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Al Assaad M, Shin N, Sigouros M, Manohar J, Antysheva Z, Kotlov N, Kiriy D, Nikitina A, Kleimenov M, Tsareva A, Makarova A, Fomchenkova V, Dubinina J, Boyko A, Almog N, Wilkes D, Escalon JG, Saxena A, Elemento O, Sternberg CN, Nanus DM, Mosquera JM. Deciphering the origin and therapeutic targets of cancer of unknown primary: a case report that illustrates the power of integrative whole-exome and transcriptome sequencing analysis. Front Oncol 2024; 13:1274163. [PMID: 38318324 PMCID: PMC10838960 DOI: 10.3389/fonc.2023.1274163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 12/18/2023] [Indexed: 02/07/2024] Open
Abstract
Cancer of unknown primary (CUP) represents a significant diagnostic and therapeutic challenge, being the third to fourth leading cause of cancer death, despite advances in diagnostic tools. This article presents a successful approach using a novel genomic analysis in the evaluation and treatment of a CUP patient, leveraging whole-exome sequencing (WES) and RNA sequencing (RNA-seq). The patient, with a history of multiple primary tumors including urothelial cancer, exhibited a history of rapid progression on empirical chemotherapy. The application of our approach identified a molecular target, characterized the tumor expression profile and the tumor microenvironment, and analyzed the origin of the tumor, leading to a tailored treatment. This resulted in a substantial radiological response across all metastatic sites and the predicted primary site of the tumor. We argue that a comprehensive genomic and molecular profiling approach, like the BostonGene© Tumor Portrait, can provide a more definitive, personalized treatment strategy, overcoming the limitations of current predictive assays. This approach offers a potential solution to an unmet clinical need for a standardized approach in identifying the tumor origin for the effective management of CUP.
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Affiliation(s)
- Majd Al Assaad
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Nara Shin
- BostonGene Corporation, Waltham, MA, United States
| | - Michael Sigouros
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Jyothi Manohar
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, United States
| | | | | | - Daria Kiriy
- BostonGene Corporation, Waltham, MA, United States
| | | | | | | | | | | | | | | | - Nava Almog
- BostonGene Corporation, Waltham, MA, United States
| | - David Wilkes
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Joanna G. Escalon
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States
| | - Ashish Saxena
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Olivier Elemento
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Cora N. Sternberg
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - David M. Nanus
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
- Department of Medicine, Weill Cornell Medicine, New York, NY, United States
| | - Juan Miguel Mosquera
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, United States
- Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, United States
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Castañer E, Escalon JG, Herold CJ, Wan YL. The Global Reading Room: Incidental Lung Nodules on Abdominopelvic CT. AJR Am J Roentgenol 2023; 221:846-847. [PMID: 36883773 DOI: 10.2214/ajr.23.29220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Affiliation(s)
- Eva Castañer
- Department of Radiology, Corporació Sanitària del Parc Taulí, Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
- Department of Radiology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joanna G Escalon
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
| | - Christian J Herold
- Department of Medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Yung-Liang Wan
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
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3
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Escalon JG, Podolanczuk AJ, Aronson KI, Legasto AC, Gruden JF, Lynch DA, Rachid L, Rabkova Y, Steinberger S. Practice patterns in reporting interstitial lung abnormality at a tertiary academic medical center. Clin Imaging 2023; 104:109996. [PMID: 37862912 DOI: 10.1016/j.clinimag.2023.109996] [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: 06/11/2023] [Revised: 09/07/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Interstitial lung abnormality (ILA) is a common finding on chest CTs and is associated with higher all-cause mortality. The 2020 Fleischner Society position paper standardized the terminology and definition of ILA. Despite these published guidelines, the extent to which radiologists use this term is unknown. We evaluated practice patterns for identification of ILAs among radiologists at a tertiary academic medical center. METHODS In this retrospective review, we identified 157 radiology reports between January 1, 2010 through December 31, 2021 containing the phrase "interstitial lung abnormality" or "interstitial abnormality". After exclusions, 125 CT scans were reviewed by thoracic-trained radiologists using the sequential reading method. RESULTS Seventy-seven (62%) patients were found to have ILA (69% subpleural fibrotic, 19% subpleural non-fibrotic, and 6% non-subpleural), nine (7%) were equivocal for ILA and 39 (31%) had no ILA. The term ILA was used exclusively by thoracic-trained radiologists except for two cases. Use of the term ILA has rapidly increased since the position paper publication (none from 2010-2017, one case in 2018, 20 cases in 2019, 41 cases in 2020, and 73 cases in 2021), and cases were typically very mild (1-25% of the lung). CONCLUSION While there has been increased use of the term ILA among thoracic-trained radiologists, non-thoracic radiologists have essentially not begun to use the term. Almost one-third of cases labeled ILA on clinical reads were re-classified as not having ILA on research reads.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - Anna J Podolanczuk
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Kerri I Aronson
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
| | - James F Gruden
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO, USA.
| | - Leena Rachid
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Yana Rabkova
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA.
| | - Sharon Steinberger
- Department of Radiology, Weill Cornell Medical College, New York, NY, USA.
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Holste G, Jiang Z, Jaiswal A, Hanna M, Minkowitz S, Legasto AC, Escalon JG, Steinberger S, Bittman M, Shen TC, Ding Y, Summers RM, Shih G, Peng Y, Wang Z. How Does Pruning Impact Long-Tailed Multi-label Medical Image Classifiers? Med Image Comput Comput Assist Interv 2023; 14224:663-673. [PMID: 37829549 PMCID: PMC10568970 DOI: 10.1007/978-3-031-43904-9_64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
Pruning has emerged as a powerful technique for compressing deep neural networks, reducing memory usage and inference time without significantly affecting overall performance. However, the nuanced ways in which pruning impacts model behavior are not well understood, particularly for long-tailed, multi-label datasets commonly found in clinical settings. This knowledge gap could have dangerous implications when deploying a pruned model for diagnosis, where unexpected model behavior could impact patient well-being. To fill this gap, we perform the first analysis of pruning's effect on neural networks trained to diagnose thorax diseases from chest X-rays (CXRs). On two large CXR datasets, we examine which diseases are most affected by pruning and characterize class "forgettability" based on disease frequency and co-occurrence behavior. Further, we identify individual CXRs where uncompressed and heavily pruned models disagree, known as pruning-identified exemplars (PIEs), and conduct a human reader study to evaluate their unifying qualities. We find that radiologists perceive PIEs as having more label noise, lower image quality, and higher diagnosis difficulty. This work represents a first step toward understanding the impact of pruning on model behavior in deep long-tailed, multi-label medical image classification. All code, model weights, and data access instructions can be found at https://github.com/VITA-Group/PruneCXR.
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Affiliation(s)
| | - Ziyu Jiang
- Texas A&M University, College Station, TX, USA
| | - Ajay Jaiswal
- The University of Texas at Austin, Austin, TX, USA
| | | | | | | | | | | | | | - Thomas C Shen
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ying Ding
- The University of Texas at Austin, Austin, TX, USA
| | - Ronald M Summers
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Yifan Peng
- Weill Cornell Medicine, New York, NY, USA
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Holste G, Jiang Z, Jaiswal A, Hanna M, Minkowitz S, Legasto AC, Escalon JG, Steinberger S, Bittman M, Shen TC, Ding Y, Summers RM, Shih G, Peng Y, Wang Z. How Does Pruning Impact Long-Tailed Multi-Label Medical Image Classifiers? ArXiv 2023:arXiv:2308.09180v1. [PMID: 37791108 PMCID: PMC10543014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Pruning has emerged as a powerful technique for compressing deep neural networks, reducing memory usage and inference time without significantly affecting overall performance. However, the nuanced ways in which pruning impacts model behavior are not well understood, particularly for long-tailed, multi-label datasets commonly found in clinical settings. This knowledge gap could have dangerous implications when deploying a pruned model for diagnosis, where unexpected model behavior could impact patient well-being. To fill this gap, we perform the first analysis of pruning's effect on neural networks trained to diagnose thorax diseases from chest X-rays (CXRs). On two large CXR datasets, we examine which diseases are most affected by pruning and characterize class "forgettability" based on disease frequency and co-occurrence behavior. Further, we identify individual CXRs where uncompressed and heavily pruned models disagree, known as pruning-identified exemplars (PIEs), and conduct a human reader study to evaluate their unifying qualities. We find that radiologists perceive PIEs as having more label noise, lower image quality, and higher diagnosis difficulty. This work represents a first step toward understanding the impact of pruning on model behavior in deep long-tailed, multi-label medical image classification. All code, model weights, and data access instructions can be found at https://github.com/VITA-Group/PruneCXR.
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Affiliation(s)
| | - Ziyu Jiang
- Texas A&M University, College Station, TX, USA
| | - Ajay Jaiswal
- The University of Texas at Austin, Austin, TX, USA
| | | | | | | | | | | | | | - Thomas C Shen
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ying Ding
- The University of Texas at Austin, Austin, TX, USA
| | - Ronald M Summers
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | | | - Yifan Peng
- Weill Cornell Medicine, New York, NY, USA
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Escalon JG, Toy D, Groner L, Legasto AC, Verzosa Weisman S, Rotman J, Asrani AV, Mahmood SS, Truong QA. Incidence, clinical associations and outcomes of intrathoracic complications with and without ARDS in COVID-19 pneumonia. Clin Imaging 2022; 85:106-114. [PMID: 35278869 PMCID: PMC8895681 DOI: 10.1016/j.clinimag.2022.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 12/06/2021] [Accepted: 02/28/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE To determine the incidence and clinical predictors of intrathoracic complications in COVID-19 patients, and the association with outcomes. METHODS In this retrospective cross-sectional study, we included 976 patients (age 61 ± 17 years, 62% male) who tested positive for SARS-CoV-2 between March 3-April 4, 2020 and underwent chest imaging. 3836 radiographs from 976 patients and 105 CTs from 88 patients were reviewed for intrathoracic complications, including pneumothorax, pneumomediastinum, pneumopericardium, lobar collapse, pleural effusion, and pneumatocele formation. RESULTS There was a high rate of intrathoracic complications (197/976, 20%). Pleural effusion was the most common complication (168/976, 17%). Pneumothorax (30/976, 3%) and pneumatoceles (9/88, 10%) were also frequent. History of hypertension and high initial CXR severity score were independent risk factors for complications. Patients with any intrathoracic complication during admission had an over 11-fold risk of ICU admission (adjusted odds ratio [aOR] 11.2, p < 0.0001) and intubation (aOR 12.4, p < 0.0001), over 50% reduction in successful extubation (aOR 0.49, p = 0.02) and longer length of stay (median 13 versus 5 days, p < 0.0001). There was no difference in overall survival between patients with and without any complication (log-rank p = 0.94). CONCLUSION In COVID-19 patients who underwent chest imaging, 1 in 5 patients have an intrathoracic complication, which are associated with higher level of care and prolonged hospital stay. Hypertension history and high CXR severity score confer an increased risk of complication. SUMMARY Intrathoracic complications in COVID-19 are common and are predictive of ICU admission, need for intubation, less successful extubation, and longer length of stay but are not predictive of mortality.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America.
| | - Dennis Toy
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America
| | - Lauren Groner
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America
| | | | - Jessica Rotman
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America
| | - Ashwin V Asrani
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America
| | - Syed S Mahmood
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
| | - Quynh A Truong
- Department of Radiology, Weill Cornell Medicine, New York, NY, United States of America; Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY, United States of America
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Escalon JG, Sullivan D, Pua BB, Girvin F, Verzosa Weisman S, Steinberger S, Toy D, Groner L, Legasto AC, Gruden JF. Management of Incidental Pulmonary Nodules: Influencing Patient Care Through Subspecialized Imaging Review. Curr Probl Diagn Radiol 2021; 51:524-528. [PMID: 34974882 DOI: 10.1067/j.cpradiol.2021.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/18/2021] [Accepted: 11/07/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate whether thoracic radiologist review of computed tomography-detected incidental pulmonary nodules initially reported by non-thoracic imagers would change management recommendations. MATERIALS AND METHODS The Radiology Consultation Service identified 468 computed tomography scans (one per patient) performed through the adult emergency department from August 2018 through December 2020 that mentioned the presence of a pulmonary nodule. Forty percent (186/468) were read by thoracic radiologists and 60% (282/468) were read by non-thoracic radiologists. The Radiology Consultation Service contacted all patients in order to assess risk factors for lung malignancy. Sixty-seven patients were excluded because they were unreachable, declined participation, or were actively followed by a pulmonologist or oncologist. A thoracic radiologist assessed the nodule and follow up recommendations in all remaining cases. RESULTS A total of 215 cases were re-reviewed by thoracic radiologists. The thoracic radiologist disagreed with the initial nodule recommendations in 38% (82/215) of cases and agreed in 62% (133/215) of cases. All discordant cases resulted in a change in management by the thoracic radiologist with approximately one-third (33%, 27/82) decreasing imaging utilization and two-thirds (67%, 55/82) increasing imaging utilization. Nodules were deemed benign and follow up eliminated in 11% (9/82) of discordant cases. DISCUSSION Our study illustrates that nodule review by thoracic radiologists results in a change in management in a large percentage of patients. Continued research is needed to determine whether subspecialty imaging review results in increased or more timely lung cancer detection.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY.
| | - Deirdre Sullivan
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Bradley B Pua
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Francis Girvin
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | | | - Sharon Steinberger
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Dennis Toy
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Lauren Groner
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - Alan C Legasto
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
| | - James F Gruden
- Department of Radiology, NewYork-Presbyterian/Weill Cornell Medicine, New York, NY
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Escalon JG, Crawford CB, Tang E, Cahill M, Toy D, Sullivan D, Pua BB. Communication of CT Lung Screening Results: Referring Providers' and Patients' Preferences. J Am Coll Radiol 2021; 18:1447-1450. [PMID: 34252372 DOI: 10.1016/j.jacr.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/09/2021] [Accepted: 06/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Joanna G Escalon
- Cardiothoracic Imaging Fellowship Director, Director of Thoracic MRI, Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York.
| | - Carolyn B Crawford
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Eve Tang
- EmblemHealth, New York, New York
| | - Meghan Cahill
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Dennis Toy
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Deirdre Sullivan
- Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Bradley B Pua
- Director of the Lung Cancer Screen Program, Chief of the Division of Interventional Radiology, Director of the Radiology Consultation Service, Department of Radiology, New York-Presbyterian/Weill Cornell Medicine, New York, New York
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9
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Escalon JG, Legasto AC, Toy D, Gruden JF. Central paradiaphragmatic middle lobe involvement in nonspecific interstitial pneumonia. Eur Radiol 2021; 31:7143-7150. [PMID: 33624164 DOI: 10.1007/s00330-021-07741-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 12/28/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Nonspecific interstitial pneumonia (NSIP) lacks specific diagnostic guidelines or criteria for imaging diagnosis, and the need for more reliable computed tomography (CT) characterization remains. We hypothesized that central paradiaphragmatic middle lobe (ML) involvement is present in most patients with NSIP. The purpose of this study was to evaluate the prevalence of ML involvement and thus to assess its potential as a unique feature of NSIP. METHODS We conducted a retrospective CT-imaging review of 40 patients with biopsy-proven (7/40, 18%) or clinically established (33/40, 82%) NSIP. Three subspecialty-trained thoracic radiologists reviewed CTs for ML involvement both independently and in consensus, and additional CT findings previously described in NSIP independently. RESULTS ML involvement was present in most cases (70%, 28/40, independent review, 78%, 31/40, consensus reading), with substantial agreement among all three readers (κ = 0.65). Fibrosis was present in almost all cases (93%, 37/40). Subpleural sparing occurred in one-third of patients (30%, 12/40). Homogeneity (48%, 19/40), central bronchiectasis (45%, 18/40), and peripheral bronchiectasis (53%, 21/40) were present in about half of patients. Apart from substantial inter-reader agreement on fibrosis (κ = 0.65), the above-mentioned imaging characteristics had fair to slight universal agreement (κ = 0.07-0.30). CONCLUSIONS Central paradiaphragmatic ML ground glass attenuation superimposed on reticulation and traction bronchiectasis occurs in most patients with NSIP, with high interobserver agreement. KEY POINTS • Central paradiaphragmatic middle lobe ground glass attenuation superimposed on reticulation and traction bronchiectasis is common in nonspecific interstitial pneumonia (NSIP). • This finding occurs more frequently than subpleural sparing and has a better interobserver agreement.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA.
| | - Alan C Legasto
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - Dennis Toy
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
| | - James F Gruden
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, 525 East 68th Street, New York, NY, 10065, USA
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Toy D, Groner LK, Escalon JG, Ersahin D, Weisman SV, Legasto AC, Naeger DM. Updates on the Role of Imaging in Cardiac Amyloidosis. Curr Treat Options Cardio Med 2021. [DOI: 10.1007/s11936-020-00890-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Rheumatoid arthritis (RA) is one of the most common chronic systemic inflammatory diseases and the most common chronic inflammatory arthritis. Classically a progressive symmetric polyarthritis, RA is characterized by inflammation, erosions, bone loss, and joint destruction. Up to half of patients with RA exhibit extra-articular manifestations (EAMs), which may precede articular disease and are more common in patients with seropositive RA (patients with detectable serum levels of rheumatoid factor and/or anticitrullinated peptide antibodies). Cardiovascular and pulmonary EAMs are the largest contributors to morbidity and mortality in RA and may be especially devastating. Imaging has a significant role in diagnosing these EAMs and assessing response to treatment. Although treatment with disease-modifying antirheumatic drugs has redefined the natural history of RA and helped many patients achieve low disease activity, patients are at risk for treatment-related complications, as well as infections. The clinical features of drug-induced lung disease and infection can overlap considerably with those of EAMs, presenting a diagnostic challenge. Radiologists, by recognizing the imaging characteristics and evolution of these various processes, are essential in diagnosing and distinguishing among EAMs, treatment-related complications, and unrelated processes and formulating an appropriate differential diagnosis. Moreover, recognizing these disease processes at imaging and contextualizing imaging findings with clinical information and laboratory and pathologic findings can facilitate definitive diagnosis and proper treatment. The authors review the articular and extra-articular thoracic imaging manifestations of RA, including cardiovascular, respiratory, and pleural diseases, as well as treatment-related complications and common infections. ©RSNA, 2021.
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Affiliation(s)
- Lauren K Groner
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Daniel B Green
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Stacey V Weisman
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Alan C Legasto
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Dennis Toy
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - James F Gruden
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | - Joanna G Escalon
- From the Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
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Toy D, Mahmood SS, Rotman J, Weisman SV, Escalon JG, Legasto AC, Cheng EP, McKenney AS, Barbar T, Balkan L, Chen Y, Razavi P, Zainul O, Abedian S, Gruden JF, Truong QA. Imaging Utilization and Outcomes in Vulnerable Populations during COVID-19 in New York City. Radiol Cardiothorac Imaging 2020; 2:e200464. [PMID: 33778647 PMCID: PMC7751279 DOI: 10.1148/ryct.2020200464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) affects vulnerable populations (VP) adversely. Purpose To evaluate overall imaging utilization in vulnerable subgroups (elderly, racial/ethnic minorities, socioeconomic status [SES] disadvantage) and determine if a particular subgroup has worse outcomes from COVID-19. Materials/Methods Of 4110 patients who underwent COVID-19 testing from March 3-April 4, 2020 at NewYork-Presbyterian Hospital (NYP) health system, we included 1121 COVID-19 positive adults (mean age 59±18 years, 59% male) from two academic hospitals and evaluated imaging utilization rates and outcomes, including mortality. Results Of 897 (80%) VP, there were 465 (41%) elderly, 380 (34%) racial/ethnic minorities, and 479 (43%) SES disadvantage patients. Imaging was performed in 88% of patients and mostly portable/bedside studies, with 87% of patients receiving chest radiographs. There were 83% hospital admissions, 25% ICU admissions, 23% intubations, and 13% deaths. Elderly patients had greater imaging utilization, hospitalizations, ICU/intubation requirement, longer hospital stays, and >4-fold increase in mortality compared to non-elderlies (adjusted hazard ratio[aHR] 4.79, p<0.001). Self-reported minorities had fewer ICU admissions (p=0.03) and reduced hazard for mortality (aHR 0.53, p=0.004; complete case analysis: aHR 0.39, p<0.001 excluding "not reported"; sensitivity analysis: aHR 0.61, p=0.005 "not reported" classified as minorities) with similar imaging utilization, compared to non-minorities. SES disadvantage patients had similar imaging utilization and outcomes as compared to their counterparts. Conclusions In a predominantly hospitalized New York City cohort, elderly patients are at highest mortality risk. Racial/ethnic minorities and SES disadvantage patients fare better or similarly to their counterparts, highlighting the critical role of access to inpatient medical care during the COVID-19 pandemic.
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Affiliation(s)
- Dennis Toy
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Syed S Mahmood
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Jessica Rotman
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Stacey Verzosa Weisman
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Joanna G Escalon
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Edward P Cheng
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Anna Sophia McKenney
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Tarek Barbar
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Lauren Balkan
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Yunchan Chen
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Peyman Razavi
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Omar Zainul
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Sajjad Abedian
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - James F Gruden
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
| | - Quynh A Truong
- Department of Radiology, Weill Cornell Medicine, New York, NY (D.T., J.R., L.K.G., S.V.W., J.G.E., A.C.L., A.S.M., J.F.G., Q.A.T); Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, NY (S.S.M., E.P.C., Q.A.T); Department of Medicine, Weill Cornell Medicine, New York, NY (T.B., L.B); Weill Cornell Medical College, New York, NY (Y.C., P.R., O.Z); Information Technologies & Services, Weill Cornell Medicine, New York, NY (S.A)
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Toy D, Escalon JG, Groner LK, Naeger DM. Preparation for the ABR Core Exam: Resident Study Habits and the Value of Case Conferences. J Am Coll Radiol 2020; 18:615-619. [PMID: 33242480 DOI: 10.1016/j.jacr.2020.10.019] [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: 09/01/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Dennis Toy
- Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York.
| | - Joanna G Escalon
- Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - Lauren K Groner
- Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, New York
| | - David M Naeger
- Director of Radiology, Denver Health, Denver, Colorado; Vice Chair, Department of Radiology, University of Colorado, Denver, Colorado
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Isakov KMM, Legasto AC, Hossain R, Verzosa Weisman S, Toy D, Groner LK, Feibusch A, Escalon JG. A Case-Based Review of Vaping-Induced Injury-Pulmonary Toxicity and Beyond. Curr Probl Diagn Radiol 2020; 50:401-409. [PMID: 32703539 DOI: 10.1067/j.cpradiol.2020.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 11/22/2022]
Abstract
The last 10 years has seen a steady rise in the use of electronic cigarettes ("e-cigarettes" or ECIGs) or "vape pens." Though initially developed to assist with smoking cessation, use among adolescents has been particularly high. A concomitant rise in ECIG-related injuries disproportionately affecting young patients has been recognized. This unique case series highlights both pulmonary and extra-pulmonary ECIG-induced injuries including vape tip ingestion, maxillofacial fractures after vape pen explosion, myocarditis, and several different manifestations of vaping-associated lung injury. Becoming familiar with expected imaging findings in the wide array of ECIG-induced complications will help radiologists recognize these findings, recommend further imaging as needed, facilitate early diagnosis by help referring clinicians elicit the relevant history from patients, and expedite appropriate treatment.
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Affiliation(s)
- Kimberly M M Isakov
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Alan C Legasto
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Rydhwana Hossain
- Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Stacey Verzosa Weisman
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Dennis Toy
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Lauren K Groner
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Amanda Feibusch
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY
| | - Joanna G Escalon
- Department of Radiology, Division of Cardiothoracic Imaging, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY.
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Escalon JG, Bang TJ, Broncano J, Vargas D. Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Potential Etiologies, Mimics and Imaging Findings. Curr Probl Diagn Radiol 2020; 50:85-94. [PMID: 32513516 DOI: 10.1067/j.cpradiol.2020.02.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/06/2023]
Abstract
Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs when a patient presents with positive cardiac enzymes in the absence of obstructive atherosclerosis on coronary angiography. Several hypotheses for the pathogenesis of MINOCA have been suggested and multiple potential underlying etiologies have been reported. This review will outline the reported causes of MINOCA and associated major imaging features. In doing so, it will increase awareness of this entity and equip cardiac imagers with the knowledge to appropriately tailor imaging to make a prompt and accurate diagnosis.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, New York-Presbyterian Hospital - Weill Cornell Medical Center, New York, NY.
| | - Tami J Bang
- Department of Radiology, Division of Cardiopulmonary Imaging, University of Colorado School of Medicine, Aurora, CO
| | - Jordi Broncano
- Department of Radiology, Hospital San Juan de Dios, Hospital de la Cruz Roja, RESSALTA, Health Time Group, Cordoba, Spain
| | - Daniel Vargas
- Department of Radiology, Division of Cardiopulmonary Imaging, University of Colorado School of Medicine, Aurora, CO
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Escalon JG, Richards JC, Koelsch T, Downey GP, Lynch DA. Isolated Cystic Lung Disease: An Algorithmic Approach to Distinguishing Birt-Hogg-Dubé Syndrome, Lymphangioleiomyomatosis, and Lymphocytic Interstitial Pneumonia. AJR Am J Roentgenol 2019; 212:1260-1264. [PMID: 30888864 DOI: 10.2214/ajr.18.20920] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Birt-Hogg-Dubé (BHD) syndrome, lymphangioleiomyomatosis (LAM), and lymphocytic interstitial pneumonia (LIP) frequently present as isolated cystic lung disease and can be challenging to distinguish. If imaging findings are otherwise unremarkable, the radiologist is unaided by ancillary CT findings in narrowing the diagnosis. We hypothesized that the distribution and morphologic features of lung cysts could be used to differentiate BHD syndrome, LAM, and LIP. Therefore, the purpose of this study was to characterize the CT appearances of these conditions and create a practical CT-based algorithm to differentiate among them. MATERIALS AND METHODS. The study was a retrospective review of the CT images of 16 patients with BHD syndrome, 17 patients with LAM, and 14 patients with LIP. On the basis of the data collected, a CT-based algorithm was created, and the CT images were reviewed again. RESULTS. Lower lung-predominant cysts were significantly more likely to be found in patients with BHD syndrome (100% of patients) or LIP (71-93% of patients) than in patients with LAM (6-12% of patients), who were more likely to have diffuse cysts. Compared with patients with LIP or LAM, patients with BHD syndrome were significantly more likely to have elliptical (floppy) paramediastinal cysts (88-94% of patients with BHD syndrome, 36-43% of patients with LIP, and 6-12% of patients with LAM) or a disproportionate number of paramediastinal cysts (69-88% of patients with BHD syndrome, 0-14% of patients with LIP, and 0-6% of patients with LAM). Our algorithm enabled differentiation of BHD syndrome, LAM, and LIP with a high level of accuracy and high interreader agreement (κ = 0.809). CONCLUSION. Radiologists can use the proposed CT-based algorithm to prospectively and confidently suggest one of these disorders as the favored diagnosis. Of importance, this will allow diagnosing the disorder early and accurately, screening for comorbidities, and prevention of potential complications.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, National Jewish Health, Denver, CO
- Present address: NewYork-Presbyterian/Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065
| | | | - Tilman Koelsch
- Department of Radiology, National Jewish Health, Denver, CO
| | - Gregory P Downey
- Department of Medicine, National Jewish Health, Denver, CO
- Department of Pediatrics, National Jewish Health, Denver, CO
- Department of Biomedical Research, National Jewish Health, Denver, CO
- Division of Pulmonary Sciences and Critical Care Medicine, Department of Medicine, University of Colorado, Aurora, CO
- Department of Immunology and Microbiology, University of Colorado, Aurora, CO
| | - David A Lynch
- Department of Radiology, National Jewish Health, Denver, CO
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Affiliation(s)
- J G Escalon
- From the Department of Radiology, National Jewish Health, Denver, CO, USA
| | - D A Lynch
- From the Department of Radiology, National Jewish Health, Denver, CO, USA
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Affiliation(s)
- Joanna G Escalon
- From the Department of Radiology, National Jewish Health, Denver, CO, USA
| | - David A Lynch
- From the Department of Radiology, National Jewish Health, Denver, CO, USA
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Escalon JG, Browne LP, Bang TJ, Restrepo CS, Ocazionez D, Vargas D. Congenital anomalies of the pulmonary arteries: an imaging overview. Br J Radiol 2018; 92:20180185. [PMID: 30102560 DOI: 10.1259/bjr.20180185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Congenital pulmonary artery anomalies represent a diverse group of abnormalities, ranging from asymptomatic incidental findings to causes of sudden cardiac death. While some may be recognized in childhood, others may be found incidentally in adulthood. We review the clinical and imaging findings in patients with congenital anomalies of the pulmonary arteries, including valvular and perivavular anomalies as well as abnormal narrowing, course and communications of the pulmonary arteries. We also discuss the role of various imaging modalities in the evaluation of these patients. It is vital to be aware of the key radiologic manifestations and associated haemodynamic consequences in these conditions in order to facilitate accurate diagnosis and prognostic stratification.
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Affiliation(s)
- Joanna G Escalon
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lorna P Browne
- Department of Radiology, Children's Hospital Colorado, Aurora, CO, USA
| | - Tami J Bang
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Daniel Ocazionez
- Department of Radiology, University of Texas Health Science Center, Houston, TX, USA
| | - Daniel Vargas
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Erratum to: Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2966-2973. [PMID: 29128990 DOI: 10.1007/s00261-017-1205-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The original version of this article unfortunately contained mistakes. The figures 7D, 7E and 7F were missing in the article and arrows were missing in the figures 6C, 8B and 11C. The year of publication and volume number for references 19, 79 and 87 have been updated. Also, the Table 2 layout has been improved for better readability. The Publisher apologizes for the mistakes and the inconvenience caused.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Abstract
RATIONALE Mediastinal nonseminomatous germ cell tumor (NSGCT) is an uncommon entity. Metastatic hepatic sarcomatous transformation is rare. PATIENT CONCERNS We report a 24-year-old man with no previous related medical history presented with chest pain and left arm numbness. DIAGNOSES The x-ray showed an anterior mediastinal mass. The chest computed tomography (CT) confirmed the presence of a mildly enhancing mass in the same location, without invasion of any vascular structure. A CT-guided biopsy was performed, revealing a primary mediastinal nonseminomatous germ cell tumor (NSGCT), yolk sac histology, with areas of somatic transformation to malignant nerve sheath tumor. After surgery patient was followed-up with imaging. Two years later a CT scan showed a new hepatic hyper vascular lesion, confirmed by a subsequent magnetic resonance imaging (MRI) and positron emission tomography (PET) scan. A CT-guided biopsy revealed a hepatic metastatic transformation to angiosarcoma of the primitive NSGCT. INTERVENTIONS The patient went on to received palliative chemotherapy. OUTCOMES The patient is being followed-up regularly at the outpatient department. LESSONS Because of the potential of metastatic sarcoma arising from germ cell tumors, these patients should undergo periodical follow-up, with periodical scans. PET\CT scan might have a role in the follow-up of these patients.
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Affiliation(s)
- Giuseppe Corrias
- Department of Radiology, Memorial Sloan Kettering Cancer Center, York Avenue, New York, NY, USA
- Department of Radiology, University of Cagliari, via Università, Cagliari, Italy
| | - Joanna G. Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, York Avenue, New York, NY, USA
- Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY
- Department of Radiology, University of Colorado, Aurora, CO
| | - Laura Tang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Luca Saba
- Department of Radiology, University of Cagliari, via Università, Cagliari, Italy
| | - Lorenzo Mannelli
- Department of Radiology, Memorial Sloan Kettering Cancer Center, York Avenue, New York, NY, USA
- Department of Radiology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2488-2512. [PMID: 28528388 PMCID: PMC5857967 DOI: 10.1007/s00261-017-1179-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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24
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Escalon JG, Wu X, Drexler IR, Lief L, Plataki M, Bender M, Gruden JF. Rare case of pulmonary involvement in an adult with Kawasaki disease. Clin Imaging 2017; 47:1-3. [PMID: 28797966 DOI: 10.1016/j.clinimag.2017.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/05/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022]
Abstract
Kawasaki disease is an acute, self-limited, febrile vasculitis typically seen in early childhood. Pulmonary involvement is uncommon and is not part of the conventional diagnostic criteria. We add to the literature a unique case of a 22year-old male with Kawasaki disease and pulmonary involvement. It illustrates the importance of recognizing unusual presentations of Kawasaki disease and highlights the possibility of pulmonary abnormalities on physical and imaging examination. Awareness of such presentations can help avoid delayed diagnosis, prevent the development of coronary aneurysms, and allow careful observation for imaging resolution.
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Affiliation(s)
- Joanna G Escalon
- NewYork-Presbyterian - Weill Cornell Medical Center, Department of Radiology, United States.
| | - Xiaoping Wu
- NewYork-Presbyterian - Weill Cornell Medical Center, Department of Medicine/Pulmonary and Critical Care, United States
| | - Ian R Drexler
- NewYork-Presbyterian - Weill Cornell Medical Center, Department of Radiology, United States
| | - Lindsay Lief
- NewYork-Presbyterian - Weill Cornell Medical Center, Department of Medicine/Pulmonary and Critical Care, United States
| | - Maria Plataki
- NewYork-Presbyterian - Weill Cornell Medical Center, Department of Medicine/Pulmonary and Critical Care, United States
| | - Michael Bender
- NewYork-Presbyterian - Weill Cornell Medical Center, Department of Medicine/Pulmonary and Critical Care, United States
| | - James F Gruden
- NewYork-Presbyterian - Weill Cornell Medical Center, Department of Medicine/Pulmonary and Critical Care, United States
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25
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Ko JP, Suh J, Ibidapo O, Escalon JG, Li J, Pass H, Naidich DP, Crawford B, Tsai EB, Koo CW, Mikheev A, Rusinek H. Lung Adenocarcinoma: Correlation of Quantitative CT Findings with Pathologic Findings. Radiology 2016; 280:931-9. [DOI: 10.1148/radiol.2016142975] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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26
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O'Beirne SL, Escalon JG, Momtahen S, Hissong E, Port JL, Schenck EJ, Legasto AC, Kaner RJ. Severe Cavitary, Fistulating Mycobacterium avium-intracellulare Complex Disease in an Immunocompetent Host. Am J Respir Crit Care Med 2016; 192:1387-8. [PMID: 26244303 DOI: 10.1164/rccm.201506-1151im] [Citation(s) in RCA: 2] [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] [Indexed: 11/16/2022] Open
Affiliation(s)
| | | | | | - Erika Hissong
- 3 Department of Pathology and Laboratory Medicine, and
| | - Jeffrey L Port
- 4 Department of Cardiothoracic Surgery, New York Presbyterian Hospital-Weill Cornell Medical College, New York, New York; and
| | | | | | - Robert J Kaner
- 1 Division of Pulmonary and Critical Care Medicine.,5 Department of Genetic Medicine, Weill Cornell Medical College, New York, New York
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27
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Campbell NM, Katz SS, Escalon JG, Do RK. Imaging patterns of intraductal papillary mucinous neoplasms of the pancreas: an illustrated discussion of the International Consensus Guidelines for the Management of IPMN. ACTA ACUST UNITED AC 2015; 40:663-77. [PMID: 25219664 DOI: 10.1007/s00261-014-0236-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Intraductal papillary mucinous neoplasms (IPMN) are being diagnosed with increasing frequency, necessitating an algorithm to help stratify patients into low- and high-risk groups, for follow-up versus more invasive evaluation. New evidence concerning their natural history and overall risk of malignancy has emerged since the 2006 International Association of Pancreatology consensus guidelines, prompting an update in 2012, that distinguishes radiologic 'worrisome features' from 'high-risk stigmata'. The aim of this article is to illustrate, with case examples, the variable imaging patterns of IPMN and how their radiologic features, such as cyst size and mural nodules, are interpreted in the context of the new 2012 guidelines. The 2012 and 2006 guidelines will be compared and discussed with reference to additional studies that have since been published. Despite these guidelines, lingering uncertainty remains about the natural history of IPMN, a source of unease to both radiologists and referring clinicians alike, mandating further refinement of clinical and radiologic parameters predictive of malignancy. Emerging data regarding the risk of extrapancreatic malignancy, as well as synchronous or metachronous pancreatic ductal adenocarcinoma remote in location from a branch duct IPMN are also reviewed. With the expanding research and evolving understanding of this clinicopathologic entity across the globe, radiologists will continue to play an important role in the management of patients with IPMN.
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Affiliation(s)
- Naomi M Campbell
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA,
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28
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Escalon JG, Arkin J, Chaump M, Harkin TJ, Wolf AS, Legasto A. Ruptured anterior mediastinal teratoma with radiologic, pathologic, and bronchoscopic correlation. Clin Imaging 2015; 39:689-91. [PMID: 25863875 DOI: 10.1016/j.clinimag.2015.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 03/24/2015] [Indexed: 12/31/2022]
Abstract
While most teratomas are asymptomatic, intrathoracic teratomas can rarely rupture spontaneously causing more alarming symptoms. Ruptured teratoma is a serious clinical entity, and early recognition is crucial for avoidance of further complications and preparation of proper surgical approach. We present a case of ruptured anterior mediastinal teratoma with radiologic, pathologic, and bronchoscopic correlation. This case uniquely illustrates a patient presenting with signs of infection and progressively worsening symptoms, thus emphasizing the need for early diagnosis and the importance of imaging.
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Affiliation(s)
- Joanna G Escalon
- New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, Department of Radiology.
| | - Jordan Arkin
- New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, Department of Pathology
| | - Michael Chaump
- New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, Department of Pathology
| | - Timothy J Harkin
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, Division of Pulmonary, Critical Care and Sleep Medicine
| | - Andrea S Wolf
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, Department of Thoracic Surgery
| | - Alan Legasto
- New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th Street, New York, NY 10065, Department of Radiology
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