92-1.00), specificity of 0.90 (95% CI, 0.76-0.97), and accuracy of 0.91 (95% CI, 0.79-0.97). CONCLUSIONS Low BMD is frequent in oncologic patients undergoing F-FDG PET/CT. Decreased F-FDG avidity of the bone marrow correlates with decreased BMD, validating the link between osteoporosis and bone marrow fat. L1HU could be a simple and accurate approach for detecting patients at risk for osteoporosis-related fractures using PET/CTdata.
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Affiliation(s)
- Fernando U Kay
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Vinh Ho
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Edmund B Dosunmu
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Avneesh Chhabra
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | | | - Xinhui Duan
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas
| | - Orhan K Öz
- From the Department of Radiology, University of Texas Southwestern Medical Center, Dallas
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Kay FU. Radiomics in Chest CT: Where Are We Going? Radiol Cardiothorac Imaging 2020; 2:e200411. [PMID: 33779624 PMCID: PMC7977728 DOI: 10.1148/ryct.2020200411] [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] [Received: 06/29/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Fernando U Kay
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
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Kay FU, Abbara S. Refining Risk Stratification in Nonmassive Acute Pulmonary Embolism. Radiol Cardiothorac Imaging 2020; 2:e200458. [PMID: 33779653 PMCID: PMC7977991 DOI: 10.1148/ryct.2020200458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 06/12/2023]
Affiliation(s)
- Fernando U. Kay
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
| | - Suhny Abbara
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390
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Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, Henry TS, Kanne JP, Kligerman S, Ko JP, Litt H. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA - Secondary Publication. J Thorac Imaging 2020; 35:219-227. [PMID: 32324653 PMCID: PMC7255403 DOI: 10.1097/rti.0000000000000524] [Citation(s) in RCA: 545] [Impact Index Per Article: 136.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Routine screening CT for the identification of COVID-19 pneumonia is currently not recommended by most radiology societies. However, the number of CTs performed in persons under investigation (PUI) for COVID-19 has increased. We also anticipate that some patients will have incidentally detected findings that could be attributable to COVID-19 pneumonia, requiring radiologists to decide whether or not to mention COVID-19 specifically as a differential diagnostic possibility. We aim to provide guidance to radiologists in reporting CT findings potentially attributable to COVID-19 pneumonia, including standardized language to reduce reporting variability when addressing the possibility of COVID-19. When typical or indeterminate features of COVID-19 pneumonia are present in endemic areas as an incidental finding, we recommend contacting the referring providers to discuss the likelihood of viral infection. These incidental findings do not necessarily need to be reported as COVID-19 pneumonia. In this setting, using the term "viral pneumonia" can be a reasonable and inclusive alternative. However, if one opts to use the term "COVID-19" in the incidental setting, consider the provided standardized reporting language. In addition, practice patterns may vary, and this document is meant to serve as a guide. Consultation with clinical colleagues at each institution is suggested to establish a consensus reporting approach. The goal of this expert consensus is to help radiologists recognize findings of COVID-19 pneumonia and aid their communication with other healthcare providers, assisting management of patients during this pandemic.
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Affiliation(s)
- Scott Simpson
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, PA
| | | | - Suhny Abbara
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, MO
| | - Jonathan H. Chung
- Department of Radiology, University of Chicago Medicine, Chicago, IL
| | - Michael Chung
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai
| | - Travis S. Henry
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco
| | - Jeffrey P. Kanne
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison WI
| | - Seth Kligerman
- Department of Radiology, University of California San Diego, San Diego, CA
| | - Jane P. Ko
- Department of Radiology, New York University Langone, New York, NY
| | - Harold Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, PA
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Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, Henry TS, Kanne JP, Kligerman S, Ko JP, Litt H. Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging 2020; 2:e200152. [PMID: 33778571 PMCID: PMC7233447 DOI: 10.1148/ryct.2020200152] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [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: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 12/15/2022]
Abstract
Routine screening CT for the identification of coronavirus disease 19 (COVID-19) pneumonia is currently not recommended by most radiology societies. However, the number of CT examinations performed in persons under investigation for COVID-19 has increased. We also anticipate that some patients will have incidentally detected findings that could be attributable to COVID-19 pneumonia, requiring radiologists to decide whether or not to mention COVID-19 specifically as a differential diagnostic possibility. We aim to provide guidance to radiologists in reporting CT findings potentially attributable to COVID-19 pneumonia, including standardized language to reduce reporting variability when addressing the possibility of COVID-19. When typical or indeterminate features of COVID-19 pneumonia are present in endemic areas as an incidental finding, we recommend contacting the referring providers to discuss the likelihood of viral infection. These incidental findings do not necessarily need to be reported as COVID-19 pneumonia. In this setting, using the term viral pneumonia can be a reasonable and inclusive alternative. However, if one opts to use the term COVID-19 in the incidental setting, consider the provided standardized reporting language. In addition, practice patterns may vary, and this document is meant to serve as a guide. Consultation with clinical colleagues at each institution is suggested to establish a consensus reporting approach. The goal of this expert consensus is to help radiologists recognize findings of COVID-19 pneumonia and aid their communication with other health care providers, assisting management of patients during this pandemic. Published under a CC BY 4.0 license.
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Affiliation(s)
| | | | - Suhny Abbara
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
| | - Sanjeev Bhalla
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
| | - Jonathan H. Chung
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
| | - Michael Chung
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
| | - Travis S. Henry
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
| | - Jeffrey P. Kanne
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
| | - Seth Kligerman
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
| | - Jane P. Ko
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
| | - Harold Litt
- From the Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (S.S., H.L.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (F.U.K., S.A.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, University of Chicago Medicine, Chicago, Ill (J.H.C.); Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (M.C.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (T.S.H.); Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (J.P.K.); Department of Radiology, University of California San Diego, San Diego, Calif (S.K.); and Department of Radiology, New York University Langone Health, New York, NY (J.P.K.)
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Kay FU, Abbara S, Joshi PH, Garg S, Khera A, Peshock RM. Identification of High-Risk Left Ventricular Hypertrophy on Calcium Scoring Cardiac Computed Tomography Scans: Validation in the DHS. Circ Cardiovasc Imaging 2020; 13:e009678. [PMID: 32066275 DOI: 10.1161/circimaging.119.009678] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Coronary artery calcium scoring only represents a small fraction of all information available in noncontrast cardiac computed tomography (CAC-CT). We hypothesized that an automated pipeline using radiomics and machine learning could identify phenotypic information about high-risk left ventricular hypertrophy (LVH) embedded in CAC-CT. METHODS This was a retrospective analysis of 1982 participants from the DHS (Dallas Heart Study) who underwent CAC-CT and cardiac magnetic resonance. Two hundred twenty-four participants with high-risk LVH were identified by cardiac magnetic resonance. We developed an automated adaptive atlas algorithm to segment the left ventricle on CAC-CT, extracting 107 radiomics features from the volume of interest. Four logistic regression models using different feature selection methods were built to predict high-risk LVH based on CAC-CT radiomics, sex, height, and body surface area in a random training subset of 1587 participants. RESULTS The respective areas under the receiver operating characteristics curves for the cluster-based model, the logistic regression model after exclusion of highly correlated features, and the penalized logistic regression models using least absolute shrinkage and selection operators with minimum or one SE λ values were 0.74 (95% CI, 0.67-0.82), 0.74 (95% CI, 0.67-0.81), 0.76 (95% CI, 0.69-0.83), and 0.73 (95% CI, 0.66-0.80) for detecting high-risk LVH in a distinct validation subset of 395 participants. CONCLUSIONS Ventricular segmentation, radiomics features extraction, and machine learning can be used in a pipeline to automatically detect high-risk phenotypes of LVH in participants undergoing CAC-CT, without the need for additional imaging or radiation exposure. Registration: URL http://www.clinicaltrials.gov. Unique identifier: NCT00344903.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology (F.U.K., S.A., R.M.P.), UT Southwestern Medical Center, Dallas, TX
| | - Suhny Abbara
- Department of Radiology (F.U.K., S.A., R.M.P.), UT Southwestern Medical Center, Dallas, TX
| | - Parag H Joshi
- Department of Cardiology (P.H.J., S.G., A.K.), UT Southwestern Medical Center, Dallas, TX
| | - Sonia Garg
- Department of Cardiology (P.H.J., S.G., A.K.), UT Southwestern Medical Center, Dallas, TX
| | - Amit Khera
- Department of Cardiology (P.H.J., S.G., A.K.), UT Southwestern Medical Center, Dallas, TX
| | - Ronald M Peshock
- Department of Radiology (F.U.K., S.A., R.M.P.), UT Southwestern Medical Center, Dallas, TX
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15
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Kay FU, Abbara S. The Many Faces of COVID-19: Spectrum of Imaging Manifestations. Radiol Cardiothorac Imaging 2020; 2:e200037. [PMID: 33779634 PMCID: PMC7233435 DOI: 10.1148/ryct.2020200037] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 05/16/2023]
Affiliation(s)
- Fernando U. Kay
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Suhny Abbara
- From the Department of Radiology, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
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Kandathil A, Kay FU, Butt YM, Wachsmann JW, Subramaniam RM. Role of FDG PET/CT in the Eighth Edition of TNM Staging of Non-Small Cell Lung Cancer. Radiographics 2019; 38:2134-2149. [PMID: 30422775 DOI: 10.1148/rg.2018180060] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States, and accurate staging plays a vital role in determining prognosis and treatment. The recently revised eighth edition of the TNM staging system for lung cancer defines new T and M descriptors and updates stage groupings on the basis of substantial differences in survival. There are new T descriptors that are based on the findings at histopathologic examination, and T descriptors are reassigned on the basis of tumor size and extent. No changes were made to the N descriptors in the eighth edition of the TNM staging of lung cancer, because the four N categories that are based on the location of the diseased nodes can be used to consistently predict prognosis. The eighth edition includes a new M1b descriptor for patients with a single extrathoracic metastatic lesion in a single organ (M1b), because they have better survival and different treatment options, compared with those with multiple extrathoracic lesions (M1c). Examination with fluorine 18 fluorodeoxyglucose (FDG) PET/CT is the standard of care and is an integral part of the clinical staging of patients with lung cancer. To provide the treating physicians with accurate staging information, radiologists and nuclear medicine physicians should be aware of the updated classification system and should be cognizant of the site-specific strengths and limitations of FDG PET/CT. In this article, the eighth edition of the TNM staging system is reviewed, as well as the role of FDG PET/CT in the staging of non-small cell lung carcinoma. ©RSNA, 2018.
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Affiliation(s)
- Asha Kandathil
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Fernando U Kay
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Yasmeen M Butt
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Jason W Wachsmann
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
| | - Rathan M Subramaniam
- From the Departments of Radiology (A.K., F.U.K., J.W.W., R.M.S.) and Pathology (Y.M.B.), University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9316
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17
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Kay FU, Oz OK, Abbara S, Mortani Barbosa EJ, Agarwal PP, Rajiah P. Translation of Quantitative Imaging Biomarkers into Clinical Chest CT. Radiographics 2019; 39:957-976. [PMID: 31199712 DOI: 10.1148/rg.2019180168] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Quantitative imaging has been proposed as the next frontier in radiology as part of an effort to improve patient care through precision medicine. In 2007, the Radiological Society of North America launched the Quantitative Imaging Biomarkers Alliance (QIBA), an initiative aimed at improving the value and practicality of quantitative imaging biomarkers by reducing variability across devices, sites, patients, and time. Chest CT occupies a strategic position in this initiative because it is one of the most frequently used imaging modalities, anatomically encompassing the leading causes of mortality worldwide. To date, QIBA has worked on profiles focused on the accurate, reproducible, and meaningful use of volumetric measurements of lung lesions in chest CT. However, other quantitative methods are on the verge of translation from research grounds into clinical practice, including (a) assessment of parenchymal and airway changes in patients with chronic obstructive pulmonary disease, (b) analysis of perfusion with dual-energy CT biomarkers, and (c) opportunistic screening for coronary atherosclerosis and low bone mass by using chest CT examinations performed for other indications. The rationale for and the key facts related to the application of these quantitative imaging biomarkers in cardiothoracic chest CT are presented. ©RSNA, 2019 See discussion on this article by Buckler (pp 977-980).
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Affiliation(s)
- Fernando U Kay
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Orhan K Oz
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Suhny Abbara
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Eduardo J Mortani Barbosa
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Prachi P Agarwal
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
| | - Prabhakar Rajiah
- From the Department of Radiology, Cardiothoracic Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Room E6.122H, Dallas, TX 75390-9316 (F.U.K., O.K.O., S.A., P.R.); the Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (E.J.M.B.); and the Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (P.P.A.)
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Mantovani LF, Santos FPS, Perini GF, Nascimento CMB, Silva LP, Wroclawski CK, Esposito BP, Ribeiro MSS, Velloso EDRP, Nomura CH, Kay FU, Baroni RH, Hamerschlak N, Schuster S. Hepatic and cardiac and iron overload detected by T2* magnetic resonance (MRI) in patients with myelodisplastic syndrome: A cross-sectional study. Leuk Res 2018; 76:53-57. [PMID: 30572266 DOI: 10.1016/j.leukres.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/17/2018] [Accepted: 12/03/2018] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Transfusion-dependent anemia and iron overload are associatedwith reduced survival in myelodysplastic syndrome (MDS). This cross-sectional study aimed to evaluate the prevalence of hepatic and cardiac overload in patients with MDS as measured by T2* magnetic resonance imaging (MRI), and its correlation with survival. METHODS MDS or chronic myelomonocytic leukemia patients had iron overload evaluated by T2* MRI. HIO was considered when hepatic iron concentration ≥ 2 g/mg. Cardiac iron overload was considered with a T2*-value < 20 ms. RESULTS Among 71 patients analyzed, median hepatic iron concentration was 3.9 g/mg (range 0.9-16 g/mg), and 68%of patients had hepatic iron overload. Patients with hepatic iron overload had higher mean ferritin levels (1182 ng/mL versus 185 ng/mL, p < 0.0001), transferrin saturation (76% versus 34%, p < 0.0001) and lower survival rates. Median cardiac T2*value was 42 ms (range 19.7-70.1 ms), and only one patienthad a T2* value indicative of cardiac iron overload. CONCLUSIONS Hepatic iron overload is found in two thirds of patients, even in cases without laboratory signs of iron overload. Hepatic iron overload by T2* MRI is associated with a decreased risk of survival in patients with MDS.
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Affiliation(s)
- L F Mantovani
- Hematology and Bone Marrow Transplantation Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - F P S Santos
- Hematology and Bone Marrow Transplantation Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - G F Perini
- Oncology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - C M B Nascimento
- Oncology Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - L P Silva
- Bone Marrow Transplantation Center, Hospital São Camilo, São Paulo, Brazil
| | - C K Wroclawski
- Hematology Department, Hospital Sírio-Libanês, São Paulo, Brazil
| | - B P Esposito
- Chemistry Institute, Universidade de São Paulo (USP), São Paulo, Brazil
| | - M S S Ribeiro
- Instituto Paulista de Cancerologia, São Paulo, Brazil
| | - E D R P Velloso
- Hematology and Hemotherapy Discipline, Universidade de São Paulo (USP), São Paulo, Brazil
| | - C H Nomura
- Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo (FMUSP), São Paulo, Brazil
| | - F U Kay
- UT Southwestern Medical Center, Dallas, TX, United States
| | - R H Baroni
- Diagnostic Imaging Department, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - N Hamerschlak
- Hematology and Bone Marrow Transplantation Department, Hospital Israelita Albert Einstein, São Paulo, Brazil.
| | - S Schuster
- Hematology Department, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Giansante L, Martins JC, Nersissian DY, Kiers KC, Kay FU, Sawamura MVY, Lee C, Gebrim EMMS, Costa PR. Organ doses evaluation for chest computed tomography procedures with TL dosimeters: Comparison with Monte Carlo simulations. J Appl Clin Med Phys 2018; 20:308-320. [PMID: 30508315 PMCID: PMC6333138 DOI: 10.1002/acm2.12505] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 09/22/2018] [Accepted: 10/25/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose To evaluate organ doses in routine and low‐dose chest computed tomography (CT) protocols using an experimental methodology. To compare experimental results with results obtained by the National Cancer Institute dosimetry system for CT (NCICT) organ dose calculator. To address the differences on organ dose measurements using tube current modulation (TCM) and fixed tube current protocols. Methods An experimental approach to evaluate organ doses in pediatric and adult anthropomorphic phantoms using thermoluminescent dosimeters (TLDs) was employed in this study. Several analyses were performed in order to establish the best way to achieve the main results in this investigation. The protocols used in this study were selected after an analysis of patient data collected from the Institute of Radiology of the School of Medicine of the University of São Paulo (InRad). The image quality was evaluated by a radiologist from this institution. Six chest adult protocols and four chest pediatric protocols were evaluated. Lung doses were evaluated for the adult phantom and lung and thyroid doses were evaluated for the pediatric phantom. The irradiations were performed using both a GE and a Philips CT scanner. Finally, organ doses measured with dosimeters were compared with Monte Carlo simulations performed with NCICT. Results After analyzing the data collected from all CT examinations performed during a period of 3 yr, the authors identified that adult and pediatric chest CT are among the most applied protocol in patients in that clinical institution, demonstrating the relevance on evaluating organ doses due to these examinations. With regards to the scan parameters adopted, the authors identified that using 80 kV instead of 120 kV for a pediatric chest routine CT, with TCM in both situations, can lead up to a 28.7% decrease on the absorbed dose. Moreover, in comparison to the standard adult protocol, which is performed with fixed mAs, TCM, and ultra low‐dose protocols resulted in dose reductions of up to 35.0% and 90.0%, respectively. Finally, the percent differences found between experimental and Monte Carlo simulated organ doses were within a 20% interval. Conclusions The results obtained in this study measured the impact on the absorbed dose in routine chest CT by changing several scan parameters while the image quality could be potentially preserved.
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Affiliation(s)
- Louise Giansante
- Group of Radiation Dosimetry and Medical Physics, Institute of Physics, University of São Paulo (IFUSP), São Paulo, SP, Brazil
| | - Juliana C Martins
- Group of Radiation Dosimetry and Medical Physics, Institute of Physics, University of São Paulo (IFUSP), São Paulo, SP, Brazil.,Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - Denise Y Nersissian
- Group of Radiation Dosimetry and Medical Physics, Institute of Physics, University of São Paulo (IFUSP), São Paulo, SP, Brazil
| | - Karen C Kiers
- Group of Radiation Dosimetry and Medical Physics, Institute of Physics, University of São Paulo (IFUSP), São Paulo, SP, Brazil.,Vrije Universiteit Amsterdam (VU), Amsterdam, The Netherlands
| | - Fernando U Kay
- Institute of Radiology, School of Medicine, University of São Paulo (InRad), São Paulo, SP, Brazil
| | - Marcio V Y Sawamura
- Institute of Radiology, School of Medicine, University of São Paulo (InRad), São Paulo, SP, Brazil
| | - Choonsik Lee
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Eloisa M M S Gebrim
- Institute of Radiology, School of Medicine, University of São Paulo (InRad), São Paulo, SP, Brazil
| | - Paulo R Costa
- Group of Radiation Dosimetry and Medical Physics, Institute of Physics, University of São Paulo (IFUSP), São Paulo, SP, Brazil
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Abstract
The increase in serendipitous detection of solid renal masses on imaging has not resulted in a reduction in mortality from renal cell carcinoma. Consequently, efforts for improved lesion characterization have been pursued and incorporated into management algorithms for distinguishing clinically significant tumors from those with favorable histology or benign conditions. Although diagnostic imaging strategies have evolved for optimized lesion detection, distinction between benign tumors and both indolent and aggressive malignant neoplasms remain an important diagnostic challenge. Recent advances in cross-sectional imaging have expanded the role of these tests in the noninvasive characterization of solid renal tumors.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA
| | - Ivan Pedrosa
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA.
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Kay FU, Canvasser NE, Xi Y, Pinho DF, Costa DN, Diaz de Leon A, Khatri G, Leyendecker JR, Yokoo T, Lay AH, Kavoussi N, Koseoglu E, Cadeddu JA, Pedrosa I. Diagnostic Performance and Interreader Agreement of a Standardized MR Imaging Approach in the Prediction of Small Renal Mass Histology. Radiology 2018; 287:543-553. [PMID: 29390196 DOI: 10.1148/radiol.2018171557] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Purpose To assess the diagnostic performance and interreader agreement of a standardized diagnostic algorithm in determining the histologic type of small (≤4 cm) renal masses (SRMs) with multiparametric magnetic resonance (MR) imaging. Materials and Methods This single-center retrospective HIPAA-compliant institutional review board-approved study included 103 patients with 109 SRMs resected between December 2011 and July 2015. The requirement for informed consent was waived. Presurgical renal MR images were reviewed by seven radiologists with diverse experience. Eleven MR imaging features were assessed, and a standardized diagnostic algorithm was used to determine the most likely histologic diagnosis, which was compared with histopathology results after surgery. Interreader variability was tested with the Cohen κ statistic. Regression models using MR imaging features were used to predict the histopathologic diagnosis with 5% significance level. Results Clear cell renal cell carcinoma (RCC) and papillary RCC were diagnosed, with sensitivities of 85% (47 of 55) and 80% (20 of 25), respectively, and specificities of 76% (41 of 54) and 94% (79 of 84), respectively. Interreader agreement was moderate to substantial (clear cell RCC, κ = 0.58; papillary RCC, κ = 0.73). Signal intensity (SI) of the lesion on T2-weighted MR images and degree of contrast enhancement (CE) during the corticomedullary phase were independent predictors of clear cell RCC (SI odds ratio [OR]: 3.19; 95% confidence interval [CI]: 1.4, 7.1; P = .003; CE OR, 4.45; 95% CI: 1.8, 10.8; P < .001) and papillary RCC (CE OR, 0.053; 95% CI: 0.02, 0.2; P < .001), and both had substantial interreader agreement (SI, κ = 0.69; CE, κ = 0.71). Poorer performance was observed for chromophobe histology, oncocytomas, and minimal fat angiomyolipomas, (sensitivity range, 14%-67%; specificity range, 97%-99%), with fair to moderate interreader agreement (κ range = 0.23-0.43). Segmental enhancement inversion was an independent predictor of oncocytomas (OR, 16.21; 95% CI: 1.0, 275.4; P = .049), with moderate interreader agreement (κ = 0.49). Conclusion The proposed standardized MR imaging-based diagnostic algorithm had diagnostic accuracy of 81% (88 of 109) and 91% (99 of 109) in the diagnosis of clear cell RCC and papillary RCC, respectively, while achieving moderate to substantial interreader agreement among seven radiologists. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Fernando U Kay
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Noah E Canvasser
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Yin Xi
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Daniella F Pinho
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Daniel N Costa
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Alberto Diaz de Leon
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Gaurav Khatri
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - John R Leyendecker
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Takeshi Yokoo
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Aaron H Lay
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Nicholas Kavoussi
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Ersin Koseoglu
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Jeffrey A Cadeddu
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
| | - Ivan Pedrosa
- From the Department of Radiology (F.U.K., Y.X., D.F.P., D.N.C., A.D.d.L., G.K., J.R.L., T.Y., J.A.C., I.P.), Department of Urology (N.E.C., A.H.L., N.K., E.K., J.A.C., I.P.), and Advanced Imaging Research Center (D.C., T.Y., I.P.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Suite NE2.210, Dallas, TX 75390-9085
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Kay FU, Kandathil A, Batra K, Saboo SS, Abbara S, Rajiah P. Revisions to the Tumor, Node, Metastasis staging of lung cancer (8 th edition): Rationale, radiologic findings and clinical implications. World J Radiol 2017; 9:269-279. [PMID: 28717413 PMCID: PMC5491654 DOI: 10.4329/wjr.v9.i6.269] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/21/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
The Tumor, Node, Metastasis (TNM) staging system, adopted by the Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC), has been recently revised, with the new 8th edition of the staging manual being published in January 2017. This edition has few but important evidence-based changes to the TNM staging system used for lung cancer. Radiologists should be aware of the updated classification system to accurately provide staging information to oncologists and oncosurgeons. In this article, we discuss the rationale, illustrate the changes with relevance to Radiology, and review the clinical implications of the 8th edition of the UICC/AJCC TNM staging system with regards to lung cancer.
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Canvasser NE, Kay FU, Xi Y, Pinho DF, Costa D, de Leon AD, Khatri G, Leyendecker JR, Yokoo T, Lay A, Kavoussi N, Koseoglu E, Cadeddu JA, Pedrosa I. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging to Identify Clear Cell Renal Cell Carcinoma in cT1a Renal Masses. J Urol 2017; 198:780-786. [PMID: 28457802 DOI: 10.1016/j.juro.2017.04.089] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 01/13/2023]
Abstract
PURPOSE The detection of small renal masses is increasing with the use of cross-sectional imaging, although many incidental lesions have negligible metastatic potential. Among malignant masses clear cell renal cell carcinoma is the most prevalent and aggressive subtype. A method to identify such histology would aid in risk stratification. Our goal was to evaluate a likelihood scale for multiparametric magnetic resonance imaging in the diagnosis of clear cell histology. MATERIALS AND METHODS We retrospectively reviewed the records of patients with cT1a masses who underwent magnetic resonance imaging and partial or radical nephrectomy from December 2011 to July 2015. Seven radiologists with different levels of experience who were blinded to final pathology findings independently reviewed studies based on a predefined algorithm. They applied a clear cell likelihood score, including 1-definitely not, 2-probably not, 3-equivocal, 4-probably and 5-definitely. Binary classification was used to determine the accuracy of clear cell vs all other histologies. Interobserver agreement was calculated with the weighted κ statistic. RESULTS A total of 110 patients with 121 masses were identified. Mean tumor size was 2.4 cm and 50% of the lesions were clear cell. Defining clear cell as scores of 4 or greater demonstrated 78% sensitivity and 80% specificity while scores of 3 or greater showed 95% sensitivity and 58% specificity. Interobserver agreement was moderate to good with a mean κ of 0.53. CONCLUSIONS A clear cell likelihood score used with magnetic resonance imaging can reasonably identify clear cell histology in small renal masses and may decrease the number of diagnostic renal mass biopsies. Standardization of imaging protocols and reporting criteria is needed to improve interobserver reliability.
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Affiliation(s)
- Noah E Canvasser
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Fernando U Kay
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Yin Xi
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Daniella F Pinho
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Daniel Costa
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | | | - Gaurav Khatri
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - John R Leyendecker
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Takeshi Yokoo
- Department of Radiology, University of Texas Southwestern, Dallas, Texas
| | - Aaron Lay
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Nicholas Kavoussi
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Ersin Koseoglu
- Department of Urology, University of Texas Southwestern, Dallas, Texas
| | - Jeffrey A Cadeddu
- Department of Urology, University of Texas Southwestern, Dallas, Texas; Department of Radiology, University of Texas Southwestern, Dallas, Texas.
| | - Ivan Pedrosa
- Department of Radiology, University of Texas Southwestern, Dallas, Texas; Imaging Research Center, University of Texas Southwestern, Dallas, Texas
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Kay FU, Canvasser NE, Xi Y, Pinho DF, Costa D, Diaz de Leon A, Khatri G, Leyendecker JR, Yokoo T, Lay A, Kavoussi N, Koseoglu E, Cadeddu JA, Pedrosa I. MP08-03 PREDICTION OF HISTOLOGICAL SUBTYPES OF SMALL RENAL MASSES: STRIVING FOR A STANDARDIZED MRI DIAGNOSTIC ALGORITHM. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.290] [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: 11/30/2022]
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Abstract
Detection of solid renal masses has increased, although it has not resulted in significant mortality reduction from renal cell carcinoma. Efforts for improved lesion characterization have been pursued and incorporated in management algorithms, in order to distinguish clinically significant tumors from favorable or benign conditions. Concurrently, imaging methods have produced evidence supporting their role as useful tools not only in lesion detection but also characterization. In addition, newer modalities, such as contrast-enhanced ultrasonography, and advanced applications of MR imaging, are being investigated. This article reviews the current role of different imaging methods in the characterization of solid renal masses.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology, UT Southwestern Medical Center, Harry Hines 5323, 2201 Inwood Road, Dallas, TX 75390, USA
| | - Ivan Pedrosa
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern Medical Center, Harry Hines 5323, 2201 Inwood Road, Dallas, TX 75390, USA.
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Assis RA, Kay FU, Conti FM, Campregher PV, Szarf G, Diniz MS, Rodrigues M, Helman R, Funari MB, Wood J, Hamerschlak N. The role of magnetic resonance imaging-T2* in the evaluation of iron overload early in hereditary hemochromatosis. A cross-sectional study with 159 patients. Am J Hematol 2015; 90:E220-1. [PMID: 26361371 DOI: 10.1002/ajh.24189] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 09/04/2015] [Accepted: 09/09/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Reijâne A. Assis
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Fernando U. Kay
- Imaging Departmemt; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Fabiana M. Conti
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Paulo V. Campregher
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Gilberto Szarf
- Imaging Departmemt; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Michelli S. Diniz
- Clinical Research Institute; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Morgani Rodrigues
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | - Ricardo Helman
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
| | | | - John Wood
- Division of Cardiology; University of Southern California, Children's Hospital; Los Angeles California
| | - Nelson Hamerschlak
- Department of Hematology; Hospital Israelita Albert Einstein; São Paulo Brazil
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Kawano-Dourado L, Baldi BG, Kay FU, Dias OM, Gripp TEH, Gomes PS, Fuller R, Caleiro MTC, Kairalla RA, Carvalho CRR. Pulmonary involvement in long-term mixed connective tissue disease: functional trends and image findings after 10 years. Clin Exp Rheumatol 2015; 33:234-240. [PMID: 25896472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 12/19/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Interstitial lung disease (ILD) is highly prevalent in patients with mixed connective tissue disease (MCTD). However, little is known about the long-term progression of ILD in MCTD. The aims of this study were to describe pulmonary function test (PFT) and high-resolution computed tomography (HRCT) results in long-term MCTD patients, to measure changes in PFT and HRCT results over a 10-year period, and to ascertain correlations in functional and imaging data. METHODS In this retrospective cohort study, comparison between baseline and follow-up PFT and HRCT data was performed for 39 unselected consecutive MCTD patients. RESULTS At baseline, 51% of the patients had abnormal PFTs. Forced vital capacity (FVC) was slightly reduced at baseline (77% of predicted), but remained stable after 10 years. A relative decrease of 15% in the diffusion capacity for carbon monoxide (DLCO) was detected (from 84% to 71% of predicted, p<0.001). The median lower lobes ILD-HRCT score progressed from 7.5% at baseline to 11.2% at follow-up (p=0.02), and findings of traction bronchiolectasis and honeycombing increased (p<0.05). A moderate negative correlation was observed between functional parameters and quantification of image findings. CONCLUSIONS Functional and radiologic alterations suggestive of ILD in long-term MCTD patients are prevalent, mild, and progressed slightly over time. The most sensitive parameters for detecting subtle progression of ILD in MCTD patients are trends in DLCO, quantification of lower-lobes disease by HRCT (lower-lobes %ILD-HRCT score), and qualitative analysis of HRCT imaging.
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Affiliation(s)
- Leticia Kawano-Dourado
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno G Baldi
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Fernando U Kay
- Radiology Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Olivia M Dias
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Thais E H Gripp
- Radiology Institute, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Paula S Gomes
- Pulmonary Division, Hospital do Servidor Publico Estadual (HSPE), Sao Paulo, Brazil
| | - Ricardo Fuller
- Rheumatology Division, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Maria T C Caleiro
- Rheumatology Division, Hospital das Clinicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ronaldo A Kairalla
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carlos R R Carvalho
- Pulmonary Division, Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
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Neto RS, Nomura CH, Kay FU, Passos RBD, Chate RC, Funari MBG, Lee HJ, Ripari MT, Santaniello R, Iquizli L. Fibrofatty replacement of myocardium and diskinetic areas in the right ventricle as nonspecific imaging findings - comparison with arrhythmogenic right ventricular dysplasia/cardiomyopathy patients. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-p199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Leick-Maldonado EA, Kay FU, Leonhardt MC, Kasahara DI, Prado CM, Fernandes FT, Martins MA, Tibério IFLC. Comparison of glucocorticoid and cysteinyl leukotriene receptor antagonist treatments in an experimental model of chronic airway inflammation in guinea-pigs. Clin Exp Allergy 2004; 34:145-52. [PMID: 14720275 DOI: 10.1111/j.1365-2222.2004.01854.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Leukotriene receptor antagonists have been demonstrated in several studies to possess bronchodilating and anti-inflammatory properties in asthma. However, there are few experimental studies performed to compare the effects of anti-leukotrienes and glucocorticoids, most used anti-inflammatory agents in asthma. In the present study, we evaluated the effects of treatment with dexamethasone or montelukast on eosinophil and mononuclear cell recruitment in an experimental model of allergen-induced chronic airway inflammation in guinea-pigs (GP). METHODS GP were submitted to increasing concentrations of aerosols of ovalbumin (OVA) twice a week for 4 weeks. After 2 weeks, animals were treated daily with dexamethasone, montelukast or saline solution. After this period, GP were anaesthetized, tracheostomized, mechanically ventilated and challenged with OVA aerosol. RESULTS Maximal changes of respiratory system resistance and elastance induced by OVA challenge were attenuated by dexamethasone (P<0.001), but not by montelukast treatment. Neither dexamethasone nor montelukast significantly influenced bronchial oedema formation. Dexamethasone but not montelukast induced a decrease in mononuclear cells in airways (P<0.001). Eosinophil infiltration in the bronchial wall was reduced by both dexamethasone and montelukast (P<0.005). Only dexamethasone treatment reduced the levels of exhaled nitric oxide (P<0.025). CONCLUSION Although leukotriene receptor antagonist treatment reduces eosinophil accumulation induced by multiple antigen challenges, glucocorticoid treatment attenuates both eosinophil and mononuclear cell infiltration.
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Affiliation(s)
- E A Leick-Maldonado
- Department of Medicine, School of Medicine, University of São Paulo, São Paulo, Brazil
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