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Lang M, Conklin J. Triage of Patients With Acute Stroke for Endovascular Therapy: Point-Moving Toward MRI-Based Acute Stroke Triage With Ultrafast Protocols. AJR Am J Roentgenol 2024. [PMID: 38691413 DOI: 10.2214/ajr.24.31303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Lang M, Clifford B, Lo WC, Applewhite BP, Tabari A, Filho ALMG, Hosseini Z, Longo MGF, Cauley SF, Setsompop K, Bilgic B, Feiweier T, Lev MH, Schaefer PW, Rapalino O, Huang SY, Conklin J. Clinical Evaluation of a 2-Minute Ultrafast Brain MR Protocol for Evaluation of Acute Pathology in the Emergency and Inpatient Settings. AJNR Am J Neuroradiol 2024; 45:379-385. [PMID: 38453413 DOI: 10.3174/ajnr.a8143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/07/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND AND PURPOSE The use of MR imaging in emergency settings has been limited by availability, long scan times, and sensitivity to motion. This study assessed the diagnostic performance of an ultrafast brain MR imaging protocol for evaluation of acute intracranial pathology in the emergency department and inpatient settings. MATERIALS AND METHODS Sixty-six adult patients who underwent brain MR imaging in the emergency department and inpatient settings were included in the study. All patients underwent both the reference and the ultrafast brain MR protocols. Both brain MR imaging protocols consisted of T1-weighted, T2/T2*-weighted, FLAIR, and DWI sequences. The ultrafast MR images were reconstructed by using a machine-learning assisted framework. All images were reviewed by 2 blinded neuroradiologists. RESULTS The average acquisition time was 2.1 minutes for the ultrafast brain MR protocol and 10 minutes for the reference brain MR protocol. There was 98.5% agreement on the main clinical diagnosis between the 2 protocols. In head-to-head comparison, the reference protocol was preferred in terms of image noise and geometric distortion (P < .05 for both). The ultrafast ms-EPI protocol was preferred over the reference protocol in terms of reduced motion artifacts (P < .01). Overall diagnostic quality was not significantly different between the 2 protocols (P > .05). CONCLUSIONS The ultrafast brain MR imaging protocol provides high accuracy for evaluating acute pathology while only requiring a fraction of the scan time. Although there was greater image noise and geometric distortion on the ultrafast brain MR protocol images, there was significant reduction in motion artifacts with similar overall diagnostic quality between the 2 protocols.
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Affiliation(s)
- Min Lang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Bryan Clifford
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Wei-Ching Lo
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Brooks P Applewhite
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Azadeh Tabari
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | | | - Zahra Hosseini
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
| | - Maria Gabriela Figueiro Longo
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Stephen F Cauley
- Siemens Medical Solutions (B.C., W.-C.L., Z.H., S.F.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Kawin Setsompop
- Departments of Radiology and Electrical Engineering (K.S.), Stanford University, Stanford, California
| | - Berkin Bilgic
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | | | - Michael H Lev
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Pamela W Schaefer
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Otto Rapalino
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
| | - Susie Y Huang
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (S.F.C., B.B., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - John Conklin
- From the Department of Radiology (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School (M.L., B.P.A., A.T., M.G.F.L., M.H.L., P.W.S., O.R., S.Y.H., J.C.), Boston, Massachusetts
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Awan KM, Goncalves Filho ALM, Tabari A, Applewhite BP, Lang M, Lo WC, Sellers R, Kollasch P, Clifford B, Nickel D, Husseni J, Rapalino O, Schaefer P, Cauley S, Huang SY, Conklin J. Diagnostic evaluation of deep learning accelerated lumbar spine MRI. Neuroradiol J 2024:19714009231224428. [PMID: 38195418 DOI: 10.1177/19714009231224428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND PURPOSE Deep learning (DL) accelerated MR techniques have emerged as a promising approach to accelerate routine MR exams. While prior studies explored DL acceleration for specific lumbar MRI sequences, a gap remains in comprehending the impact of a fully DL-based MRI protocol on scan time and diagnostic quality for routine lumbar spine MRI. To address this, we assessed the image quality and diagnostic performance of a DL-accelerated lumbar spine MRI protocol in comparison to a conventional protocol. METHODS We prospectively evaluated 36 consecutive outpatients undergoing non-contrast enhanced lumbar spine MRIs. Both protocols included sagittal T1, T2, STIR, and axial T2-weighted images. Two blinded neuroradiologists independently reviewed images for foraminal stenosis, spinal canal stenosis, nerve root compression, and facet arthropathy. Grading comparison employed the Wilcoxon signed rank test. For the head-to-head comparison, a 5-point Likert scale to assess image quality, considering artifacts, signal-to-noise ratio (SNR), anatomical structure visualization, and overall diagnostic quality. We applied a 15% noninferiority margin to determine whether the DL-accelerated protocol was noninferior. RESULTS No significant differences existed between protocols when evaluating foraminal and spinal canal stenosis, nerve compression, or facet arthropathy (all p > .05). The DL-spine protocol was noninferior for overall diagnostic quality and visualization of the cord, CSF, intervertebral disc, and nerve roots. However, it exhibited reduced SNR and increased artifact perception. Interobserver reproducibility ranged from moderate to substantial (κ = 0.50-0.76). CONCLUSION Our study indicates that DL reconstruction in spine imaging effectively reduces acquisition times while maintaining comparable diagnostic quality to conventional MRI.
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Affiliation(s)
- Komal M Awan
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | | | - Azadeh Tabari
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Brooks P Applewhite
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Min Lang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | | | | | | | | | | | - Jad Husseni
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Otto Rapalino
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | - Pamela Schaefer
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
| | | | - Susie Y Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, USA
| | - John Conklin
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, USA
- Harvard Medical School, USA
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Gartshteyn Y, Conklin J, Petri MA, Kyttaris VC, Goldman DW, Kammesheidt A, Askanase AD, Alexander RV. Role of Platelet-Bound C4d (PC4d) in Predicting Risk of Future Thrombotic Events in Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2023; 75:2088-2095. [PMID: 36807703 DOI: 10.1002/acr.25107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/31/2023] [Accepted: 02/16/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Platelet-bound complement activation product C4d (PC4d) levels correlate with history of thrombosis in patients with systemic lupus erythematosus (SLE). The present study evaluated whether PC4d levels could assess risk of future thrombosis events. METHODS PC4d level was measured by flow cytometry. Thromboses were confirmed by electronic medical record data review. RESULTS The study included 418 patients. Nineteen events (13 arterial and 6 venous) occurred in 15 subjects in the 3 years post-PC4d level measurement. PC4d levels above the optimum cutoff of 13 mean fluorescence intensity (MFI) predicted future arterial thrombosis with a hazard ratio of 4.34 (95% confidence interval [95% CI] 1.03-18.3) (P = 0.046) and a diagnostic odds ratio (OR) of 4.30 (95% CI 1.19-15.54). Negative predictive value of PC4d level of ≤13 MFI for arterial thrombosis was 99% (95% CI 97-100%). Although a PC4d level of >13 MFI did not reach statistical significance for prediction of total thrombosis (arterial and venous) (diagnostics OR 2.50 [95% CI 0.88-7.06]; P = 0.08), it was associated with all thrombosis (n = 70 historic and future arterial and venous events in the 5 years pre- to 3 years post-PC4d level measurement) with an OR of 2.45 (95% CI 1.37-4.32; P = 0.0016). In addition, the negative predictive value of PC4d level of ≤13 MFI for all future thrombosis events was 97% (95% CI 95-99%). CONCLUSIONS A PC4d level of >13 MFI predicted future arterial thrombosis and was associated with all thrombosis. Patients with SLE presenting with a PC4d level of ≤13 MFI had high probability of not experiencing arterial or any thrombosis in the 3 years afterwards. Taken together, these findings indicate that PC4d levels may help predict the risk of future thrombosis events in SLE.
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Tabari A, Lang M, Awan K, Liu W, Clifford B, Lo WC, Splitthoff DN, Cauley S, Rapalino O, Schaefer P, Huang SY, Conklin J. Optimized flow compensation for contrast-enhanced T1-weighted Wave-CAIPI 3D MPRAGE imaging of the brain. Eur Radiol Exp 2023; 7:34. [PMID: 37394534 DOI: 10.1186/s41747-023-00351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 04/25/2023] [Indexed: 07/04/2023] Open
Abstract
Flow-related artifacts have been observed in highly accelerated T1-weighted contrast-enhanced wave-controlled aliasing in parallel imaging (CAIPI) magnetization-prepared rapid gradient-echo (MPRAGE) imaging and can lead to diagnostic uncertainty. We developed an optimized flow-mitigated Wave-CAIPI MPRAGE acquisition protocol to reduce these artifacts through testing in a custom-built flow phantom. In the phantom experiment, maximal flow artifact reduction was achieved with the combination of flow compensation gradients and radial reordered k-space acquisition and was included in the optimized sequence. Clinical evaluation of the optimized MPRAGE sequence was performed in 64 adult patients, who all underwent contrast-enhanced Wave-CAIPI MPRAGE imaging without flow-compensation and with optimized flow-compensation parameters. All images were evaluated for the presence of flow-related artifacts, signal-to-noise ratio (SNR), gray-white matter contrast, enhancing lesion contrast, and image sharpness on a 3-point Likert scale. In the 64 cases, the optimized flow mitigation protocol reduced flow-related artifacts in 89% and 94% of the cases for raters 1 and 2, respectively. SNR, gray-white matter contrast, enhancing lesion contrast, and image sharpness were rated as equivalent for standard and flow-mitigated Wave-CAIPI MPRAGE in all subjects. The optimized flow mitigation protocol successfully reduced the presence of flow-related artifacts in the majority of cases.Relevance statementAs accelerated MRI using novel encoding schemes become increasingly adopted in clinical practice, our work highlights the need to recognize and develop strategies to minimize the presence of unexpected artifacts and reduction in image quality as potential compromises to achieving short scan times.Key points• Flow-mitigation technique led to an 89-94% decrease in flow-related artifacts.• Image quality, signal-to-noise ratio, enhancing lesion conspicuity, and image sharpness were preserved with the flow mitigation technique.• Flow mitigation reduced diagnostic uncertainty in cases where flow-related artifacts mimicked enhancing lesions.
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Affiliation(s)
- Azadeh Tabari
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Min Lang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Komal Awan
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | | | | | | | - Stephen Cauley
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Otto Rapalino
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Pamela Schaefer
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Susie Y Huang
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - John Conklin
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, 55 Fruit Street, Charlestown, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
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Polak D, Hossbach J, Splitthoff DN, Clifford B, Lo WC, Tabari A, Lang M, Huang SY, Conklin J, Wald LL, Cauley S. Motion guidance lines for robust data consistency-based retrospective motion correction in 2D and 3D MRI. Magn Reson Med 2023; 89:1777-1790. [PMID: 36744619 PMCID: PMC10518424 DOI: 10.1002/mrm.29534] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To develop a robust retrospective motion-correction technique based on repeating k-space guidance lines for improving motion correction in Cartesian 2D and 3D brain MRI. METHODS The motion guidance lines are inserted into the standard sequence orderings for 2D turbo spin echo and 3D MPRAGE to inform a data consistency-based motion estimation and reconstruction, which can be guided by a low-resolution scout. The extremely limited number of required guidance lines are repeated during each echo train and discarded in the final image reconstruction. Thus, integration within a standard k-space acquisition ordering ensures the expected image quality/contrast and motion sensitivity of that sequence. RESULTS Through simulation and in vivo 2D multislice and 3D motion experiments, we demonstrate that respectively 2 or 4 optimized motion guidance lines per shot enables accurate motion estimation and correction. Clinically acceptable reconstruction times are achieved through fully separable on-the-fly motion optimizations (˜1 s/shot) using standard scanner GPU hardware. CONCLUSION The addition of guidance lines to scout accelerated motion estimation facilitates robust retrospective motion correction that can be effectively introduced without perturbing standard clinical protocols and workflows.
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Affiliation(s)
- Daniel Polak
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Siemens Healthcare GmbH, Erlangen, Germany
| | | | | | | | | | - Azadeh Tabari
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Min Lang
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Susie Y. Huang
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - John Conklin
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence L. Wald
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Stephen Cauley
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Goncalves Filho ALM, Awan KM, Conklin J, Ngamsombat C, Cauley SF, Setsompop K, Liu W, Splitthoff DN, Lo WC, Kirsch JE, Schaefer PW, Rapalino O, Huang SY. Validation of a highly accelerated post-contrast wave-controlled aliasing in parallel imaging (CAIPI) 3D-T1 MPRAGE compared to standard 3D-T1 MPRAGE for detection of intracranial enhancing lesions on 3-T MRI. Eur Radiol 2023; 33:2905-2915. [PMID: 36460923 PMCID: PMC9718459 DOI: 10.1007/s00330-022-09265-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/26/2022] [Accepted: 09/30/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES High-resolution post-contrast T1-weighted imaging is a workhorse sequence in the evaluation of neurological disorders. The T1-MPRAGE sequence has been widely adopted for the visualization of enhancing pathology in the brain. However, this three-dimensional (3D) acquisition is lengthy and prone to motion artifact, which often compromises diagnostic quality. The goal of this study was to compare a highly accelerated wave-controlled aliasing in parallel imaging (CAIPI) post-contrast 3D T1-MPRAGE sequence (Wave-T1-MPRAGE) with the standard 3D T1-MPRAGE sequence for visualizing enhancing lesions in brain imaging at 3 T. METHODS This study included 80 patients undergoing contrast-enhanced brain MRI. The participants were scanned with a standard post-contrast T1-MPRAGE sequence (acceleration factor [R] = 2 using GRAPPA parallel imaging technique, acquisition time [TA] = 5 min 18 s) and a prototype post-contrast Wave-T1-MPRAGE sequence (R = 4, TA = 2 min 32 s). Two neuroradiologists performed a head-to-head evaluation of both sequences and rated the visualization of enhancement, sharpness, noise, motion artifacts, and overall diagnostic quality. A 15% noninferiority margin was used to test whether post-contrast Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE. Inter-rater and intra-rater agreement were calculated. Quantitative assessment of CNR/SNR was performed. RESULTS Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE for delineating enhancing lesions with unanimous agreement in all cases between raters. Wave-T1-MPRAGE was noninferior in the perception of noise (p < 0.001), motion artifact (p < 0.001), and overall diagnostic quality (p < 0.001). CONCLUSION High-accelerated post-contrast Wave-T1-MPRAGE enabled a two-fold reduction in acquisition time compared to the standard sequence with comparable performance for visualization of enhancing pathology and equivalent perception of noise, motion artifacts and overall diagnostic quality without loss of clinically important information. KEY POINTS • Post-contrast wave-controlled aliasing in parallel imaging (CAIPI) T1-MPRAGE accelerated the acquisition of three-dimensional (3D) high-resolution post-contrast images by more than two-fold. • Post-contrast Wave-T1-MPRAGE was noninferior to standard T1-MPRAGE with unanimous agreement between reviewers (100% in 80 cases) for the visualization of intracranial enhancing lesions. • Wave-T1-MPRAGE was equivalent to the standard sequence in the perception of noise in 94% (75 of 80) of cases and was preferred in 16% (13 of 80) of cases for decreased motion artifact.
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Affiliation(s)
- Augusto Lio M Goncalves Filho
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Komal Manzoor Awan
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Chanon Ngamsombat
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
- Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Nakhon Pathom, Thailand
| | - Stephen F Cauley
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Kawin Setsompop
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | | | | | - John E Kirsch
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital (MGH), Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA.
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, 55 Fruit St, GRB-273A, Boston, MA, 02114, USA.
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Chung J, Kim D, Choi J, Yune S, Song KD, Kim S, Chua M, Succi MD, Conklin J, Longo MGF, Ackman JB, Petranovic M, Lev MH, Do S. Author Correction: Prediction of oxygen requirement in patients with COVID-19 using a pre-trained chest radiograph xAI model: efficient development of auditable risk prediction models via a fine-tuning approach. Sci Rep 2023; 13:4296. [PMID: 36922618 PMCID: PMC10015513 DOI: 10.1038/s41598-023-31333-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Affiliation(s)
- Joowon Chung
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Doyun Kim
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Jongmun Choi
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Sehyo Yune
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Kyoung Doo Song
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA.,Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro, Gangnam-Gu, Seoul, 06351, Republic of Korea
| | - Seonkyoung Kim
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Michelle Chua
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Marc D Succi
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Maria G Figueiro Longo
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Jeanne B Ackman
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Milena Petranovic
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA
| | - Synho Do
- Department of Radiology, Massachusetts General Brigham and Harvard Medical School, Boston, MA, USA.
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Lang M, Tabari A, Polak D, Ford J, Clifford B, Lo WC, Manzoor K, Splitthoff DN, Wald LL, Rapalino O, Schaefer P, Conklin J, Cauley S, Huang SY. Clinical Evaluation of Scout Accelerated Motion Estimation and Reduction Technique for 3D MR Imaging in the Inpatient and Emergency Department Settings. AJNR Am J Neuroradiol 2023; 44:125-133. [PMID: 36702502 PMCID: PMC9891324 DOI: 10.3174/ajnr.a7777] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE A scout accelerated motion estimation and reduction (SAMER) framework has been developed for efficient retrospective motion correction. The goal of this study was to perform an initial evaluation of SAMER in a series of clinical brain MR imaging examinations. MATERIALS AND METHODS Ninety-seven patients who underwent MR imaging in the inpatient and emergency department settings were included in the study. SAMER motion correction was retrospectively applied to an accelerated T1-weighted MPRAGE sequence that was included in brain MR imaging examinations performed with and without contrast. Two blinded neuroradiologists graded images with and without SAMER motion correction on a 5-tier motion severity scale (none = 1, minimal = 2, mild = 3, moderate = 4, severe = 5). RESULTS The median SAMER reconstruction time was 1 minute 47 seconds. SAMER motion correction significantly improved overall motion grades across all examinations (P < .005). Motion artifacts were reduced in 28% of cases, unchanged in 64% of cases, and increased in 8% of cases. SAMER improved motion grades in 100% of moderate motion cases and 75% of severe motion cases. Sixty-nine percent of nondiagnostic motion cases (grades 4 and 5) were considered diagnostic after SAMER motion correction. For cases with minimal or no motion, SAMER had negligible impact on the overall motion grade. For cases with mild, moderate, and severe motion, SAMER improved the motion grade by an average of 0.3 (SD, 0.5), 1.1 (SD, 0.3), and 1.1 (SD, 0.8) grades, respectively. CONCLUSIONS SAMER improved the diagnostic image quality of clinical brain MR imaging examinations with motion artifacts. The improvement was most pronounced for cases with moderate or severe motion.
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Affiliation(s)
- M Lang
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - A Tabari
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - D Polak
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Siemens Healthcare GmbH (D.P., D.N.S.), Erlangen, Germany
| | - J Ford
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - B Clifford
- Siemens Medical Solutions (B.C., W.-C.L.), Boston, Massachusetts
| | - W-C Lo
- Siemens Medical Solutions (B.C., W.-C.L.), Boston, Massachusetts
| | - K Manzoor
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - D N Splitthoff
- Siemens Healthcare GmbH (D.P., D.N.S.), Erlangen, Germany
| | - L L Wald
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
- Harvard-MIT Health Sciences and Technology (L.L.W.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - O Rapalino
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - P Schaefer
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - J Conklin
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - S Cauley
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
| | - S Y Huang
- From the Department of Radiology (M.L., A.T., D.P., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
- Harvard Medical School (M.L., A.T., J.F., K.M., L.L.W., O.R., P.S., J.C., S.C., S.Y.H.), Boston, Massachusetts
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Lang M, Cartmell S, Tabari A, Briggs D, Pianykh O, Kirsch J, Cauley S, Lo WC, Risacher S, Filho AG, Succi MD, Rapalino O, Schaefer P, Conklin J, Huang SY. Evaluation of the Aggregated Time Savings in Adopting Fast Brain MRI Techniques for Outpatient Brain MRI. Acad Radiol 2023; 30:341-348. [PMID: 34635436 PMCID: PMC8989721 DOI: 10.1016/j.acra.2021.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/29/2021] [Accepted: 07/02/2021] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Clinical validation studies have demonstrated the ability of accelerated MRI sequences to decrease acquisition time and motion artifact while preserving image quality. The operational benefits, however, have been less explored. Here, we report our initial clinical experience in implementing fast MRI techniques for outpatient brain imaging during the COVID-19 pandemic. METHODS Aggregate acquisition times were extracted from the medical record on consecutive imaging examinations performed during matched pre-implementation (7/1/2019-12/31/2019) and post-implementation periods (7/1/2020-12/31/2020). Expected acquisition time reduction for each MRI protocol was calculated through manual collection of acquisition times for the conventional and accelerated sequences performed during the pre- and post-implementation periods. Aggregate and expected acquisition times were compared for the five most frequently performed brain MRI protocols: brain without contrast (BR-), brain with and without contrast (BR+), multiple sclerosis (MS), memory loss (MML), and epilepsy (EPL). RESULTS The expected time reductions for BR-, BR+, MS, MML, and EPL protocols were 6.6 min, 11.9 min, 14 min, 10.8 min, and 14.1 min, respectively. The overall median aggregate acquisition time was 31 [25, 36] min for the pre-implementation period and 18 [15, 22] min for the post-implementation period, with a difference of 13 min (42%). The median acquisition time was reduced by 4 min (25%) for BR-, 14.0 min (44%) for BR+, 14 min (38%) for MS, 11 min (52%) for MML, and 16 min (35%) for EPL. CONCLUSION The implementation of fast brain MRI sequences significantly reduced the acquisition times for the most commonly performed outpatient brain MRI protocols.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Samuel Cartmell
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Daniel Briggs
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Oleg Pianykh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - John Kirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Stephen Cauley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Wei-Ching Lo
- Siemens Medical Solutions, Boston, Massachusetts
| | - Seretha Risacher
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Augusto Goncalves Filho
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, Massachusetts
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Pamela Schaefer
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Boston, Boston, Massachusetts; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts.
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Yoon BC, Pomerantz SR, Mercaldo ND, Goyal S, L’Italien EM, Lev MH, Buch KA, Buchbinder BR, Chen JW, Conklin J, Gupta R, Hunter GJ, Kamalian SC, Kelly HR, Rapalino O, Rincon SP, Romero JM, He J, Schaefer PW, Do S, González RG. Incorporating algorithmic uncertainty into a clinical machine deep learning algorithm for urgent head CTs. PLoS One 2023; 18:e0281900. [PMID: 36913348 PMCID: PMC10010506 DOI: 10.1371/journal.pone.0281900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 02/03/2023] [Indexed: 03/14/2023] Open
Abstract
Machine learning (ML) algorithms to detect critical findings on head CTs may expedite patient management. Most ML algorithms for diagnostic imaging analysis utilize dichotomous classifications to determine whether a specific abnormality is present. However, imaging findings may be indeterminate, and algorithmic inferences may have substantial uncertainty. We incorporated awareness of uncertainty into an ML algorithm that detects intracranial hemorrhage or other urgent intracranial abnormalities and evaluated prospectively identified, 1000 consecutive noncontrast head CTs assigned to Emergency Department Neuroradiology for interpretation. The algorithm classified the scans into high (IC+) and low (IC-) probabilities for intracranial hemorrhage or other urgent abnormalities. All other cases were designated as No Prediction (NP) by the algorithm. The positive predictive value for IC+ cases (N = 103) was 0.91 (CI: 0.84-0.96), and the negative predictive value for IC- cases (N = 729) was 0.94 (0.91-0.96). Admission, neurosurgical intervention, and 30-day mortality rates for IC+ was 75% (63-84), 35% (24-47), and 10% (4-20), compared to 43% (40-47), 4% (3-6), and 3% (2-5) for IC-. There were 168 NP cases, of which 32% had intracranial hemorrhage or other urgent abnormalities, 31% had artifacts and postoperative changes, and 29% had no abnormalities. An ML algorithm incorporating uncertainty classified most head CTs into clinically relevant groups with high predictive values and may help accelerate the management of patients with intracranial hemorrhage or other urgent intracranial abnormalities.
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Affiliation(s)
- Byung C. Yoon
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Stuart R. Pomerantz
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Data Science Office, Boston, MA, United States of America
| | - Nathaniel D. Mercaldo
- Massachusetts General Hospital Institute for Technology Assessment, Boston, MA, United States of America
| | - Swati Goyal
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Department of Radiology/ Information Systems, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Eric M. L’Italien
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Department of Radiology/ Information Systems, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michael H. Lev
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Karen A. Buch
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Bradley R. Buchbinder
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - John W. Chen
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Massachusetts General Hospital Center for Systems Biology (CSB), Boston, MA, United States of America
| | - John Conklin
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Rajiv Gupta
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Massachusetts General Hospital Consortia for Integration of Medicine and Innovative Technologies (CIMIT), Boston, MA, United States of America
- Massachusetts General Hospital CT Innovation and Advanced X-ray Imaging Science (AXIS) Center, Boston, MA, United States of America
| | - George J. Hunter
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Shahmir C. Kamalian
- Emergency Radiology & Neuroradiology Divisions, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Hillary R. Kelly
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Radiology, Massachusetts Eye and Ear Institute, Harvard Medical School, Boston, MA, United States of America
| | - Otto Rapalino
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sandra P. Rincon
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Javier M. Romero
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Julian He
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Pamela W. Schaefer
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Enterprise Radiology, Boston, MA, United States of America
| | - Synho Do
- Mass General Brigham Data Science Office, Boston, MA, United States of America
| | - Ramon Gilberto González
- Neuroradiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Mass General Brigham Data Science Office, Boston, MA, United States of America
- Massachusetts General Hospital Athinoula A. Martinos Center for Biomedical Imaging, Boston, MA, United States of America
- * E-mail:
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12
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Conklin J, Golpanian M, Engel A, Izmirly P, Belmont HM, Dervieux T, Buyon JP, Alexander RV. Erythrocyte complement receptor 1 (ECR1) and erythrocyte-bound C4d (EC4d) in the prediction of poor pregnancy outcomes in systemic lupus erythematosus (SLE). Lupus Sci Med 2022; 9:9/1/e000754. [PMID: 36755365 PMCID: PMC9445792 DOI: 10.1136/lupus-2022-000754] [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: 06/18/2022] [Accepted: 08/19/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Complement activation has been associated with adverse pregnancy outcomes (APO) in SLE. Pregnant women with SLE were studied to evaluate whether complement dysregulation within the first two pregnancy trimesters predicts APO. METHODS Pregnant women fulfilled classification criteria for SLE. APO included neonatal death, preterm delivery before 36 weeks and small for gestational age newborn. Pre-eclampsia was also evaluated. Erythrocyte complement receptor 1 (ECR1) and erythrocyte-bound C4d (EC4d) were measured by flow cytometry. Complement proteins C3 and C4 were measured by immunoturbidimetry and anti-double-stranded DNA by ELISA in serum. Statistical analysis consisted of t-test, confusion matrix-derived diagnostic analysis, and multivariate logistic regression. RESULTS Fifty-one women had 57 pregnancies and 169 visits during the study. Baseline visits occurred mainly in the first (n=32) and second trimester (n=21). Fourteen (24.6%) pregnancies resulted in 21 APO with preterm delivery being the most common (n=10). ECR1 <5.5 net mean fluorescence intensity in the first trimester predicted APO with a diagnostic OR (DOR) of 18.33 (95% CI: 2.39 to 140.4; t-test p=0.04). Other individual biomarkers did not reach statistical significance. To estimate the likelihood of APO, we developed an algorithm that included the week of pregnancy, ECR1 and EC4d. From this algorithm, a Pregnancy Adversity Index (PAI) was calculated, and a PAI >0 indicated an elevated likelihood of pregnancy complications (DOR: 20.0 (95% CI: 3.64 to 109.97)). CONCLUSIONS Low levels of ECR1 in early or mid-pregnancy are predictive of an APO. Incorporating the weeks of gestation and both ECR1 and EC4d generated a PAI, which further predicted serious pregnancy complications.
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Affiliation(s)
| | - Michael Golpanian
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Alexis Engel
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Peter Izmirly
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - H Michael Belmont
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
| | - Thierry Dervieux
- Research and Development, Prometheus Laboratories, San Diego, California, USA
| | - Jill P Buyon
- Division of Rheumatology, New York University School of Medicine, New York, New York, USA
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Lang M, Rapalino O, Huang S, Lev MH, Conklin J, Wald LL. Emerging Techniques and Future Directions: Fast and Portable Magnetic Resonance Imaging. Magn Reson Imaging Clin N Am 2022; 30:565-582. [PMID: 35995480 DOI: 10.1016/j.mric.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fast MRI and portable MRI are emerging as promising technologies to improve the speed, efficiency, and availability of MR imaging. Fast MRI methods are increasingly being adopted to create screening protocols for the diagnosis and management of acute pathology in the emergency department. Faster imaging can facilitate timely diagnosis, reduce motion artifacts, and improve departmental MR operations. Point-of-care and portable MRI are emerging technologies that require radiologists to reenvision the role of MRI as a tool with greater accessibility, fewer siting constraints, and the ability to provide valuable diagnostic information at the bedside. Recently introduced commercially available pulse sequences and new MRI scanners are bringing these technologies closer to the patient's clinical setting, and we expect their use to only increase over the coming decade. This article provides an overview of these emerging technologies for emergency radiologists.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Susie Huang
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Charleston, MA 02129, USA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
| | - Lawrence L Wald
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA; Athinoula A. Martinos Center for Biomedical Imaging, 149 13th Street, Charleston, MA 02129, USA
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14
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Conklin J, Lev MH. Preface. Magn Reson Imaging Clin N Am 2022; 30:xvii-xix. [PMID: 35995482 DOI: 10.1016/j.mric.2022.05.001] [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: 10/15/2022]
Affiliation(s)
- John Conklin
- Director of ED MRI and ED Radiology QA, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
| | - Michael H Lev
- Director of Emergency Radiology and Emergency Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
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15
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Conklin J, Lev MH. MR in the Emergency Room. Magn Reson Imaging Clin N Am 2022. [DOI: 10.1016/s1064-9689(22)00051-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Misquitta K, Daou M, Conklin J, Liao C, Setsompop K, Poublanc J, Shirzadi Z, MacIntosh BJ, Tomlinson G, Cohn M, Aviv RI, Silver FL, Mandell DM. Detecting Silent Acute Microinfarcts in Cerebral Small Vessel Disease Using Submillimeter Diffusion-Weighted Magnetic Resonance Imaging: Preliminary Results. Stroke 2022; 53:e251-e252. [PMID: 35695007 DOI: 10.1161/strokeaha.122.039723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karen Misquitta
- University Health Network (K.M., M.D., J.P., G.T., M.C., F.S., D.M.M.), University of Toronto, Canada
| | - Marietou Daou
- University Health Network (K.M., M.D., J.P., G.T., M.C., F.S., D.M.M.), University of Toronto, Canada
| | | | - Congyu Liao
- Stanford University, Stanford, CA (C.L., K.S.)
| | | | - Julien Poublanc
- University Health Network (K.M., M.D., J.P., G.T., M.C., F.S., D.M.M.), University of Toronto, Canada
| | - Zahra Shirzadi
- Department of Medical Biophysics (Z.S., B.J.M.), University of Toronto, Canada
| | - Bradley J MacIntosh
- Department of Medical Biophysics (Z.S., B.J.M.), University of Toronto, Canada
| | - George Tomlinson
- University Health Network (K.M., M.D., J.P., G.T., M.C., F.S., D.M.M.), University of Toronto, Canada
| | - Melanie Cohn
- University Health Network (K.M., M.D., J.P., G.T., M.C., F.S., D.M.M.), University of Toronto, Canada
| | | | - Frank L Silver
- University Health Network (K.M., M.D., J.P., G.T., M.C., F.S., D.M.M.), University of Toronto, Canada
| | - Daniel M Mandell
- University Health Network (K.M., M.D., J.P., G.T., M.C., F.S., D.M.M.), University of Toronto, Canada
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Conklin J, Tabari A, Longo MGF, Cobos CJ, Setsompop K, Cauley SF, Kirsch JE, Huang SY, Rapalino O, Gee MS, Caruso PJ. Evaluation of highly accelerated wave controlled aliasing in parallel imaging (Wave-CAIPI) susceptibility-weighted imaging in the non-sedated pediatric setting: a pilot study. Pediatr Radiol 2022; 52:1115-1124. [PMID: 35119490 DOI: 10.1007/s00247-021-05273-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Received: 04/22/2021] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Susceptibility-weighted imaging (SWI) is highly sensitive for intracranial hemorrhagic and mineralized lesions but is associated with long scan times. Wave controlled aliasing in parallel imaging (Wave-CAIPI) enables greater acceleration factors and might facilitate broader application of SWI, especially in motion-prone populations. OBJECTIVE To compare highly accelerated Wave-CAIPI SWI to standard SWI in the non-sedated pediatric outpatient setting, with respect to the following variables: estimated scan time, image noise, artifacts, visualization of normal anatomy and visualization of pathology. MATERIALS AND METHODS Twenty-eight children (11 girls, 17 boys; mean age ± standard deviation [SD] = 128.3±62 months) underwent 3-tesla (T) brain MRI, including standard three-dimensional (3-D) SWI sequence followed by a highly accelerated Wave-CAIPI SWI sequence for each subject. We rated all studies using a predefined 5-point scale and used the Wilcoxon signed rank test to assess the difference for each variable between sequences. RESULTS Wave-CAIPI SWI provided a 78% and 67% reduction in estimated scan time using the 32- and 20-channel coils, respectively, corresponding to estimated scan time reductions of 3.5 min and 3 min, respectively. All 28 children were imaged without anesthesia. Inter-reader agreement ranged from fair to substantial (k=0.67 for evaluation of pathology, 0.55 for anatomical contrast, 0.3 for central noise, and 0.71 for artifacts). Image noise was rated higher in the central brain with wave SWI (P<0.01), but not in the peripheral brain. There was no significant difference in the visualization of normal anatomical structures and visualization of pathology between the standard and wave SWI sequences (P=0.77 and P=0.79, respectively). CONCLUSION Highly accelerated Wave-CAIPI SWI of the brain can provide similar image quality to standard SWI, with estimated scan time reduction of 3-3.5 min depending on the radiofrequency coil used, with fewer motion artifacts, at a cost of mild but perceptibly increased noise in the central brain.
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Affiliation(s)
- John Conklin
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Azadeh Tabari
- Harvard Medical School, Boston, MA, USA. .,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
| | - Maria Gabriela Figueiro Longo
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Camilo Jaimes Cobos
- Harvard Medical School, Boston, MA, USA.,Department of Radiology, Boston Children's Hospital, Boston, MA, USA
| | - Kawin Setsompop
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Stephen F Cauley
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - John E Kirsch
- Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
| | - Susie Yi Huang
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Otto Rapalino
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael S Gee
- Harvard Medical School, Boston, MA, USA.,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
| | - Paul J Caruso
- Divisions of Emergency Imaging and Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Division of Pediatric Imaging, Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA
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18
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Demir S, Clifford B, Lo WC, Tabari A, Goncalves Filho ALM, Lang M, Cauley SF, Setsompop K, Bilgic B, Lev MH, Schaefer PW, Rapalino O, Huang SY, Hilbert T, Feiweier T, Conklin J. Optimization of magnetization transfer contrast for EPI FLAIR brain imaging. Magn Reson Med 2022; 87:2380-2387. [PMID: 34985151 PMCID: PMC8847235 DOI: 10.1002/mrm.29141] [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: 08/27/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the impact of magnetization transfer (MT) on brain tissue contrast in turbo-spin-echo (TSE) and EPI fluid-attenuated inversion recovery (FLAIR) images, and to optimize an MT-prepared EPI FLAIR pulse sequence to match the tissue contrast of a clinical reference TSE FLAIR protocol. METHODS Five healthy volunteers underwent 3T brain MRI, including single slice TSE FLAIR, multi-slice TSE FLAIR, EPI FLAIR without MT-preparation, and MT-prepared EPI FLAIR with variations of the MT-preparation parameters, including number of preparation pulses, pulse amplitude, and resonance offset. Automated co-registration and gray matter (GM) versus white matter (WM) segmentation was performed using a T1-MPRAGE acquisition, and the GM versus WM signal intensity ratio (contrast ratio) was calculated for each FLAIR acquisition. RESULTS Without MT preparation, EPI FLAIR showed poor tissue contrast (contrast ratio = 0.98), as did single slice TSE FLAIR. Multi-slice TSE FLAIR provided high tissue contrast (contrast ratio = 1.14). MT-prepared EPI FLAIR closely approximated the contrast of the multi-slice TSE FLAIR images for two combinations of the MT-preparation parameters (contrast ratio = 1.14). Optimized MT-prepared EPI FLAIR provided a 50% reduction in scan time compared to the reference TSE FLAIR acquisition. CONCLUSION Optimized MT-prepared EPI FLAIR provides comparable brain tissue contrast to the multi-slice TSE FLAIR images used in clinical practice.
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Affiliation(s)
- Serdest Demir
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bryan Clifford
- Siemens Medical Solutions USA, Boston, Massachusetts, USA
| | - Wei-Ching Lo
- Siemens Medical Solutions USA, Boston, Massachusetts, USA
| | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Min Lang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Stephen F Cauley
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
| | - Kawin Setsompop
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Berkin Bilgic
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
| | | | | | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Boston, Massachusetts, USA
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19
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Polak D, Splitthoff DN, Clifford B, Lo WC, Huang SY, Conklin J, Wald LL, Setsompop K, Cauley S. Scout accelerated motion estimation and reduction (SAMER). Magn Reson Med 2022; 87:163-178. [PMID: 34390505 PMCID: PMC8616778 DOI: 10.1002/mrm.28971] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/29/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To demonstrate a navigator/tracking-free retrospective motion estimation technique that facilitates clinically acceptable reconstruction time. METHODS Scout accelerated motion estimation and reduction (SAMER) uses a single 3-5 s, low-resolution scout scan and a novel sequence reordering to independently determine motion states by minimizing the data-consistency error in a SENSE plus motion forward model. This eliminates time-consuming alternating optimization as no updates to the imaging volume are required during the motion estimation. The SAMER approach was assessed quantitatively through extensive simulation and was evaluated in vivo across multiple motion scenarios and clinical imaging contrasts. Finally, SAMER was synergistically combined with advanced encoding (Wave-CAIPI) to facilitate rapid motion-free imaging. RESULTS The highly accelerated scout provided sufficient information to achieve accurate motion trajectory estimation (accuracy ~0.2 mm or degrees). The novel sequence reordering improved the stability of the motion parameter estimation and image reconstruction while preserving the clinical imaging contrast. Clinically acceptable computation times for the motion estimation (~4 s/shot) are demonstrated through a fully separable (non-alternating) motion search across the shots. Substantial artifact reduction was demonstrated in vivo as well as corresponding improvement in the quantitative error metric. Finally, the extension of SAMER to Wave-encoding enabled rapid high-quality imaging at up to R = 9-fold acceleration. CONCLUSION SAMER significantly improved the computational scalability for retrospective motion estimation and correction.
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Affiliation(s)
- Daniel Polak
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA.,Siemens Healthcare GmbH, Erlangen, Germany
| | | | | | | | - Susie Y. Huang
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - John Conklin
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Lawrence L. Wald
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Harvard-MIT Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Kawin Setsompop
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| | - Stephen Cauley
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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20
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Clifford B, Conklin J, Huang SY, Feiweier T, Hosseini Z, Goncalves Filho ALM, Tabari A, Demir S, Lo WC, Longo MGF, Lev M, Schaefer P, Rapalino O, Setsompop K, Bilgic B, Cauley S. An artificial intelligence-accelerated 2-minute multi-shot echo planar imaging protocol for comprehensive high-quality clinical brain imaging. Magn Reson Med 2021; 87:2453-2463. [PMID: 34971463 DOI: 10.1002/mrm.29117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 08/06/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE We introduce and validate an artificial intelligence (AI)-accelerated multi-shot echo-planar imaging (msEPI)-based method that provides T1w, T2w, T 2 ∗ , T2-FLAIR, and DWI images with high SNR, high tissue contrast, low specific absorption rates (SAR), and minimal distortion in 2 minutes. METHODS The rapid imaging technique combines a novel machine learning (ML) scheme to limit g-factor noise amplification and improve SNR, a magnetization transfer preparation module to provide clinically desirable contrast, and high per-shot EPI undersampling factors to reduce distortion. The ML training and image reconstruction incorporates a tunable parameter for controlling the level of denoising/smoothness. The performance of the reconstruction method is evaluated across various acceleration factors, contrasts, and SNR conditions. The 2-minute protocol is directly compared to a 10-minute clinical reference protocol through deployment in a clinical setting, where five representative cases with pathology are examined. RESULTS Optimization of custom msEPI sequences and protocols was performed to balance acquisition efficiency and image quality compared to the five-fold longer clinical reference. Training data from 16 healthy subjects across multiple contrasts and orientations were used to produce ML networks at various acceleration levels. The flexibility of the ML reconstruction was demonstrated across SNR levels, and an optimized regularization was determined through radiological review. Network generalization toward novel pathology, unobserved during training, was illustrated in five clinical case studies with clinical reference images provided for comparison. CONCLUSION The rapid 2-minute msEPI-based protocol with tunable ML reconstruction allows for advantageous trade-offs between acquisition speed, SNR, and tissue contrast when compared to the five-fold slower standard clinical reference exam.
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Affiliation(s)
- Bryan Clifford
- Siemens Medical Solutions USA, Boston, Massachusetts, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | | | - Azadeh Tabari
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Serdest Demir
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Wei-Ching Lo
- Siemens Medical Solutions USA, Boston, Massachusetts, USA
| | | | - Michael Lev
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Pam Schaefer
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kawin Setsompop
- Department of Radiology and Department of Electrical Engineering, Stanford University, Stanford, California, USA
| | - Berkin Bilgic
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen Cauley
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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21
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Li Z, Tian Q, Ngamsombat C, Cartmell S, Conklin J, Filho ALMG, Lo WC, Wang G, Ying K, Setsompop K, Fan Q, Bilgic B, Cauley S, Huang SY. High-fidelity fast volumetric brain MRI using synergistic wave-controlled aliasing in parallel imaging and a hybrid denoising generative adversarial network (HDnGAN). Med Phys 2021; 49:1000-1014. [PMID: 34961944 DOI: 10.1002/mp.15427] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/16/2021] [Revised: 11/22/2021] [Accepted: 12/12/2021] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The goal of this study is to leverage an advanced fast imaging technique, wave-controlled aliasing in parallel imaging (Wave-CAIPI), and a generative adversarial network (GAN) for denoising to achieve accelerated high-quality high-signal-to-noise-ratio (SNR) volumetric MRI. METHODS Three-dimensional (3D) T2 -weighted fluid-attenuated inversion recovery (FLAIR) image data were acquired on 33 multiple sclerosis (MS) patients using a prototype Wave-CAIPI sequence (acceleration factor R = 3×2, 2.75 minutes) and a standard T2 -SPACE FLAIR sequence (R = 2, 7.25 minutes). A hybrid denoising GAN entitled "HDnGAN" consisting of a 3D generator and a 2D discriminator was proposed to denoise highly accelerated Wave-CAIPI images. HDnGAN benefits from the improved image synthesis performance provided by the 3D generator and increased training samples from a limited number of patients for training the 2D discriminator. HDnGAN was trained and validated on data from 25 MS patients with the standard FLAIR images as the target and evaluated on data from 8 MS patients not seen during training. HDnGAN was compared to other denoising methods including AONLM, BM4D, MU-Net, and 3D GAN in qualitative and quantitative analysis of output images using the mean squared error (MSE) and VGG perceptual loss compared to standard FLAIR images, and a reader assessment by two neuroradiologists regarding sharpness, SNR, lesion conspicuity, and overall quality. Finally, the performance of these denoising methods was compared at higher noise levels using simulated data with added Rician noise. RESULTS HDnGAN effectively denoised low-SNR Wave-CAIPI images with sharpness and rich textural details, which could be adjusted by controlling the contribution of the adversarial loss to the total loss when training the generator. Quantitatively, HDnGAN (λ = 10-3 ) achieved low MSE and the lowest VGG perceptual loss. The reader study showed that HDnGAN (λ = 10-3 ) significantly improved the SNR of Wave-CAIPI images (P<0.001), outperformed AONLM (P = 0.015), BM4D (P<0.001), MU-Net (P<0.001) and 3D GAN (λ = 10-3 ) (P<0.001) regarding image sharpness, and outperformed MU-Net (P<0.001) and 3D GAN (λ = 10-3 ) (P = 0.001) regarding lesion conspicuity. The overall quality score of HDnGAN (λ = 10-3 ) (4.25±0.43) was significantly higher than those from Wave-CAIPI (3.69±0.46, P = 0.003), BM4D (3.50±0.71, P = 0.001), MU-Net (3.25±0.75, P<0.001), and 3D GAN (λ = 10-3 ) (3.50±0.50, P<0.001), with no significant difference compared to standard FLAIR images (4.38±0.48, P = 0.333). The advantages of HDnGAN over other methods were more obvious at higher noise levels. CONCLUSION HDnGAN provides robust and feasible denoising while preserving rich textural detail in empirical volumetric MRI data. Our study using empirical patient data and systematic evaluation supports the use of HDnGAN in combination with modern fast imaging techniques such as Wave-CAIPI to achieve high-fidelity fast volumetric MRI and represents an important step to the clinical translation of GANs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ziyu Li
- Department of Biomedical Engineering, Tsinghua University, Beijing, P.R. China
| | - Qiyuan Tian
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Chanon Ngamsombat
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Mahidol, Thailand
| | - Samuel Cartmell
- Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - John Conklin
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - Augusto Lio M Gonçalves Filho
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Department of Radiology, Massachusetts General Hospital, Boston, USA
| | | | - Guangzhi Wang
- Department of Biomedical Engineering, Tsinghua University, Beijing, P.R. China
| | - Kui Ying
- Department of Engineering Physics, Tsinghua University, Beijing, P. R. China
| | - Kawin Setsompop
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Qiuyun Fan
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Berkin Bilgic
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Stephen Cauley
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA.,Harvard Medical School, Boston, MA, USA.,Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
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22
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Iglesias JE, Billot B, Balbastre Y, Tabari A, Conklin J, Gilberto González R, Alexander DC, Golland P, Edlow BL, Fischl B. Joint super-resolution and synthesis of 1 mm isotropic MP-RAGE volumes from clinical MRI exams with scans of different orientation, resolution and contrast. Neuroimage 2021; 237:118206. [PMID: 34048902 PMCID: PMC8354427 DOI: 10.1016/j.neuroimage.2021.118206] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 12/14/2022] Open
Abstract
Most existing algorithms for automatic 3D morphometry of human brain MRI scans are designed for data with near-isotropic voxels at approximately 1 mm resolution, and frequently have contrast constraints as well-typically requiring T1-weighted images (e.g., MP-RAGE scans). This limitation prevents the analysis of millions of MRI scans acquired with large inter-slice spacing in clinical settings every year. In turn, the inability to quantitatively analyze these scans hinders the adoption of quantitative neuro imaging in healthcare, and also precludes research studies that could attain huge sample sizes and hence greatly improve our understanding of the human brain. Recent advances in convolutional neural networks (CNNs) are producing outstanding results in super-resolution and contrast synthesis of MRI. However, these approaches are very sensitive to the specific combination of contrast, resolution and orientation of the input images, and thus do not generalize to diverse clinical acquisition protocols - even within sites. In this article, we present SynthSR, a method to train a CNN that receives one or more scans with spaced slices, acquired with different contrast, resolution and orientation, and produces an isotropic scan of canonical contrast (typically a 1 mm MP-RAGE). The presented method does not require any preprocessing, beyond rigid coregistration of the input scans. Crucially, SynthSR trains on synthetic input images generated from 3D segmentations, and can thus be used to train CNNs for any combination of contrasts, resolutions and orientations without high-resolution real images of the input contrasts. We test the images generated with SynthSR in an array of common downstream analyses, and show that they can be reliably used for subcortical segmentation and volumetry, image registration (e.g., for tensor-based morphometry), and, if some image quality requirements are met, even cortical thickness morphometry. The source code is publicly available at https://github.com/BBillot/SynthSR.
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Affiliation(s)
- Juan Eugenio Iglesias
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, USA.
| | - Benjamin Billot
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Yaël Balbastre
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Azadeh Tabari
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - John Conklin
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Department of Radiology, Massachusetts General Hospital, Boston, USA
| | - R Gilberto González
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Neuroradiology Division, Massachusetts General Hospital, Boston, USA
| | - Daniel C Alexander
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Polina Golland
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Boston, USA
| | - Brian L Edlow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, USA
| | - Bruce Fischl
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, USA
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23
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Edlow BL, Conklin J, Huang SY. Reader Response: Critical Illness-Associated Cerebral Microbleeds in COVID-19 Acute Respiratory Distress Syndrome. Neurology 2021; 97:254. [PMID: 34341081 DOI: 10.1212/wnl.0000000000012364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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24
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Alexander RV, Rey DS, Conklin J, Domingues V, Ahmed M, Qureshi J, Weinstein A. A multianalyte assay panel with cell-bound complement activation products demonstrates clinical utility in systemic lupus erythematosus. Lupus Sci Med 2021; 8:8/1/e000528. [PMID: 34253650 PMCID: PMC8276296 DOI: 10.1136/lupus-2021-000528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023]
Abstract
Objective To evaluate the clinical utility of the multianalyte assay panel (MAP), commercially known as AVISE Lupus test (Exagen Inc.), in patients suspected of SLE. Methods A systematic review of medical records of ANA-positive patients with a positive (>0.1) or negative (<−0.1) MAP score was conducted when the MAP was ordered (T0), when the test results were reviewed (T1) and at a later time (T2, ≥8 months after T1). Confidence in the diagnosis of SLE and initiation of hydroxychloroquine (HCQ) were assessed. Results A total of 161 patient records from 12 centres were reviewed at T0 and T1. T2 occurred for 90 patients. At T0, low, moderate and high confidence in SLE diagnosis was reported for 58%, 30% and 12% patients, respectively. Confidence in SLE diagnosis increased for the MAP positive, while MAP negative made SLE less likely. Odds of higher confidence in SLE diagnosis increased by 1.74-fold for every unit of increase of the MAP score (p<0.001). Using the MAP-negative/anti-double-stranded DNA-negative patients as reference, the HR of assigning an International Classification of Diseases, Tenth Revision lupus code was 7.02-fold, 11.2-fold and 14.8-fold higher in the low tier-2, high tier-2 and tier-1 positive, respectively (p<0.001). The HR of initiating HCQ therapy after T0 was 2.90-fold, 4.22-fold and 3.98-fold higher, respectively (p<0.001). Conclusion The MAP helps increase the confidence in ruling-in and ruling-out SLE in patients suspected of the disease and informs on appropriate treatment decisions.
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Affiliation(s)
| | | | | | - Vinicius Domingues
- Florida State University Regional Medical School, Daytona Beach, Florida, USA
| | - Mansoor Ahmed
- Arthritis & Osteoporosis Center of Kentucky, Richmond, Kentucky, USA
| | | | - Arthur Weinstein
- Exagen Inc, Vista, California, USA
- Loma Linda University Health Rheumatology Division, Loma Linda, California, USA
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Ngamsombat C, Gonçalves Filho ALM, Longo MGF, Cauley SF, Setsompop K, Kirsch JE, Tian Q, Fan Q, Polak D, Liu W, Lo WC, Gilberto González R, Schaefer PW, Rapalino O, Conklin J, Huang SY. Evaluation of Ultrafast Wave-Controlled Aliasing in Parallel Imaging 3D-FLAIR in the Visualization and Volumetric Estimation of Cerebral White Matter Lesions. AJNR Am J Neuroradiol 2021; 42:1584-1590. [PMID: 34244127 DOI: 10.3174/ajnr.a7191] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/29/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate an ultrafast 3D-FLAIR sequence using Wave-controlled aliasing in parallel imaging encoding (Wave-FLAIR) compared with standard 3D-FLAIR in the visualization and volumetric estimation of cerebral white matter lesions in a clinical setting. MATERIALS AND METHODS Forty-two consecutive patients underwent 3T brain MR imaging, including standard 3D-FLAIR (acceleration factor = 2, scan time = 7 minutes 50 seconds) and resolution-matched ultrafast Wave-FLAIR sequences (acceleration factor = 6, scan time = 2 minutes 45 seconds for the 20-channel coil; acceleration factor = 9, scan time = 1 minute 50 seconds for the 32-channel coil) as part of clinical evaluation for demyelinating disease. Automated segmentation of cerebral white matter lesions was performed using the Lesion Segmentation Tool in SPM. Student t tests, intraclass correlation coefficients, relative lesion volume difference, and Dice similarity coefficients were used to compare volumetric measurements among sequences. Two blinded neuroradiologists evaluated the visualization of white matter lesions, artifacts, and overall diagnostic quality using a predefined 5-point scale. RESULTS Standard and Wave-FLAIR sequences showed excellent agreement of lesion volumes with an intraclass correlation coefficient of 0.99 and mean Dice similarity coefficient of 0.97 (SD, 0.05) (range, 0.84-0.99). Wave-FLAIR was noninferior to standard FLAIR for visualization of lesions and motion. The diagnostic quality for Wave-FLAIR was slightly greater than for standard FLAIR for infratentorial lesions (P < .001), and there were fewer pulsation artifacts on Wave-FLAIR compared with standard FLAIR (P < .001). CONCLUSIONS Ultrafast Wave-FLAIR provides superior visualization of infratentorial lesions while preserving overall diagnostic quality and yields white matter lesion volumes comparable with those estimated using standard FLAIR. The availability of ultrafast Wave-FLAIR may facilitate the greater use of 3D-FLAIR sequences in the evaluation of patients with suspected demyelinating disease.
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Affiliation(s)
- C Ngamsombat
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Department of Radiology (C.N.), Faculty of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - A L M Gonçalves Filho
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - M G F Longo
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - S F Cauley
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - K Setsompop
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - J E Kirsch
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - Q Tian
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - Q Fan
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - D Polak
- Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Department of Physics and Astronomy (D.P.), Heidelberg University, Heidelberg, Germany.,Siemens Healthcare GmbH, (D.P., W.-C.L.), Erlangen, Germany
| | - W Liu
- Siemens Shenzhen Magnetic Resonance Ltd (W.L.), Shenzhen, China
| | - W-C Lo
- Siemens Healthcare GmbH, (D.P., W.-C.L.), Erlangen, Germany
| | - R Gilberto González
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - P W Schaefer
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - O Rapalino
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - J Conklin
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.).,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts
| | - S Y Huang
- From the Department of (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.) .,Athinoula A. Martinos Center for Biomedical Imaging (C.N., A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F, D.P., J.C., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (A.L.M.G.F., M.G.F.L., S.F.C., K.S., J.E.K., Q.T., Q.F., R.G.G., P.W.S., O.R., J.C., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
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Witowski J, Choi J, Jeon S, Kim D, Chung J, Conklin J, Longo MGF, Succi MD, Do S. MarkIt: A Collaborative Artificial Intelligence Annotation Platform Leveraging Blockchain For Medical Imaging Research. Blockchain Healthc Today 2021; 4:176. [PMID: 36777485 PMCID: PMC9907418 DOI: 10.30953/bhty.v4.176] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 06/18/2023]
Abstract
Current research on medical image processing relies heavily on the amount and quality of input data. Specifically, supervised machine learning methods require well-annotated datasets. A lack of annotation tools limits the potential to achieve high-volume processing and scaled systems with a proper reward mechanism. We developed MarkIt, a web-based tool, for collaborative annotation of medical imaging data with artificial intelligence and blockchain technologies. Our platform handles both Digital Imaging and Communications in Medicine (DICOM) and non-DICOM images, and allows users to annotate them for classification and object detection tasks in an efficient manner. MarkIt can accelerate the annotation process and keep track of user activities to calculate a fair reward. A proof-of-concept experiment was conducted with three fellowship-trained radiologists, each of whom annotated 1,000 chest X-ray studies for multi-label classification. We calculated the inter-rater agreement and estimated the value of the dataset to distribute the reward for annotators using a crypto currency. We hypothesize that MarkIt allows the typically arduous annotation task to become more efficient. In addition, MarkIt can serve as a platform to evaluate the value of data and trade the annotation results in a more scalable manner in the future. The platform is publicly available for testing on https://markit.mgh.harvard.edu.
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Affiliation(s)
- Jan Witowski
- Laboratory of Medical Imaging and Computation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jongmun Choi
- Laboratory of Medical Imaging and Computation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Soomin Jeon
- Laboratory of Medical Imaging and Computation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Doyun Kim
- Laboratory of Medical Imaging and Computation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Joowon Chung
- Laboratory of Medical Imaging and Computation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - John Conklin
- Division of Emergency Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Maria Gabriela Figueiro Longo
- Division of Emergency Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marc D. Succi
- Medically Engineered Solutions in Healthcare (MESH) Incubator, Massachusetts General Hospital, Boston, MA, USA
| | - Synho Do
- Laboratory of Medical Imaging and Computation, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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27
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Goncalves Filho ALM, Longo MGF, Conklin J, Cauley SF, Polak D, Liu W, Splitthoff DN, Lo WC, Kirsch JE, Setsompop K, Schaefer PW, Huang SY, Rapalino O. MRI Highly Accelerated Wave-CAIPI T1-SPACE versus Standard T1-SPACE to detect brain gadolinium-enhancing lesions at 3T. J Neuroimaging 2021; 31:893-901. [PMID: 34081374 DOI: 10.1111/jon.12893] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2021] [Accepted: 05/21/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE High-resolution three-dimensional (3D) post-contrast imaging of the brain is essential for comprehensive evaluation of inflammatory, neoplastic, and neurovascular diseases of the brain. 3D T1-weighted spin-echo-based sequences offer increased sensitivity for the detection of enhancing lesions but are relatively prolonged examinations. We evaluated whether a highly accelerated Wave-controlled aliasing in parallel imaging (Wave-CAIPI) post-contrast 3D T1-sampling perfection with application-optimized contrasts using different flip angle evolutions (T1-SPACE) sequence (Wave-T1-SPACE) was noninferior to the standard high-resolution 3D T1-SPACE sequence for visualizing enhancing lesions with comparable diagnostic quality. METHODS One hundred and three consecutive patients were prospectively evaluated with a standard post-contrast 3D T1-SPACE sequence (acquisition time [TA] = 4 min 19 s) and an optimized Wave-CAIPI 3D T1-SPACE sequence (TA = 1 min 40 s) that was nearly three times faster than the standard sequence. Two blinded neuroradiologists performed a head-to-head comparison to evaluate the visualization of enhancing pathology, perception of artifacts, and overall diagnostic quality. A 15% margin was used to test whether post-contrast Wave-T1-SPACE was noninferior to standard T1-SPACE. RESULTS Wave-T1-SPACE was noninferior to standard T1-SPACE for delineating parenchymal and meningeal enhancing pathology (p < 0.01). Wave-T1-SPACE showed marginally higher background noise compared to the standard sequence and was noninferior in the overall diagnostic quality (p = 0.03). CONCLUSIONS Our findings show that Wave-T1-SPACE was noninferior to standard T1-SPACE for visualization of enhancing pathology and overall diagnostic quality with a three-fold reduction in acquisition time compared to the standard sequence. Wave-T1-SPACE may be used to accelerate 3D post-contrast T1-weighted spin-echo imaging without loss of clinically important information.
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Affiliation(s)
- Augusto Lio M Goncalves Filho
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - M Gabriela Figueiro Longo
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephen F Cauley
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | | | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | | | - Wei-Ching Lo
- Siemens Medical Solutions, Boston, Massachusetts, USA
| | - John E Kirsch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kawin Setsompop
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, Massachusetts, USA
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Gartshteyn Y, Mor A, Shimbo D, Khalili L, Kapoor T, Geraldino-Pardilla L, Alexander RV, Conklin J, Dervieux T, Askanase AD. Platelet bound complement split product (PC4d) is a marker of platelet activation and arterial vascular events in Systemic Lupus Erythematosus. Clin Immunol 2021; 228:108755. [PMID: 33984497 DOI: 10.1016/j.clim.2021.108755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 05/05/2021] [Accepted: 05/08/2021] [Indexed: 11/25/2022]
Abstract
Platelet-bound complement activation products (PC4d) are associated with thrombosis in Systemic Lupus Erythematosus (SLE). This study investigated the effect of PC4d on platelet function, as a mechanistic link to arterial thrombosis. In a cohort of 150 SLE patients, 13 events had occurred within five years of enrollment. Patients with arterial events had higher PC4d levels (13.6 [4.4-24.0] vs. 4.0 [2.5-8.3] net MFI), with PC4d 10 being the optimal cutoff for event detection. The association of arterial events with PC4d remained significant after adjusting for antiphospholipid status, smoking, and prednisone use (p = 0.045). PC4d levels correlated with lower platelet counts (r = -0.26, p = 0.002), larger platelet volumes (r = 0.22, p = 0.009) and increased platelet aggregation: the adenosine diphosphate (ADP) concentration to achieve 50% maximal aggregation (EC50) was lower in patients with PC4d 10 compared with PC4d < 10 (1.6 vs. 3.7, p = 0.038, respectively). These results suggest that PC4d may be a mechanistic marker for vascular disease in SLE.
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Affiliation(s)
- Yevgeniya Gartshteyn
- Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America.
| | - Adam Mor
- Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
| | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
| | - Leila Khalili
- Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
| | - Teja Kapoor
- Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
| | - Laura Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
| | | | - John Conklin
- Exagen Diagnostics Inc, Vista, CA, United States of America
| | | | - Anca D Askanase
- Division of Rheumatology, Department of Medicine, Columbia University Medical Center, New York, NY, United States of America
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29
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Arriens C, Alexander RV, Narain S, Saxena A, Collins CE, Wallace DJ, Massarotti E, Conklin J, Kalunian KC, Putterman C, Ramsey-Goldman R, Buyon JP, Askanase A, Furie RA, James JA, Bello GA, Manzi S, Ahearn J, O'Malley T, Weinstein A, Dervieux T. Cell-bound complement activation products associate with lupus severity in SLE. Lupus Sci Med 2021; 7:7/1/e000377. [PMID: 32371480 PMCID: PMC7228655 DOI: 10.1136/lupus-2019-000377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/21/2019] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 11/11/2022]
Abstract
Objectives To evaluate the association between lupus severity and cell-bound complement activation products (CB-CAPs) or low complement proteins C3 and C4. Methods All subjects (n=495) fulfilled the American College of Rheumatology (ACR) classification criteria for SLE. Abnormal CB-CAPs (erythrocyte-bound C4d or B-lymphocyte-bound C4d levels >99th percentile of healthy) and complement proteins C3 and C4 were determined using flow cytometry and turbidimetry, respectively. Lupus severity was estimated using the Lupus Severity Index (LSI). Statistical analysis consisted of multivariable linear regression and groups comparisons. Results Abnormal CB-CAPs were more prevalent than low complement values irrespective of LSI levels (62% vs 38%, respectively, p<0.0001). LSI was low (median 5.44, IQR: 4.77–6.93) in patients with no complement abnormality, intermediate in patients with abnormal CB-CAPs (median 6.09, IQR: 5.31–8.20) and high in the group presenting with both abnormal CB-CAPs and low C3 and/or C4 (median 7.85, IQR: 5.51–8.37). Odds of immunosuppressant use was higher in subjects with LSI ≥5.95 compared with subjects with LSI <5.95 (1.60 vs 0.53, p<0.0001 for both). Multivariable regression analysis revealed that higher LSI scores associated with abnormal CB-CAPs—but not low C3/C4—after adjusting for younger age, race and longer disease duration (p=0.0001), which were also independent predictors of disease severity (global R2=0.145). Conclusion Abnormalities in complement activation as measured by CB-CAPs are associated with increased LSI.
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Affiliation(s)
- Cristina Arriens
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | - Sonali Narain
- Rheumatology, Northwell Health, Great Neck, New York, USA
| | - Amit Saxena
- Center for Musculoskeletal Care, New York University, New York, New York, USA
| | | | | | | | | | - Kenneth C Kalunian
- Rheumatology, University iof California San Diego, La Jolla, California, USA
| | - Chaim Putterman
- Division of Rheumatology, Albert Einstein College of Medicine, Bronx, New York, USA.,Azrieli Faculty of Medicine, Bar Ilan University, Zefat, Israel.,Research Institute, Galilee Medical Center, Nahariya, Israel
| | | | - Jill P Buyon
- New York University School of Medicine, New York, New York, USA
| | - Anca Askanase
- Rheumatology, Columbia University Medical Center, New York, New York, USA
| | | | - Judith A James
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Ghalib A Bello
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Susan Manzi
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Joseph Ahearn
- Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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30
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Ramsey-Goldman R, Alexander RV, Conklin J, Arriens C, Narain S, Massarotti EM, Wallace DJ, Collins CE, Saxena A, Putterman C, Brady K, Kalunian KC, Weinstein A. A Multianalyte Assay Panel With Cell-Bound Complement Activation Products Predicts Transition of Probable Lupus to American College of Rheumatology-Classified Lupus. ACR Open Rheumatol 2021; 3:116-123. [PMID: 33538130 PMCID: PMC7882535 DOI: 10.1002/acr2.11219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 12/01/2022] Open
Abstract
Objective To evaluate the usefulness of biomarkers to predict the evolution of patients suspected of systemic lupus erythematosus (SLE), designated as probable SLE (pSLE), into classifiable SLE according to the American College of Rheumatology (ACR) classification criteria. Methods Patients suspected of SLE were enrolled by lupus experts if they fulfilled three ACR criteria for SLE and were followed for approximately 1‐3 years to evaluate transition into ACR‐classifiable SLE. Individual cell‐bound complement activation products (CB‐CAPs), serum complement proteins (C3 and C4), and autoantibodies were measured by flow cytometry, turbidimetry, and enzyme‐linked immunosorbent assay, respectively. Blood levels of hydroxychloroquine (HCQ) were measured by mass spectrometry. A multianalyte assay panel (MAP), which includes CB‐CAPs, was also evaluated. A MAP of greater than 0.8 reflected the optimal cutoff for transition to SLE. Time to fulfillment of ACR criteria was evaluated by Kaplan‐Meier analysis and Cox proportional hazards model. Results Of the 92 patients with pSLE enrolled, 74 had one or two follow‐up visits 9‐35 months after enrollment for a total of 128 follow‐up visits. Overall, 28 patients with pSLE (30.4%) transitioned to ACR‐classifiable SLE, including 16 (57%) in the first year and 12 (43%) afterwards. A MAP score of greater than 0.8 at enrollment predicted transition to classifiable SLE during the follow‐up period (hazard ratio = 2.72; P = 0.012), whereas individual biomarkers or fulfillment of Systemic Lupus International Collaborating Clinics criteria did not. HCQ therapy was not associated with the prevention of transition to SLE. Conclusion Approximately one‐third of patients with pSLE transitioned within the study period. MAP of greater than 0.8 predicted disease evolution into classifiable SLE.
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Affiliation(s)
| | | | | | | | - Sonali Narain
- Hofstra Northwell School of Medicine, Great Neck, New York
| | | | | | | | - Amit Saxena
- New York University School of Medicine, New York
| | - Chaim Putterman
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, Azrieli School of Medicine, Safed, Israel, and Galillee Medical Center, Nahariya, Israel
| | | | | | - Arthur Weinstein
- Exagen, Inc, Vista, California, and Loma Linda University, Loma Linda, California
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Lang M, Li MD, Jiang KZ, Yoon BC, Mendoza DP, Flores EJ, Rincon SP, Mehan WA, Conklin J, Huang SY, Lang AL, Giao DM, Leslie-Mazwi TM, Kalpathy-Cramer J, Little BP, Buch K. Severity of Chest Imaging is Correlated with Risk of Acute Neuroimaging Findings among Patients with COVID-19. AJNR Am J Neuroradiol 2021; 42:831-837. [PMID: 33541897 DOI: 10.3174/ajnr.a7032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/11/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Severe respiratory distress in patients with COVID-19 has been associated with higher rate of neurologic manifestations. Our aim was to investigate whether the severity of chest imaging findings among patients with coronavirus disease 2019 (COVID-19) correlates with the risk of acute neuroimaging findings. MATERIALS AND METHODS This retrospective study included all patients with COVID-19 who received care at our hospital between March 3, 2020, and May 6, 2020, and underwent chest imaging within 10 days of neuroimaging. Chest radiographs were assessed using a previously validated automated neural network algorithm for COVID-19 (Pulmonary X-ray Severity score). Chest CTs were graded using a Chest CT Severity scoring system based on involvement of each lobe. Associations between chest imaging severity scores and acute neuroimaging findings were assessed using multivariable logistic regression. RESULTS Twenty-four of 93 patients (26%) included in the study had positive acute neuroimaging findings, including intracranial hemorrhage (n = 7), infarction (n = 7), leukoencephalopathy (n = 6), or a combination of findings (n = 4). The average length of hospitalization, prevalence of intensive care unit admission, and proportion of patients requiring intubation were significantly greater in patients with acute neuroimaging findings than in patients without them (P < .05 for all). Compared with patients without acute neuroimaging findings, patients with acute neuroimaging findings had significantly higher mean Pulmonary X-ray Severity scores (5.0 [SD, 2.9] versus 9.2 [SD, 3.4], P < .001) and mean Chest CT Severity scores (9.0 [SD, 5.1] versus 12.1 [SD, 5.0], P = .041). The pulmonary x-ray severity score was a significant predictor of acute neuroimaging findings in patients with COVID-19. CONCLUSIONS Patients with COVID-19 and acute neuroimaging findings had more severe findings on chest imaging on both radiographs and CT compared with patients with COVID-19 without acute neuroimaging findings. The severity of findings on chest radiography was a strong predictor of acute neuroimaging findings in patients with COVID-19.
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Affiliation(s)
- M Lang
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - M D Li
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Z Jiang
- School of Medicine (K.Z.J.), Baylor College of Medicine, Houston, Texas
| | - B C Yoon
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D P Mendoza
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - E J Flores
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S P Rincon
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - W A Mehan
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - J Conklin
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - S Y Huang
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - A L Lang
- Department of Anesthesia, Critical Care, and Pain Medicine (A.L.L.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - D M Giao
- Harvard Medical School (D.M.G.), Boston, Massachusetts
| | | | - J Kalpathy-Cramer
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (J.C., S.Y.H., J.K.-C.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - B P Little
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - K Buch
- Department of Radiology (M.L., M.D.L., B.C.Y., D.P.M., E.J.F., S.P.R., W.A.M., J.C., S.Y.H., J.K.-C., B.P.L., K.B.), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Rapalino O, Pourvaziri A, Maher M, Jaramillo-Cardoso A, Edlow BL, Conklin J, Huang S, Westover B, Romero JM, Halpern E, Gupta R, Pomerantz S, Schaefer P, Gonzalez RG, Mukerji SS, Lev MH. Clinical, Imaging, and Lab Correlates of Severe COVID-19 Leukoencephalopathy. AJNR Am J Neuroradiol 2021; 42:632-638. [PMID: 33414226 DOI: 10.3174/ajnr.a6966] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/28/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology. MATERIALS AND METHODS Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included. Seven (7/27, 26%) developed an unusual pattern of "leukoencephalopathy with reduced diffusivity" on diffusion-weighted MR imaging. The remaining patients did not exhibit this pattern. Clinical and laboratory indices, as well as neuroimaging findings, were compared between groups. RESULTS The reduced-diffusivity group had a significantly higher body mass index (36 versus 28 kg/m2, P < .01). Patients with reduced diffusivity trended toward more frequent acute renal failure (7/7, 100% versus 9/20, 45%; P = .06) and lower estimated glomerular filtration rate values (49 versus 85 mL/min; P = .06) at the time of MRI. Patients with reduced diffusivity also showed lesser mean values of the lowest hemoglobin levels (8.1 versus 10.2 g/dL, P < .05) and higher serum sodium levels (147 versus 139 mmol/L, P = .04) within 24 hours before MR imaging. The reduced-diffusivity group showed a striking and highly reproducible distribution of confluent, predominantly symmetric, supratentorial, and middle cerebellar peduncular white matter lesions (P < .001). CONCLUSIONS Our findings highlight notable correlations between severe COVID-19 leukoencephalopathy with reduced diffusivity and obesity, acute renal failure, mild hypernatremia, anemia, and an unusual brain MR imaging white matter lesion distribution pattern. Together, these observations may shed light on possible SARS-CoV-2 pathophysiologic mechanisms associated with leukoencephalopathy, including borderzone ischemic changes, electrolyte transport disturbances, and silent hypoxia in the setting of the known cytokine storm syndrome that accompanies severe COVID-19.
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Affiliation(s)
- O Rapalino
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - A Pourvaziri
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - M Maher
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - A Jaramillo-Cardoso
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - J Conklin
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - S Huang
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - J M Romero
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - E Halpern
- Institute for Technology Assessment (E.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - R Gupta
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - S Pomerantz
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - P Schaefer
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | - R G Gonzalez
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
| | | | - M H Lev
- From the Department of Radiology (O.R., A.P., M.M., A.J.-C., J.C., S.H., J.M.R., R.G., S.P., P.S., R.G.G., M.H.L.)
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33
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Jabehdar Maralani P, Myrehaug S, Mehrabian H, Chan AKM, Wintermark M, Heyn C, Conklin J, Ellingson BM, Rahimi S, Lau AZ, Tseng CL, Soliman H, Detsky J, Daghighi S, Keith J, Munoz DG, Das S, Atenafu EG, Lipsman N, Perry J, Stanisz G, Sahgal A. Intravoxel incoherent motion (IVIM) modeling of diffusion MRI during chemoradiation predicts therapeutic response in IDH wildtype glioblastoma. Radiother Oncol 2021; 156:258-265. [PMID: 33418005 PMCID: PMC8186561 DOI: 10.1016/j.radonc.2020.12.037] [Citation(s) in RCA: 8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/14/2020] [Accepted: 12/22/2020] [Indexed: 12/12/2022]
Abstract
Background: Prediction of early progression in glioblastoma may provide an opportunity to personalize treatment. Simplified intravoxel incoherent motion (IVIM) MRI offers quantitative estimates of diffusion and perfusion metrics. We investigated whether these metrics, during chemoradiation, could predict treatment outcome. Methods: 38 patients with newly diagnosed IDH-wildtype glioblastoma undergoing 6-week/30-fraction chemoradiation had standardized post-operative MRIs at baseline (radiation planning), and at the 10th and 20th fractions. Non-overlapping T1-enhancing (T1C) and non-enhancing T2-FLAIR hyperintense regions were independently segmented. Apparent diffusion coefficient (ADCT1C, ADCT2-FLAIR) and perfusion fraction (fT1C, fT2-FLAIR) maps were generated with simplified IVIM modelling. Parameters associated with progression before or after 6.9 months (early vs late progression, respectively), overall survival (OS) and progression-free survival (PFS) were investigated. Results: Higher ADCT2-FLAIR at baseline [Odds Ratio (OR) = 1.06, 95% CI 1.01–1.15, p = 0.025], lower fT2-FLAIR at fraction 10 (OR = 2.11, 95% CI 1.04–4.27, p = 0.018), and lack of increase in ADCT2-FLAIR at fraction 20 compared to baseline (OR = 1.12, 95% CI 1.02–1.22, p = 0.02) were associated with early progression. Combining ADCT2-FLAIR at baseline, fT2-FLAIR at fraction 10, ECOG and MGMT promoter methylation status significantly improved AUC to 90.3% compared to a model with only ECOG and MGMT promoter methylation status (p = 0.001). Using multivariable analysis, neither IVIM metrics were associated with OS but higher fT2-FLAIR at fraction 10 (HR = 0.72, 95% CI 0.56–0.95, p = 0.018) was associated with longer PFS. Conclusion: ADCT2-FLAIR at baseline, its lack of increase from baseline to fraction 20, or fT2-FLAIR at fraction 10 significantly predicted early progression. fT2-FLAIR at fraction 10 was associated with PFS.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada.
| | - Sten Myrehaug
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Hatef Mehrabian
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Aimee K M Chan
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Max Wintermark
- Department of Radiology, Stanford University, United States
| | - Chris Heyn
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, United States
| | - Benjamin M Ellingson
- Department of Radiological Sciences and Psychiatry, University of California Los Angeles, United States
| | - Saba Rahimi
- Department of Biomedical Engineering, University of Toronto, Canada
| | - Angus Z Lau
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Hany Soliman
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Jay Detsky
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Shadi Daghighi
- Department of Medical Imaging, Sunnybrook Health Sciences Center, University of Toronto, Canada
| | - Julia Keith
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - David G Munoz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
| | - Sunit Das
- Department of Surgery, Division of Neurosurgery, University of Toronto, Canada
| | | | - Nir Lipsman
- Department of Surgery, Division of Neurosurgery, University of Toronto, Canada
| | - James Perry
- Department of Medicine, Division of Neurology, University of Toronto, Canada
| | - Greg Stanisz
- Department of Medical Biophysics, Sunnybrook Research Institute, University of Toronto, Canada
| | - Arjun Sahgal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, University of Toronto, Canada
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Goncalves Filho ALM, Conklin J, Longo MGF, Cauley SF, Polak D, Liu W, Splitthoff DN, Lo WC, Kirsch JE, Setsompop K, Schaefer PW, Huang SY, Rapalino O. Accelerated Post-contrast Wave-CAIPI T1 SPACE Achieves Equivalent Diagnostic Performance Compared With Standard T1 SPACE for the Detection of Brain Metastases in Clinical 3T MRI. Front Neurol 2020; 11:587327. [PMID: 33193054 PMCID: PMC7653188 DOI: 10.3389/fneur.2020.587327] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 07/25/2020] [Accepted: 09/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose: Brain magnetic resonance imaging (MRI) examinations using high-resolution 3D post-contrast sequences offer increased sensitivity for the detection of metastases in the central nervous system but are usually long exams. We evaluated whether the diagnostic performance of a highly accelerated Wave-controlled aliasing in parallel imaging (Wave-CAIPI) post-contrast 3D T1 SPACE sequence was non-inferior to the standard high-resolution 3D T1 SPACE sequence for the evaluation of brain metastases. Materials and Methods: Thirty-three patients undergoing evaluation for brain metastases were prospectively evaluated with a standard post-contrast 3D T1 SPACE sequence and an optimized Wave-CAIPI 3D T1 SPACE sequence, which was three times faster than the standard sequence. Two blinded neuroradiologists performed a head-to-head comparison to evaluate the visualization of pathology, perception of artifacts, and the overall diagnostic quality. Wave-CAIPI post-contrast T1 SPACE was tested for non-inferiority relative to standard T1 SPACE using a 15% non-inferiority margin. Results: Wave-CAIPI post-contrast T1 SPACE was non-inferior to the standard T1 SPACE for visualization of enhancing lesions (P < 0.01) and offered equivalent diagnostic quality performance and only marginally higher background noise compared to the standard sequence. Conclusions: Our findings suggest that Wave-CAIPI post-contrast T1 SPACE provides equivalent visualization of pathology and overall diagnostic quality with three times reduced scan time compared to the standard 3D T1 SPACE.
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Affiliation(s)
- Augusto Lio M Goncalves Filho
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - John Conklin
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Maria Gabriela F Longo
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Stephen F Cauley
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Daniel Polak
- Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Siemens Healthcare GmbH, Erlangen, Germany
| | - Wei Liu
- Siemens Shenzhen Magnetic Resonance Ltd., Shenzhen, China
| | | | - Wei-Ching Lo
- Siemens Medical Solutions, Boston, MA, United States
| | - John E Kirsch
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Kawin Setsompop
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Pamela W Schaefer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Susie Y Huang
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States.,Harvard Medical School, Boston, MA, United States.,Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA, United States
| | - Otto Rapalino
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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35
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Longo MGF, Conklin J, Cauley SF, Setsompop K, Tian Q, Polak D, Polackal M, Splitthoff D, Liu W, González RG, Schaefer PW, Kirsch JE, Rapalino O, Huang SY. Evaluation of Ultrafast Wave-CAIPI MPRAGE for Visual Grading and Automated Measurement of Brain Tissue Volume. AJNR Am J Neuroradiol 2020; 41:1388-1396. [PMID: 32732274 DOI: 10.3174/ajnr.a6703] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 05/18/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND AND PURPOSE Volumetric brain MR imaging typically has long acquisition times. We sought to evaluate an ultrafast MPRAGE sequence based on Wave-CAIPI (Wave-MPRAGE) compared with standard MPRAGE for evaluation of regional brain tissue volumes. MATERIALS AND METHODS We performed scan-rescan experiments in 10 healthy volunteers to evaluate the intraindividual variability of the brain volumes measured using the standard and Wave-MPRAGE sequences. We then evaluated 43 consecutive patients undergoing brain MR imaging. Patients underwent 3T brain MR imaging, including a standard MPRAGE sequence (acceleration factor [R] = 2, acquisition time [TA] = 5.2 minutes) and an ultrafast Wave-MPRAGE sequence (R = 9, TA = 1.15 minutes for the 32-channel coil; R = 6, TA = 1.75 minutes for the 20-channel coil). Automated segmentation of regional brain volume was performed. Two radiologists evaluated regional brain atrophy using semiquantitative visual rating scales. RESULTS The mean absolute symmetrized percent change in the healthy volunteers participating in the scan-rescan experiments was not statistically different in any brain region for both the standard and Wave-MPRAGE sequences. In the patients undergoing evaluation for neurodegenerative disease, the Dice coefficient of similarity between volumetric measurements obtained from standard and Wave-MPRAGE ranged from 0.86 to 0.95. Similarly, for all regions, the absolute symmetrized percent change for brain volume and cortical thickness showed <6% difference between the 2 sequences. In the semiquantitative visual comparison, the differences between the 2 radiologists' scores were not clinically or statistically significant. CONCLUSIONS Brain volumes estimated using ultrafast Wave-MPRAGE show low intraindividual variability and are comparable with those estimated using standard MPRAGE in patients undergoing clinical evaluation for suspected neurodegenerative disease.
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Affiliation(s)
- M G F Longo
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.)
| | - J Conklin
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.).,Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts
| | - S F Cauley
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts
| | - K Setsompop
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - Q Tian
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - D Polak
- Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Department of Physics and Astronomy (D.P.), Heidelberg University, Heidelberg, Germany.,Siemens (D.P., D.S., W.L.), Erlangen, Germany
| | - M Polackal
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.)
| | | | - W Liu
- Siemens (D.P., D.S., W.L.), Erlangen, Germany
| | - R G González
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.).,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts
| | - P W Schaefer
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.).,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts
| | - J E Kirsch
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.)
| | - O Rapalino
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.)
| | - S Y Huang
- From the Departments of Radiology (M.G.F.L., J.C., M.P., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.).,Radiology, Athinoula A. Martinos Center for Biomedical Imaging, (J.C., S.F.C., K.S., Q.T., D.P., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School (J.C., S.F.C., K.S., R.G.G., P.W.S., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
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Conklin J, Frosch MP, Mukerji S, Rapalino O, Maher M, Schaefer PW, Lev MH, Gonzalez RG, Das S, Champion SN, Magdamo C, Sen P, Harrold GK, Alabsi H, Normandin E, Shaw B, Lemieux J, Sabeti P, Branda JA, Brown EN, Westover MB, Huang SY, Edlow BL. Cerebral Microvascular Injury in Severe COVID-19. medRxiv 2020. [PMID: 32743599 DOI: 10.1101/2020.07.21.20159376] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
IMPORTANCE Microvascular lesions are common in patients with severe COVID-19. Radiologic-pathologic correlation in one case suggests a combination of microvascular hemorrhagic and ischemic lesions that may reflect an underlying hypoxic mechanism of injury, which requires validation in larger studies. OBJECTIVE To determine the incidence, distribution, and clinical and histopathologic correlates of microvascular lesions in patients with severe COVID-19. DESIGN Observational, retrospective cohort study: March to May 2020. SETTING Single academic medical center. PARTICIPANTS Consecutive patients (16) admitted to the intensive care unit with severe COVID-19, undergoing brain MRI for evaluation of coma or focal neurologic deficits. EXPOSURES Not applicable. MAIN OUTCOME AND MEASURES Hypointense microvascular lesions identified by a prototype ultrafast high-resolution susceptibility-weighted imaging (SWI) MRI sequence, counted by two neuroradiologists and categorized by neuroanatomic location. Clinical and laboratory data (most recent measurements before brain MRI). Brain autopsy and cerebrospinal fluid PCR for SARS-CoV 2 in one patient who died from severe COVID-19. RESULTS Eleven of 16 patients (69%) had punctate and linear SWI lesions in the subcortical and deep white matter, and eight patients (50%) had >10 SWI lesions. In 4/16 patients (25%), lesions involved the corpus callosum. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterized by perivascular and parenchymal petechial hemorrhages and microscopic ischemic lesions. CONCLUSIONS AND RELEVANCE SWI lesions are common in patients with neurological manifestations of severe COVID-19 (coma and focal neurologic deficits). The distribution of lesions is similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. Collectively, these radiologic and histopathologic findings suggest that patients with severe COVID-19 are at risk for multifocal microvascular hemorrhagic and ischemic lesions in the subcortical and deep white matter.
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Affiliation(s)
- James R Stone
- From the Departments of Pathology (J.R.S., M.M.-K.), Medicine (K.M.T.), and Radiology (J.C.), Massachusetts General Hospital, and the Departments of Pathology (J.R.S., M.M.-K.), Medicine (K.M.T.), and Radiology (J.C.), Harvard Medical School - both in Boston
| | - Kathy M Tran
- From the Departments of Pathology (J.R.S., M.M.-K.), Medicine (K.M.T.), and Radiology (J.C.), Massachusetts General Hospital, and the Departments of Pathology (J.R.S., M.M.-K.), Medicine (K.M.T.), and Radiology (J.C.), Harvard Medical School - both in Boston
| | - John Conklin
- From the Departments of Pathology (J.R.S., M.M.-K.), Medicine (K.M.T.), and Radiology (J.C.), Massachusetts General Hospital, and the Departments of Pathology (J.R.S., M.M.-K.), Medicine (K.M.T.), and Radiology (J.C.), Harvard Medical School - both in Boston
| | - Mari Mino-Kenudson
- From the Departments of Pathology (J.R.S., M.M.-K.), Medicine (K.M.T.), and Radiology (J.C.), Massachusetts General Hospital, and the Departments of Pathology (J.R.S., M.M.-K.), Medicine (K.M.T.), and Radiology (J.C.), Harvard Medical School - both in Boston
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Wardeh A, Conklin J, Ko M. Case reports of observed significant improvement in patients with ARDS due to COVID-19 and maximum ventilatory support after inhalation of sodium bicarbonate. ACTA ACUST UNITED AC 2020. [DOI: 10.29328/journal.jcicm.1001029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Conklin J, Longo MGF, Cauley SF, Setsompop K, González RG, Schaefer PW, Kirsch JE, Rapalino O, Huang SY. Validation of Highly Accelerated Wave-CAIPI SWI Compared with Conventional SWI and T2*-Weighted Gradient Recalled-Echo for Routine Clinical Brain MRI at 3T. AJNR Am J Neuroradiol 2019; 40:2073-2080. [PMID: 31727749 DOI: 10.3174/ajnr.a6295] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 09/09/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE SWI is valuable for characterization of intracranial hemorrhage and mineralization but has long acquisition times. We compared a highly accelerated wave-controlled aliasing in parallel imaging (CAIPI) SWI sequence with 2 commonly used alternatives, standard SWI and T2*-weighted gradient recalled-echo (T2*W GRE), for routine clinical brain imaging at 3T. MATERIALS AND METHODS A total of 246 consecutive adult patients were prospectively evaluated using a conventional SWI or T2*W GRE sequence and an optimized wave-CAIPI SWI sequence, which was 3-5 times faster than the standard sequence. Two blinded radiologists scored each sequence for the presence of hemorrhage, the number of microhemorrhages, and severity of motion artifacts. Wave-CAIPI SWI was then evaluated in head-to-head comparison with the conventional sequences for visualization of pathology, artifacts, and overall diagnostic quality. Forced-choice comparisons were used for all scores. Wave-CAIPI SWI was tested for superiority relative to T2*W GRE and for noninferiority relative to standard SWI using a 15% noninferiority margin. RESULTS Compared with T2*W GRE, wave-CAIPI SWI detected hemorrhages in more cases (P < .001) and detected more microhemorrhages (P < .001). Wave-CAIPI SWI was superior to T2*W GRE for visualization of pathology, artifacts, and overall diagnostic quality (all P < .001). Compared with standard SWI, wave-CAIPI SWI showed no difference in the presence or number of hemorrhages identified. Wave-CAIPI SWI was noninferior to standard SWI for the visualization of pathology (P < .001), artifacts (P < .01), and overall diagnostic quality (P < .01). Motion was less severe with wave-CAIPI SWI than with standard SWI (P < .01). CONCLUSIONS Wave-CAIPI SWI provided superior visualization of pathology and overall diagnostic quality compared with T2*W GRE and was noninferior to standard SWI with reduced scan times and reduced motion artifacts.
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Affiliation(s)
- J Conklin
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - M G F Longo
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - S F Cauley
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (S.F.C., K.S., S.Y.H.), Boston, Massachusetts
| | - K Setsompop
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (S.F.C., K.S., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - R G González
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - P W Schaefer
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - J E Kirsch
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - O Rapalino
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - S Y Huang
- From the Department of Radiology (J.C., M.G.F.L., S.F.C., K.S., R.G.G., P.W.S., J.E.K., O.R., S.Y.H.), Massachusetts General Hospital, Boston, Massachusetts.,Athinoula A. Martinos Center for Biomedical Imaging (S.F.C., K.S., S.Y.H.), Boston, Massachusetts.,Harvard-MIT Division of Health Sciences and Technology (K.S., S.Y.H.), Massachusetts Institute of Technology, Cambridge, Massachusetts
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Brady K, Qu Y, Stimson D, Apilado R, Vezza Alexander R, Reddy S, Chitkara P, Conklin J, O'Malley T, Ibarra C, Dervieux T. Transition of Methotrexate Polyglutamate Drug Monitoring Assay from Venipuncture to Capillary Blood-Based Collection Method in Rheumatic Diseases. J Appl Lab Med 2019; 4:40-49. [DOI: 10.1373/jalm.2018.027730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/26/2018] [Indexed: 01/25/2023]
Abstract
Abstract
Objective
Methotrexate (MTX) polyglutamate (MTXPG3) levels from isolated red blood cells (RBCs) collected by venipuncture have clinical utility in guiding MTX dosing for patients with rheumatoid arthritis (RA). Our objective was to transition this RBC-based therapeutic drug monitoring (TDM) assay to dried capillary blood collected by fingerstick.
Methods
Patients with RA treated with MTX were enrolled. Specimens were collected by fingerstick (volumetric absorptive microsampler) and venipuncture to measure MTXPG3 from dried capillary blood, total venous blood, and isolated RBCs. MTXPG3 levels from dried capillary blood were measured using LC-MS/MS, converted to RBC equivalent (nmol/L), and compared with those from isolated RBCs (reference method). Following transition to fingerstick collection, comparability in the distributions of dried capillary and venipuncture-based RBC MTXPG3 levels was assessed using the Kolmogorov–Smirnov (K-S) test.
Results
Intraday and interday precision ranged from 2.0% to 10.9% and 3.1% to 10.8%, respectively, at MTXPG3 concentrations ranging from 5 to 100 nmol/L. In 106 participants treated with MTX, MTXPG3 levels from total venous and dried capillary blood were comparable [slope = 0.97 (95% CI, 0.92–1.03); R2 = 0.92]. Dried capillary blood MTXPG3 converted to RBC equivalent was similar to levels from isolated RBCs (30 ± 18 nmol/L vs 33 ± 19 nmol/L; n = 106). After implementation in the clinical laboratory, RBC equivalents MTXPG3 from the fingerstick method were similar to levels from venipuncture [39 ± 22 nmol/L (n = 825) vs 39 ± 24 nmol/L (n = 47935)] (K-S test P = 0.09). Underexposure to MTX (MTXPG3 ≤5 nmol/L RBCs) was detected in 7.0% and 8.5% patient specimens collected using the fingerstick and venipuncture methods, respectively.
Conclusion
Capillary blood MTXPG3 levels can be used to guide MTX dosing in TDM practice.
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Affiliation(s)
| | - Ying Qu
- Exagen Diagnostics Inc., Vista, CA
| | | | | | | | | | - Puja Chitkara
- Center for Arthritis and Rheumatologic Excellence, Chula Vista, CA
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Polak D, Cauley S, Huang SY, Longo MG, Conklin J, Bilgic B, Ohringer N, Raithel E, Bachert P, Wald LL, Setsompop K. Highly-accelerated volumetric brain examination using optimized wave-CAIPI encoding. J Magn Reson Imaging 2019; 50:961-974. [PMID: 30734388 PMCID: PMC6687581 DOI: 10.1002/jmri.26678] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Rapid volumetric imaging protocols could better utilize limited scanner resources. PURPOSE To develop and validate an optimized 6-minute high-resolution volumetric brain MRI examination using Wave-CAIPI encoding. STUDY TYPE Prospective. POPULATION/SUBJECTS Ten healthy subjects and 20 patients with a variety of intracranial pathologies. FIELD STRENGTH/SEQUENCE At 3 T, MPRAGE, T2 -weighted SPACE, SPACE FLAIR, and SWI were acquired at 9-fold acceleration using Wave-CAIPI and for comparison at 2-4-fold acceleration using conventional GRAPPA. ASSESSMENT Extensive simulations were performed to optimize the Wave-CAIPI protocol and minimize both g-factor noise amplification and potential T1 /T2 blurring artifacts. Moreover, refinements in the autocalibrated reconstruction of Wave-CAIPI were developed to ensure high-quality reconstructions in the presence of gradient imperfections. In a randomized and blinded fashion, three neuroradiologists assessed the diagnostic quality of the optimized 6-minute Wave-CAIPI exam and compared it to the roughly 3× slower GRAPPA accelerated protocol using both an individual and head-to-head analysis. STATISTICAL TEST A noninferiority test was used to test whether the diagnostic quality of Wave-CAIPI was noninferior to the GRAPPA acquisition, with a 15% noninferiority margin. RESULTS Among all sequences, Wave-CAIPI achieved negligible g-factor noise amplification (gavg ≤ 1.04) and burring artifacts from T1 /T2 relaxation. Improvements of our autocalibration approach for gradient imperfections enabled increased robustness to gradient mixing imperfections in tilted-field of view (FOV) prescriptions as well as variations in gradient and analog-to-digital converter (ADC) sampling rates. In the clinical evaluation, Wave-CAIPI achieved similar mean scores when compared with GRAPPA (MPRAGE: ØW = 4.03, ØG = 3.97; T2 w SPACE: ØW = 4.00, ØG = 4.00; SPACE FLAIR: ØW = 3.97, ØG = 3.97; SWI: ØW = 3.93, ØG = 3.83) and was statistically noninferior (N = 30, P < 0.05 for all sequences). DATA CONCLUSION The proposed volumetric brain exam retained comparable image quality when compared with the much longer conventional protocol. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:961-974.
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Affiliation(s)
- Daniel Polak
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Siemens Healthcare, Erlangen, Germany
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Stephen Cauley
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Susie Y Huang
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Maria Gabriela Longo
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - John Conklin
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Berkin Bilgic
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ned Ohringer
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | | | - Peter Bachert
- Department of Physics and Astronomy, Heidelberg University, Heidelberg, Germany
- Medical Physics in Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Lawrence L Wald
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Kawin Setsompop
- Department of Radiology, A. A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
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Petri MA, Conklin J, O'Malley T, Dervieux T. Platelet-bound C4d, low C3 and lupus anticoagulant associate with thrombosis in SLE. Lupus Sci Med 2019; 6:e000318. [PMID: 31168401 PMCID: PMC6519690 DOI: 10.1136/lupus-2019-000318] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [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: 01/07/2019] [Revised: 02/14/2019] [Accepted: 02/27/2019] [Indexed: 11/26/2022]
Abstract
Background Low C3 and lupus anticoagulant (LAC) are known risk factors for thrombosis in SLE. We evaluated the association between C4d products deposited on platelets (PC4d) and thrombosis in SLE. Antiphosphatidyl serine/prothrombin (PS/PT) complex antibody was also evaluated as an alternative to LAC. Methods This was a cross-sectional analysis of 149 consented patients with SLE (mean age: 47±1 years, 86% female) classified with (n=16) or without (n=133) thrombotic events in the past 5 years. Abnormal PC4d (≥20 units) was measured using flow cytometry. LAC and C3 were measured using dilute Russell’s viper venom time (>37 s) and immunoturbidimetry, respectively. Anti-PS/PT antibody status (IgG) was measured by immunoassay. Statistical analysis consisted of logistic regression and calculation of OR estimates with 95% CI. Results Abnormal PC4d (OR=8.4, 95% CI 2.8 to 24.8), low C3 (OR=9.5, 95% CI 3.0 to 30.3), LAC (OR=5.4, 95% CI 1.3 to 22.3) and anti-PS/PT IgG (OR=3.4, 95% CI 1.2 to 9.7) status associated with thrombosis (p<0.05). Cumulatively, the presence of PC4d, low C3 and LAC abnormalities as a composite risk score was higher in the presence of thrombosis (1.93±0.25) than in its absence (0.81±0.06) (p<0.01). Each unit of this composite risk score yielded an OR of 5.2 (95% CI 2.5 to 10.7) to have thrombosis (p<0.01). The composite risk score with anti-PS/PT antibody status instead of LAC also associated with thrombosis (p<0.01). Conclusion A composite risk score including PC4d, low C3 and LAC was associated with recent thrombosis and acknowledges the multifactorial nature of thrombosis in SLE.
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Affiliation(s)
- Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John Conklin
- Research and Development, Exagen, Vista, California, USA
| | - Tyler O'Malley
- Research and Development, Exagen, Vista, California, USA
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Shi J, Milo J, Brady K, Bentow C, Conklin J, O’Malley T, Poling D, Ibarra C, Mahler M, Dervieux T. Diagnostic performance of a new anti-carbamylated protein assay in rheumatic diseases. Scand J Rheumatol 2018; 48:249-250. [DOI: 10.1080/03009742.2018.1530372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- J Shi
- Exagen Diagnostics, Vista, CA, USA
| | - J Milo
- Inova Diagnostics, Inc., San Diego, CA, USA
| | - K Brady
- Exagen Diagnostics, Vista, CA, USA
| | - C Bentow
- Inova Diagnostics, Inc., San Diego, CA, USA
| | | | | | - D Poling
- Exagen Diagnostics, Vista, CA, USA
| | - C Ibarra
- Exagen Diagnostics, Vista, CA, USA
| | - M Mahler
- Inova Diagnostics, Inc., San Diego, CA, USA
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Hui-Yuen JS, Gartshteyn Y, Ma M, O'Malley T, Conklin J, Eichenfield AH, Imundo LF, Dervieux T, Askanase AD. Cell-bound complement activation products (CB-CAPs) have high sensitivity and specificity in pediatric-onset systemic lupus erythematosus and correlate with disease activity. Lupus 2018; 27:2262-2268. [PMID: 30376789 DOI: 10.1177/0961203318809181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Elevated levels of cell-bound complement activation products (CB-CAPs) (C4d deposition on B lymphocytes (BC4d) and/or erythrocytes (EC4d)) are sensitive and specific in diagnosis and monitoring of adult systemic lupus erythematosus (SLE). Our objective was to evaluate the role of CB-CAPs for diagnosis and monitoring of pediatric-onset SLE (pSLE). METHODS A prospective cohort study of 28 pSLE and 22 juvenile arthritis patients was conducted. SLE disease activity was determined using a clinical Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) that excluded serologies. Autoantibodies were measured using solid-phase immunoassays, C3 and C4 using immunoturbidimetry, and CB-CAPs using quantitative flow cytometry. Abnormal CB-CAPs were defined as EC4d or BC4d above the 99th percentile for healthy adults (>14 and > 60 net mean fluorescence intensity (MFI), respectively). Performance characteristics of CB-CAPs were assessed using area under the curve (AUC) for receiver operating characteristics. Linear mixed effect models evaluated the correlation between CB-CAPs and clinical SLEDAI over 6 months. RESULTS BC4d yielded higher AUC (0.91 ± 0.04) than C3 (0.63 ± 0.08) and C4 (0.67 ± 0.08) ( p < 0.05). Abnormal CB-CAPs were 78% sensitive and 86% specific for diagnosis of pSLE (Youden's index = 0.64 ± 0.11). In contrast to BC4d, EC4d levels correlated with clinical SLEDAI ( p < 0.01). CONCLUSION CB-CAPs (EC4d and BC4d) have higher sensitivity and specificity than low complement in pSLE, and may help with diagnosis of pSLE. EC4d could provide a useful biomarker for disease activity monitoring.
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Affiliation(s)
- J S Hui-Yuen
- 1 Division of Pediatric Rheumatology, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York, USA.,2 Department of Pediatrics, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Y Gartshteyn
- 3 Division of Rheumatology, Columbia University Medical Center, New York, New York, USA
| | - M Ma
- 1 Division of Pediatric Rheumatology, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York, USA.,2 Department of Pediatrics, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - T O'Malley
- 4 Exagen Diagnostics, Vista, California, USA
| | - J Conklin
- 4 Exagen Diagnostics, Vista, California, USA
| | - A H Eichenfield
- 5 Division of Pediatric Rheumatology, Columbia University Medical Center, New York, New York, USA
| | - L F Imundo
- 3 Division of Rheumatology, Columbia University Medical Center, New York, New York, USA
| | - T Dervieux
- 4 Exagen Diagnostics, Vista, California, USA
| | - A D Askanase
- 3 Division of Rheumatology, Columbia University Medical Center, New York, New York, USA
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Merrill JT, Petri MA, Buyon J, Ramsey-Goldman R, Kalunian K, Putterman C, Conklin J, Furie RA, Dervieux T. Erythrocyte-bound C4d in combination with complement and autoantibody status for the monitoring of SLE. Lupus Sci Med 2018; 5:e000263. [PMID: 29868177 PMCID: PMC5976122 DOI: 10.1136/lupus-2018-000263] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 02/22/2018] [Revised: 03/30/2018] [Accepted: 04/28/2018] [Indexed: 11/03/2022]
Abstract
Background We examined the usefulness of erythrocyte-bound C4d (EC4d) to monitor disease activity in SLE. Methods Data and blood samples were collected from three different studies, each of which included longitudinal evaluations using the Physicians Global Assessment (PGA) of disease activity and the Safety of Estrogens in Lupus Erythematosus National Assessment (SELENA) SLE Disease Activity Index (SLEDAI), which was assessed without anti-double-stranded DNA (dsDNA) and low complement C3/C4 (clinical SELENA-SLEDAI). EC4d levels were determined using flow cytometry; other laboratory measures included antibodies to dsDNA, C3 and C4 proteins. Relationships between clinical SELENA-SLEDAI, PGA and the laboratory measures were analysed using linear mixed effect models. Results The three studies combined enrolled 124 patients with SLE (mean age 42 years, 97% women, 31% Caucasians and 34% African-Americans) followed for an average of 5 consecutive visits (range 2-13 visits). EC4d levels and low C3/C4 status were significantly associated the clinical SELENA-SLEDAI or PGA in each of the three study groups (p<0.05). Multivariate analysis revealed that EC4d levels (estimate=0.94±0.28) and low complement C3/C4 (estimate=1.24±0.43) were both independently and significantly associated with the clinical SELENA-SLEDAI (p<0.01) and PGA. EC4d levels were also associated with the clinical SELENA-SLEDAI (estimate: 1.20±0.29) and PGA (estimate=0.19±0.04) among patients with chronically low or normal C3/C4 (p<0.01). Anti-dsDNA titres were generally associated with disease activity. Conclusion These data support the association of EC4d with disease activity regardless of complement C3/C4 status and its usefulness in monitoring SLE disease. Additional studies will be required to support these validation data.
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Affiliation(s)
- Joan T Merrill
- Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Michelle A Petri
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jill Buyon
- New York University School of Medicine, New York City, New York, USA
| | | | - Kenneth Kalunian
- University of California San Diego School of Medicine, La Jolla, California, USA
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Payne R, Halik L, Ma J, Zhang H, Zhang J, Conklin J, Gaylord M, Yokoyama K, Bahrainy Y, Ozgen N, Balderson J, Chase A, Gorman R, Plouffe B, Deflippi C. P2754Performance evaluation of the siemens advia centaur high sensitivity troponin i assay. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Farrell B, Conklin J, Raman-Wilms L, McCarthy L, Pottie K, Rojas-Fernandez C, Bjerre L, Irving H. DEVELOPMENT AND IMPLEMENTATION OF DEPRESCRIBING GUIDELINES. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2475] [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: 11/13/2022] Open
Affiliation(s)
- B. Farrell
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
- University of Waterloo, Kitchener, Ontario, Canada,
| | - J. Conklin
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- Concordia University, Montreal, Quebec, Canada,
| | | | - L. McCarthy
- University of Toronto, Toronto, Ontario, Canada,
- Women’s College Hospital, Toronto, Ontario, Canada
| | - K. Pottie
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
| | | | - L. Bjerre
- Bruyere Research Institute, Ottawa, Ontario, Canada,
- University of Ottawa, Ottawa, Ontario, Canada,
| | - H. Irving
- Bruyere Research Institute, Ottawa, Ontario, Canada,
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Iliuta IA, Kalatharan V, Wang K, Cornec-Le Gall E, Conklin J, Pourafkari M, Ting R, Chen C, Borgo AC, He N, Song X, Heyer CM, Senum SR, Hwang YH, Paterson AD, Harris PC, Khalili K, Pei Y. Polycystic Kidney Disease without an Apparent Family History. J Am Soc Nephrol 2017; 28:2768-2776. [PMID: 28522688 DOI: 10.1681/asn.2016090938] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 09/02/2016] [Accepted: 03/24/2017] [Indexed: 01/14/2023] Open
Abstract
The absence of a positive family history (PFH) in 10%-25% of patients poses a diagnostic challenge for autosomal dominant polycystic kidney disease (ADPKD). In the Toronto Genetic Epidemiology Study of Polycystic Kidney Disease, 210 affected probands underwent renal function testing, abdominal imaging, and comprehensive PKD1 and PKD2 mutation screening. From this cohort, we reviewed all patients with and without an apparent family history, examined their parental medical records, and performed renal imaging in all available parents of unknown disease status. Subsequent reclassification of 209 analyzed patients revealed 72.2% (151 of 209) with a PFH, 15.3% (32 of 209) with de novo disease, 10.5% (22 of 209) with an indeterminate family history, and 1.9% (four of 209) with PFH in retrospect. Among the patients with de novo cases, we found two families with germline mosaicism and one family with somatic mosaicism. Additionally, analysis of renal imaging revealed that 16.3% (34 of 209) of patients displayed atypical PKD, most of which followed one of three patterns: asymmetric or focal PKD with PFH and an identified PKD1 or PKD2 mutation (15 of 34), asymmetric and de novo PKD with proven or suspected somatic mosaicism (seven of 34), or focal PKD without any identifiable PKD1 or PKD2 mutation (eight of 34). In conclusion, PKD without an apparent family history may be due to de novo disease, missing parental medical records, germline or somatic mosaicism, or mild disease from hypomorphic PKD1 and PKD2 mutations. Furthermore, mutations of a newly identified gene for ADPKD, GANAB, and somatic mosaicism need to be considered in the mutation-negative patients with focal disease.
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Affiliation(s)
| | | | | | | | - John Conklin
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Marina Pourafkari
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | - Christina M Heyer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Sarah R Senum
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | | | - Andrew D Paterson
- Program in Genetics and Genome Biology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Peter C Harris
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Korosh Khalili
- Department of Medical Imaging, University Health Network and University of Toronto, Toronto, Ontario, Canada
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Dervieux T, Conklin J, Ligayon JA, Wolover L, O'Malley T, Alexander RV, Weinstein A, Ibarra CA. Validation of a multi-analyte panel with cell-bound complement activation products for systemic lupus erythematosus. J Immunol Methods 2017; 446:54-59. [PMID: 28389175 DOI: 10.1016/j.jim.2017.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 03/07/2017] [Revised: 03/31/2017] [Accepted: 04/03/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND We describe the analytical validation of an assay panel intended to assist clinicians with the diagnosis of systemic lupus erythematosus (SLE). The multi-analyte panel includes quantitative assessment of complement activation and measurement of autoantibodies. METHODS The levels of the complement split product C4d bound to erythrocytes (EC4d) and B-lymphocytes (BC4d) (expressed as mean fluorescence intensity [MFI]) are measured by quantitative flow cytometry, while autoantibodies (inclusive of antinuclear and anti-double stranded DNA antibodies) are determined by immunoassays. Results of the multi-analyte panel are reported as positive or negative based on a 2-tiered index score. Post-phlebotomy stability of EC4d and BC4d in EDTA-anticoagulated blood is determined using specimens collected from patients with SLE and normal donors. Three-level C4 coated positive beads are run daily as controls. Analytical validity is reported using intra-day and inter-day coefficient of variation (CV). RESULTS EC4d and BC4d are stable for 2days at ambient temperature and for 4days at 4°C post-phlebotomy. Median intra-day and inter-day CV range from 2.9% to 7.8% (n=30) and 7.3% to 12.4% (n=66), respectively. The 2-tiered index score is reproducible over 4 consecutive daysupon storage of blood at 4°C. A total of 2,888 three-level quality control data were collected from 6 flow cytometers with an overall failure rate below 3%. Median EC4d level is 6 net MFI (Interquartile [IQ] range 4-9 net MFI) and median BC4d is 18 net MFI (IQ range 13-27 net MFI) among 86,852 specimens submitted for testing. The incidence of 2-tiered positive test results is 13.4%. CONCLUSION We have established the analytical validity of a multi-analyte assay panel for SLE.
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Sam K, Peltenburg B, Conklin J, Sobczyk O, Poublanc J, Crawley AP, Mandell DM, Venkatraghavan L, Duffin J, Fisher JA, Black SE, Mikulis DJ. Cerebrovascular reactivity and white matter integrity. Neurology 2016; 87:2333-2339. [PMID: 27794113 DOI: 10.1212/wnl.0000000000003373] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 08/24/2016] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To compare the diffusion and perfusion MRI metrics of normal-appearing white matter (NAWM) with and without impaired cerebrovascular reactivity (CVR). METHODS Seventy-five participants with moderate to severe leukoaraiosis underwent blood oxygen level-dependent CVR mapping using a 3T MRI system with precise carbon dioxide stimulus manipulation. Several MRI metrics were statistically compared between areas of NAWM with positive and negative CVR using one-way analysis of variance with Bonferroni correction for multiple comparisons. RESULTS Areas of NAWM with negative CVR showed a significant reduction in fractional anisotropy by a mean (SD) of 3.7% (2.4), cerebral blood flow by 22.1% (8.2), regional cerebral blood volume by 22.2% (7.0), and a significant increase in mean diffusivity by 3.9% (3.1) and time to maximum by 10.9% (13.2) (p < 0.01), compared to areas with positive CVR. CONCLUSIONS Impaired CVR is associated with subtle changes in the tissue integrity of NAWM, as evaluated using several quantitative diffusion and perfusion MRI metrics. These findings suggest that impaired CVR may contribute to the progression of white matter disease.
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Affiliation(s)
- Kevin Sam
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Boris Peltenburg
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - John Conklin
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Olivia Sobczyk
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Julien Poublanc
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Adrian P Crawley
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Daniel M Mandell
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Lakshmikumar Venkatraghavan
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - James Duffin
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Joseph A Fisher
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sandra E Black
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada
| | - David J Mikulis
- From the Department of Physiology (K.S., J.D., J.A.F.), Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital (K.S., J.C., O.S., J.P., A.P.C., D.M.M., D.J.M.), Department of Medical Imaging (A.P.C., D.M.M., D.J.M.), and Department of Anaesthesia, Toronto General Hospital (L.V., J.D., J.A.F.), The University of Toronto, Canada; Department of Radiotherapy (B.P.), Imaging Division, University Medical Center Utrecht, Utrecht University, the Netherlands; and L.C. Campbell Cognitive Neurology Research Unit (S.E.B.), Sunnybrook Health Sciences Centre, Toronto, Canada.
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