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Hunter SA, Baker ME, Ream JM, Sweet DE, Austin NA, Remer EM, Primak A, Bullen J, Obuchowski N, Karim W, Herts BR. Visceral adipose tissue volume effect in Crohn's disease using reduced exposure CT enterography. J Appl Clin Med Phys 2024; 25:e14235. [PMID: 38059633 PMCID: PMC10795447 DOI: 10.1002/acm2.14235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 11/08/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
PURPOSE The purpose of this investigation was to assess the effect of visceral adipose tissue volume (VA) on reader efficacy in diagnosing and characterizing small bowel Crohn's disease using lower exposure CT enterography (CTE). Secondarily, we investigated the effect of lower exposure and VA on reader diagnostic confidence. METHODS Prospective paired investigation of 256 CTE, 129 with Crohn's disease, were reconstructed at 100% and simulated 50% and 30% exposure. The senior author provided the disease classification for the 129 patients with Crohn's disease. Patient VA was measured, and exams were evaluated by six readers for presence or absence of Crohn's disease and phenotype using a 0-10-point scale. Logistic regression models assessed the effect of VA on sensitivity and specificity. RESULTS The effect of VA on sensitivity was significantly reduced at 30% exposure (odds radio [OR]: 1.00) compared to 100% exposure (OR: 1.12) (p = 0.048). There was no statistically significant difference among the exposures with respect to the effect of visceral fat on specificity (p = 0.159). The study readers' probability of agreement with the senior author on disease classification was 60%, 56%, and 53% at 100%, 50%, and 30% exposure, respectively (p = 0.004). When detecting low severity Crohn's disease, readers' mean sensitivity was 83%, 75%, and 74% at 100%, 50%, and 30% exposure, respectively (p = 0.002). In low severity disease, sensitivity also tended to increase as visceral fat increased (ORs per 1000 cm3 increase in visceral fat: 1.32, 1.31, and 1.18, p = 0.010, 0.016, and 0.100, at 100%, 50%, and 30% exposure). CONCLUSIONS While the interaction is complex, VA plays a role in detecting and characterizing small bowel Crohn's disease when exposure is altered, particularly in low severity disease.
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Affiliation(s)
| | - Mark E. Baker
- Imaging Institute – Cleveland ClinicClevelandOhioUSA
| | | | | | | | | | | | - Jennifer Bullen
- Department of Quantitative Health Sciences – Cleveland ClinicClevelandOhioUSA
| | - Nancy Obuchowski
- Department of Quantitative Health Sciences – Cleveland ClinicClevelandOhioUSA
| | - Wadih Karim
- Imaging Institute – Cleveland ClinicClevelandOhioUSA
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Ream JM, Luk L, Sheedy S, Fletcher JG, Church JM, Baker ME. Dynamic ileal pouch emptying studies. Abdom Radiol (NY) 2023; 48:2956-2968. [PMID: 36732408 DOI: 10.1007/s00261-023-03811-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/04/2023]
Abstract
Although much radiologic literature has focused on the short-term post-operative complications associated with ileal pouches, as the number of patients with long-term pouches has grown, there is increasing realization of the functional deficits that may occur long after pouch creation. Dynamic pouch imaging using fluoroscopy and MRI can provide assessment of the underlying causes of symptomatic pouch dysfunction and can provide critical insight to the management of this complex patient population. In this paper, we provide an overview of the unique problems encountered in patients with long-term ileal pouches, and provide an overview of the techniques, interpretation, and reporting for fluoroscopic and MR pouch defecography.
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Affiliation(s)
- Justin M Ream
- Imaging Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Lyndon Luk
- Department of Radiology, Columbia University Medical Center, New York, NY, USA
| | - Shannon Sheedy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - J G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - James M Church
- Division of Colorectal Surgery, Columbia University Medical Center, New York, NY, USA
| | - Mark E Baker
- Imaging Institute, Digestive Diseases and Surgery Institute, and Cancer Institute, Cleveland Clinic, Cleveland, OH, USA
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Luk L, Hecht EM, Kang S, Bhosale PR, Francis IR, Gandhi N, Hough DM, Khatri G, Megibow A, Morgan DE, Ream JM, Sahani D, Shin LK, Yaghmai V, Zafar H, Zaheer A, Kaza R. Society of Abdominal Radiology Disease Focused Panel Survey on Clinical Utilization of Incidental Pancreatic Cyst Management Recommendations and Template Reporting. J Am Coll Radiol 2021; 18:1324-1331. [PMID: 34004175 DOI: 10.1016/j.jacr.2021.04.012] [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: 02/11/2021] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To assess current practice patterns with respect to protocols used for incidental pancreatic cyst follow-up, management guidelines, and template reporting. METHODS The Society of Abdominal Radiology Disease Focused Panel on intraductal pancreatic neoplasms distributed an anonymous 14-question survey to its members in June 2018 that focused on current utilization of incidental pancreatic cyst guidelines, protocols, and template reporting. RESULTS Among the 1,390 email invitations, 323 responded, and 94.7% (306 of 323) completed all questions. Respondents were mainly radiologists (93.8%, 303 of 323) from academic institutions (74.7%, 227 of 304) in North America (93.7%, 286 of 305). Of respondents, 42.5% (136 of 320) preferred 2017 ACR recommendations, 17.8% (57 of 320) homegrown systems, 15.0% (48 of 320) Fukuoka guidelines, and 7.8% (25 of 320) American Gastroenterological Association guidelines. The majority (68.7%, 222 of 323) agreed or strongly agreed that developing a single international consensus recommendation for management was important, and most radiologists preferred to include them in reports (231 of 322, 71.7%); yet only half included recommendations in >75% of reports (161 of 321). MR cholangiopancreatography was the modality of choice for follow-up of <2.5 cm cysts. Intravenous contrast was routinely used by 69.7% (212 of 304). Standardized reporting templates were rarely used in practice (12.8% 39 of 306). CONCLUSIONS Nearly 7 of 10 radiologists desire a unified international consensus recommendation for management of incidental cystic pancreatic lesions; ACR 2017 recommendations are most commonly used, followed by homegrown systems and Fukuoka guidelines. The majority of radiologists routinely use MR cholangiopancreatography with intravenous contrast for follow-up of incidental cystic lesions, but template reporting is rarely used.
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Affiliation(s)
- Lyndon Luk
- Abdominal Imaging Fellowship Director, Department of Radiology, New York Presbyterian-Columbia University Irving Medical Center, New York, New York.
| | - Elizabeth M Hecht
- Vice Chair of Academic Affairs and Faculty Development, Department of Radiology, New York Presbyterian-Weill Cornell Medicine, New York, New York
| | - Stella Kang
- Director of Comparative Effectiveness and Outcomes Research, Departments of Radiology and Surgery, NYU Grossman School of Medicine, New York, New York
| | - Priya R Bhosale
- Department of Abdominal Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Issac R Francis
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Namita Gandhi
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
| | - David M Hough
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Gaurav Khatri
- Chief of Body MRI and the Body MRI Fellowship Director, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alec Megibow
- Director of FPO Outpatient Imaging Services, Departments of Radiology and Surgery, NYU Grossman School of Medicine, New York, New York
| | - Desiree E Morgan
- Vice Chair of Education, Department of Radiology, The University of Alabama, Birmingham, Alabama
| | - Justin M Ream
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, Ohio
| | - Dushyant Sahani
- Chairman of Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Lewis K Shin
- Department of Radiology, Stanford University Medical Center, Palo Alto, California
| | - Vahid Yaghmai
- Chairman of Radiology, Department of Radiological Sciences, University of California, Irvine, Orange, California
| | - Hanna Zafar
- Vice Chair of Quality, Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Atif Zaheer
- Cross-Sectional Body Imaging Fellowship Director, Department of Radiology, John Hopkins Medicine, Baltimore, Maryland
| | - Ravi Kaza
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
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Hecht EM, Khatri G, Morgan D, Kang S, Bhosale PR, Francis IR, Gandhi NS, Hough DM, Huang C, Luk L, Megibow A, Ream JM, Sahani D, Yaghmai V, Zaheer A, Kaza R. Intraductal papillary mucinous neoplasm (IPMN) of the pancreas: recommendations for Standardized Imaging and Reporting from the Society of Abdominal Radiology IPMN disease focused panel. Abdom Radiol (NY) 2021; 46:1586-1606. [PMID: 33185741 DOI: 10.1007/s00261-020-02853-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 02/07/2023]
Abstract
There have been many publications detailing imaging features of malignant transformation of intraductal papillary mucinous neoplasms (IPMN), management and recommendations for imaging follow-up of diagnosed or presumed IPMN. However, there is no consensus on several practical aspects of imaging IPMN that could serve as a clinical guide for radiologists and enable future data mining for research. These aspects include how to measure IPMN, define reporting terminology, standardize reporting and unify guidelines for surveillance. The Society of Abdominal Radiology (SAR) created multiple Disease-Focused Panels (DFP) comprised multidisciplinary panel members who focus on a particular disease, with the goal to develop ways for radiologists to improve patient care, education, and research. DFP members met to identify the current controversies and limitations of imaging pancreatic IPMN. This paper aims to provide a practical review of the key imaging characteristics of IPMN for trainees and practicing radiologists, to guide uniformity of performance and interpretation of surveillance imaging studies, and to improve communication with clinicians by providing a lexicon and reporting template based on the experience of the SAR-DFP panel members.
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Affiliation(s)
- Elizabeth M Hecht
- Department of Radiology, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA.
| | - Gaurav Khatri
- Department of Diagnostic Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Desiree Morgan
- Department of Radiology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Stella Kang
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Priya R Bhosale
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Isaac R Francis
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Namita S Gandhi
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - David M Hough
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Chenchan Huang
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Lyndon Luk
- Department of Radiology, New York Presbyterian-Columbia University Medical Center, New York, NY, USA
| | - Alec Megibow
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Justin M Ream
- Department of Diagnostic Radiology, Cleveland Clinic, Cleveland, OH, USA
| | - Dushyant Sahani
- Department of Radiology, University of Washington, Seattle, WA, USA
| | - Vahid Yaghmai
- Department of Radiological Sciences, University of California, Irvine, Orange, CA, USA
| | - Atif Zaheer
- Department of Radiology, John Hopkins Medicine, Baltimore, MD, USA
| | - Ravi Kaza
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
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Smereka P, Doshi AM, Ream JM, Rosenkrantz AB. The American College of Radiology Incidental Findings Committee Recommendations for Management of Incidental Lymph Nodes: A Single-Center Evaluation. Acad Radiol 2017; 24:603-608. [PMID: 28169142 DOI: 10.1016/j.acra.2016.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 12/12/2016] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVES To assess the American College of Radiology Incidental Findings Committee's (ACR-IFC) recommendations for defining and following up abnormal incidental abdominopelvic lymph nodes. MATERIALS AND METHODS A total of 59 lymph nodes satisfying ACR-IFC criteria as incidental (no malignancy or lymphoproliferative disorder) and with sufficient follow-up to classify as benign (biopsy, decreased size, ≥12-month stability) or malignant (biopsy, detection of primary malignancy combined with either fluorodeoxyglucose hyperactivity or increase in size of the node) were included. Two radiologists independently assessed nodes for suspicious features by ACR-IFC criteria (round with indistinct hilum, hypervascularity, necrosis, cluster ≥3 nodes, cluster ≥2 nodes in ≥2 stations, size ≥1 cm in retroperitoneum). Outcomes were assessed with attention to ACR-IFC's recommendation for initial 3-month follow-up. RESULTS A total of 8.5% of nodes were malignant; 91.5% were benign. Two of six malignant nodes were stable at 3 to <6-month follow-up before diagnosis; diagnosis of four of five malignant nodes was facilitated by later development of non-nodal sites of tumor. A total of 13, 5, 8, and 9 nodes were deemed benign given a decrease at <3 months, 3-5 months, 6-11 months, or ≥12 months of follow-up. No ACR-IFC feature differentiated benign and malignant nodes (P = 0.164-1.0). A cluster ≥3 nodes was present in 88.1%-93.2% of nodes. A total of 96.6%-98.3% had ≥1 suspicious feature for both readers. Necrosis and hypervascularity were not identified in any node. CONCLUSIONS ACR-IFC imaging features overwhelmingly classified incidental nodes as abnormal, although did not differentiate benign and malignant nodes. Nodes stable at the ACR-IFC's advised initial 3-month follow-up were occasionally proven malignant or decreased on further imaging. Refinement of imaging criteria to define nodes of particularly high risk, integrated with other clinical criteria, may help optimize the follow-up of incidental abdominopelvic lymph nodes.
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Hoffman DH, Ream JM, Hajdu CH, Rosenkrantz AB. Utility of whole-lesion ADC histogram metrics for assessing the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs). Abdom Radiol (NY) 2017; 42:1222-1228. [PMID: 27900458 DOI: 10.1007/s00261-016-1001-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To evaluate whole-lesion ADC histogram metrics for assessing the malignant potential of pancreatic intraductal papillary mucinous neoplasms (IPMNs), including in comparison with conventional MRI features. METHODS Eighteen branch-duct IPMNs underwent MRI with DWI prior to resection (n = 16) or FNA (n = 2). A blinded radiologist placed 3D volumes-of-interest on the entire IPMN on the ADC map, from which whole-lesion histogram metrics were generated. The reader also assessed IPMN size, mural nodularity, and adjacent main-duct dilation. Benign (low-to-intermediate grade dysplasia; n = 10) and malignant (high-grade dysplasia or invasive adenocarcinoma; n = 8) IPMNs were compared. RESULTS Whole-lesion ADC histogram metrics demonstrating significant differences between benign and malignant IPMNs were: entropy (5.1 ± 0.2 vs. 5.4 ± 0.2; p = 0.01, AUC = 86%); mean of the bottom 10th percentile (2.2 ± 0.4 vs. 1.6 ± 0.7; p = 0.03; AUC = 81%); and mean of the 10-25th percentile (2.8 ± 0.4 vs. 2.3 ± 0.6; p = 0.04; AUC = 79%). The overall mean ADC, skewness, and kurtosis were not significantly different between groups (p ≥ 0.06; AUC = 50-78%). For entropy (highest performing histogram metric), an optimal threshold of >5.3 achieved a sensitivity of 100%, a specificity of 70%, and an accuracy of 83% for predicting malignancy. No significant difference (p = 0.18-0.64) was observed between benign and malignant IPMNs for cyst size ≥3 cm, adjacent main-duct dilatation, or mural nodule. At multivariable analysis of entropy in combination with all other ADC histogram and conventional MRI features, entropy was the only significant independent predictor of malignancy (p = 0.004). CONCLUSION Although requiring larger studies, ADC entropy obtained from 3D whole-lesion histogram analysis may serve as a biomarker for identifying the malignant potential of IPMNs, independent of conventional MRI features.
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Iranmahboob AK, Kierans AS, Huang C, Ream JM, Rosenkrantz AB. Preliminary investigation of whole-pancreas 3D histogram ADC metrics for predicting progression of acute pancreatitis. Clin Imaging 2017; 42:172-177. [DOI: 10.1016/j.clinimag.2016.12.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/23/2016] [Accepted: 12/14/2016] [Indexed: 12/24/2022]
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Rosenkrantz AB, Khasgiwala A, Doshi AM, Ream JM, Taneja SS, Lepor H. Detection of prostate cancer local recurrence following radical prostatectomy: assessment using a continuously acquired radial golden-angle compressed sensing acquisition. Abdom Radiol (NY) 2017; 42:290-297. [PMID: 27576605 DOI: 10.1007/s00261-016-0881-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare image quality and diagnostic performance for detecting local recurrence (LR) of prostate cancer after radical prostatectomy (RP) between standard dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) and a high spatiotemporal resolution, continuously acquired Golden-angle RAdial Sparse Parallel acquisition employing compressed sensing reconstruction ("GRASP"). METHODS A search was conducted for prostate MRI examinations performed in patients with PSA ≥0.2 ng/mL after RP in whom follow-up evaluation allowed classification as positive (≥50% PSA reduction after pelvic radiation or positive biopsy) or negative (<50% PSA reduction after pelvic radiation; spontaneous PSA normalization) for LR, yielding 13 patients with standard DCE (11 LR+) and 12 with GRASP (10 LR+). Standard DCE had voxel size 3.0 × 1.9 × 1.9 mm and temporal resolution 5.5 s. GRASP had voxel size 1.0 × 1.1 × 1.1 cm and was retrospectively reconstructed at 2.3 s resolution. Two radiologists evaluated DCE sequences for image quality measures (1-5 scale) and the presence of LR. RESULTS GRASP achieved higher scores than standard DCE from both readers (p < 0.001-0.136) for anatomic clarity (R1: 4.4 ± 0.8 vs. 2.8 ± 0.67 R2: 4.8 ± 0.5 vs. 3.2 ± 0.6), sharpness (3.6 ± 0.9 vs. 2.5 ± 0.7; 4.6 ± 0.5 vs. 2.6 ± 0.5), confidence in interpretation (3.8 ± 0.8 vs. 3.1 ± 0.9; 3.8 ± 1.0 vs. 3.1 ± 1.2), and conspicuity of detected lesions (4.7 ± 0.5 vs. 3.8 ± 1.1; 4.5 ± 0.5 vs. 3.8 ± 1.0). For detecting LR, GRASP also achieved higher sensitivity (70% vs. 36%; 80% vs. 45%), specificity (R1 and R2: 100% vs. 50%), and accuracy (75% vs. 38%; 83% vs. 46%) for both readers. CONCLUSION Although requiring larger studies, high spatiotemporal resolution GRASP achieved substantially better image quality and diagnostic performance than standard DCE for detecting LR in patients with elevated PSA after prostatectomy.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 First Avenue, Third Floor, New York, 10016, NY, USA.
| | - Anunita Khasgiwala
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 First Avenue, Third Floor, New York, 10016, NY, USA
| | - Ankur M Doshi
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 First Avenue, Third Floor, New York, 10016, NY, USA
| | - Justin M Ream
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 660 First Avenue, Third Floor, New York, 10016, NY, USA
| | - Samir S Taneja
- Department of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, 660 First Avenue, Third Floor, New York, 10016, NY, USA
| | - Herbert Lepor
- Department of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, 660 First Avenue, Third Floor, New York, 10016, NY, USA
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Abstract
Purpose To test the impact of existing Prostate Imaging Reporting and Data System (PI-RADS) version 2 (V2) decision rules, as well as of proposed adjustments to these decision rules, on detection of Gleason score (GS) 7 or greater (GS ≥7) prostate cancer. Materials and Methods Two radiologists independently provided PI-RADS V2 scores for the dominant lesion on 343 prostate magnetic resonance (MR) examinations. Diagnostic performance for GS ≥7 tumor was assessed by using MR imaging-ultrasonography fusion-targeted biopsy as the reference. The impact of existing PI-RADS V2 decision rules, as well as a series of exploratory proposed adjustments, on the frequency of GS ≥7 tumor detection, was evaluated. Results A total of 210 lesions were benign, 43 were GS 6, and 90 were GS ≥7. Lesions were GS ≥7 in 0%-4.1% of PI-RADS categories 1 and 2, 11.4%-27.1% of PI-RADS category 3, 44.4%-49.3% of PI-RADS category 4, and 72.1%-73.7% of PI-RADS category 5 lesions. PI-RADS category 4 or greater had sensitivity of 78.9%-87.8% and specificity of 75.5%-79.1 for detecting GS ≥7 tumor. The frequency of GS ≥7 tumor for existing PI-RADS V2 decision rules was 30.0%-33.3% in peripheral zone (PZ) lesions upgraded from category 3 to 4 based on dynamic contrast enhancement (DCE) score of positive; 50.0%-66.7% in transition zone (TZ) lesions upgraded from category 3 to 4 based on diffusion-weighted imaging (DWI) score of 5; and 71.7%-72.7% of lesions in both zones upgraded from category 4 to 5 based on size of 15 mm or greater. The frequency of GS ≥7 tumor for proposed adjustments to the decision rules was 30.0%-60.0% for TZ lesions upgraded from category 3 to 4 based on DWI score of 4; 33.3%-57.1% for TZ lesions upgraded from category 3 to 4 based on DCE score of positive when incorporating new criteria (unencapsulated sheetlike enhancement) for DCE score of positive in TZ; and 56.4%-61.9% for lesions in both zones upgraded from category 4 to 5 based on size of 10-14 mm. Other proposed adjustments yielded GS ≥7 tumor in less than 15% of cases for one or more readers. Conclusion Existing PI-RADS V2 decision rules exhibited reasonable performance in detecting GS ≥7 tumor. Several proposed adjustments to the criteria (in TZ, upgrading category 3 to 4 based on DWI score of 4 or modified DCE score of positive; in PZ or TZ, upgrading category 4 to 5 based on size of 10-14 mm) may also have value for this purpose. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Andrew B Rosenkrantz
- From the Department of Radiology, Center for Biomedical Imaging (A.B.R., J.S.B., J.M.R.), and Department of Urology, Division of Urologic Oncology (S.S.T.), NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Floor, New York, NY 10016
| | - James S Babb
- From the Department of Radiology, Center for Biomedical Imaging (A.B.R., J.S.B., J.M.R.), and Department of Urology, Division of Urologic Oncology (S.S.T.), NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Floor, New York, NY 10016
| | - Samir S Taneja
- From the Department of Radiology, Center for Biomedical Imaging (A.B.R., J.S.B., J.M.R.), and Department of Urology, Division of Urologic Oncology (S.S.T.), NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Floor, New York, NY 10016
| | - Justin M Ream
- From the Department of Radiology, Center for Biomedical Imaging (A.B.R., J.S.B., J.M.R.), and Department of Urology, Division of Urologic Oncology (S.S.T.), NYU School of Medicine, NYU Langone Medical Center, 660 First Ave, 3rd Floor, New York, NY 10016
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Ream JM, Doshi AM, Dunst D, Parikh N, Kong MX, Babb JS, Taneja SS, Rosenkrantz AB. Dynamic contrast-enhanced MRI of the prostate: An intraindividual assessment of the effect of temporal resolution on qualitative detection and quantitative analysis of histopathologically proven prostate cancer. J Magn Reson Imaging 2016; 45:1464-1475. [PMID: 27649481 DOI: 10.1002/jmri.25451] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 06/06/2016] [Accepted: 08/17/2016] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To assess the effects of temporal resolution (RT ) in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) on qualitative tumor detection and quantitative pharmacokinetic parameters in prostate cancer. MATERIALS AND METHODS This retrospective Institutional Review Board (IRB)-approved study included 58 men (64 ± 7 years). They underwent 3T prostate MRI showing dominant peripheral zone (PZ) tumors (24 with Gleason ≥ 4 + 3), prior to prostatectomy. Continuously acquired DCE utilizing GRASP (Golden-angle RAdial Sparse Parallel) was retrospectively reconstructed at RT of 1.4 sec, 3.7 sec, 6.0 sec, 9.7 sec, and 14.9 sec. A reader placed volumes-of-interest on dominant tumors and benign PZ, generating quantitative pharmacokinetic parameters (ktrans , ve ) at each RT . Two blinded readers assessed each RT for lesion presence, location, conspicuity, and reader confidence on a 5-point scale. Data were assessed by mixed-model analysis of variance (ANOVA), generalized estimating equation (GEE), and receiver operating characteristic (ROC) analysis. RESULTS RT did not affect sensitivity (R1all : 69.0%-72.4%, all Padj = 1.000; R1GS≥4 + 3 : 83.3-91.7%, all Padj = 1.000; R2all : 60.3-69.0%, all Padj = 1.000; R2GS≥4 + 3 : 58.3%-79.2%, all Padj = 1.000). R1 reported greater conspicuity of GS ≥ 4 + 3 tumors at RT of 1.4 sec vs. 14.9 sec (4.29 ± 1.23 vs. 3.46 ± 1.44; Padj = 0.029). No other tumor conspicuity pairwise comparison reached significance (R1all : 2.98-3.43, all Padj ≥ 0.205; R2all : 2.57-3.19, all Padj ≥ 0.059; R1GS≥4 + 3 : 3.46-4.29, all other Padj ≥ 0.156; R2GS≥4 + 3 : 2.92-3.71, all Padj ≥ 0.439). There was no effect of RT on reader confidence (R1all : 3.17-3.34, all Padj = 1.000; R2all : 2.83-3.19, all Padj ≥ 0.801; R1GS≥4 + 3 : 3.79-4.21, all Padj = 1.000; R2GS≥4 + 3 : 3.13-3.79, all Padj = 1.000). ktrans and ve of tumor and benign tissue did not differ across RT (all adjusted P values [Padj ] = 1.000). RT did not significantly affect area under the curve (AUC) of Ktrans or ve for differentiating tumor from benign (all Padj = 1.000). CONCLUSION Current PI-RADS recommendations for RT of 10 seconds may be sufficient, with further reduction to the stated PI-RADS preference of RT ≤ 7 seconds offering no benefit in tumor detection or quantitative analysis. LEVEL OF EVIDENCE 3 J. MAGN. RESON. IMAGING 2017;45:1464-1475.
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Affiliation(s)
- Justin M Ream
- Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Ankur M Doshi
- Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Diane Dunst
- Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Nainesh Parikh
- Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Max X Kong
- Department of Pathology, NYU Langone Medical Center, New York, New York, USA
| | - James S Babb
- Department of Radiology, NYU Langone Medical Center, New York, New York, USA
| | - Samir S Taneja
- Department of Urology, NYU Langone Medical Center, New York, New York, USA
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Rosenkrantz AB, Parikh N, Kierans AS, Kong MX, Babb JS, Taneja SS, Ream JM. Prostate Cancer Detection Using Computed Very High b-value Diffusion-weighted Imaging: How High Should We Go? Acad Radiol 2016; 23:704-11. [PMID: 26992738 DOI: 10.1016/j.acra.2016.02.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/29/2016] [Accepted: 02/01/2016] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to assess prostate cancer detection using a broad range of computed b-values up to 5000 s/mm(2). MATERIALS AND METHODS This retrospective Health Insurance Portability and Accountability Act-compliant study was approved by an institutional review board with consent waiver. Forty-nine patients (63 ± 8 years) underwent 3T prostate magnetic resonance imaging before prostatectomy. Examinations included diffusion-weighted imaging (DWI) with b-values of 50 and 1000 s/mm(2). Seven computed DWI image sets (b-values: 1000, 1500, 2000, 2500, 3000, 4000, and 5000 s/mm(2)) were generated by mono-exponential fit. Two blinded radiologists (R1 [attending], R2 [fellow]) independently evaluated diffusion weighted image sets for image quality and dominant lesion location. A separate unblinded radiologist placed regions of interest to measure tumor-to-peripheral zone (PZ) contrast. Pathologic findings from prostatectomy served as reference standard. Measures were compared between b-values using the Jonckheere-Terpstra trend test, Spearman correlation coefficient, and generalized estimating equations based on logistic regression for correlated data. RESULTS As b-value increased, tumor-to-PZ contrast and benign prostate suppression for both readers increased (r = +0.65 to +0.71, P ≤ 0.001), whereas anatomic clarity, visualization of the capsule, and visualization of peripheral-transition zone edge decreased (r = -0.69 to -0.75, P ≤ 0.003). Sensitivity for tumor was highest for R1 at b1500-3000 (84%-88%) and for R2 at b1500-2500 (70%-76%). Sensitivities for both pathologic outcomes were lower for both readers at both b1000 and the highest computed b-values. Sensitivity for Gleason >6 tumor was highest for R1 at b1500-3000 (90%-93%) and for R2 at 1500-2500 (78%-80%). The positive predictive value for tumor for R1 was similar from b1000 to 4000 (93%-98%) and for R2 was similar from b1500 to 4000 (88%-94%). CONCLUSIONS Computed b-values in the range of 1500-2500 s/mm(2) (but not higher) were optimal for prostate cancer detection; b-values of 1000 or 3000-5000 exhibited overall lower performance.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Nainesh Parikh
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016
| | - Andrea S Kierans
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016
| | - Max Xiangtian Kong
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York
| | - James S Babb
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016
| | - Samir S Taneja
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York
| | - Justin M Ream
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016
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Ream JM, Glielmi C, Lazar M, Campbell N, Pfeuffer J, Schneider R, Rosenkrantz AB. Zoomed echo-planar diffusion tensor imaging for MR tractography of the prostate gland neurovascular bundle without an endorectal coil: a feasibility study. Abdom Radiol (NY) 2016; 41:919-25. [PMID: 27193790 DOI: 10.1007/s00261-015-0587-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The purpose of this study was to assess the feasibility of zoomed echo-planar imaging (EPI) diffusion tensor imaging (DTI) with 2-channel parallel transmission (pTx) for MR tractography of the periprostatic neurovascular bundle (NVB) without an endorectal coil, and to compare its performance to that of conventionally acquired DTI. METHODS 8 healthy males (28.9 ± 4.6 years) underwent pelvic phased-array coil prostate MRI on a 3T system using both zoomed-EPI DTI (z-DTI) with 2-channel pTx and conventional single-shot spin-echo EPI DTI (c-DTI) acquisitions with 6 encoding directions and b-values of 0 and 1000 s/mm(2). Fractional anisotropy (FA) maps and tractography analysis incorporating 3D visualization of the NVB were performed from each acquisition. Fiber tract counts, estimated signal-to-noise ratio (eSNR), and image quality measures of the FA maps and NVB tractography were compared. Quantitative and image quality measures were compared using Wilcoxon signed rank tests. RESULTS 3 of 8 subjects had no tracts detected with c-DTI acquisition, while all 8 had tracts detected with z-DTI. z-DTI acquisition yielded significantly more fiber tracts (c-DTI: 77 ± 116 tracts; z-DTI: 430 ± 228 tracts; p = 0.019) and higher eSNR (c-DTI: 2.9 ± 1.2; z-DTI: 13.17 ± 9.9; p = 0.014). Relative to c-DTI acquisitions, z-DTI FA maps showed significantly reduced artifact (p = 0.008) and reduced anatomic distortion of the prostate (p = 0.010), while z-DTI tractography showed significantly better overall visual quality (p = 0.011), tract symmetry (p = 0.010), tract coherence (p = 0.011), and subjective similarity to the actual NVB (p = 0.011). CONCLUSION Zoomed-EPI DTI acquisition for tractography of the prostate gland NVB improves quantitative and qualitative measures of image and tract fiber quality, allowing tractography of the NVB at 3T without using an endorectal coil.
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Affiliation(s)
- Justin M Ream
- Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, 660 1st Avenue, New York, NY, 10016, USA.
| | | | - Mariana Lazar
- Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, 660 1st Avenue, New York, NY, 10016, USA
| | - Naomi Campbell
- Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, 660 1st Avenue, New York, NY, 10016, USA
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Josef Pfeuffer
- Imaging and Therapy Division, Siemens AG Healthcare Sector, Erlangen, Germany
| | - Rainer Schneider
- Imaging and Therapy Division, Siemens AG Healthcare Sector, Erlangen, Germany
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, 660 1st Avenue, New York, NY, 10016, USA
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Dunst D, Ream JM, Khalef V, Hajdu CH, Rosenkrantz AB. Comparison of MRI features of pathologically proven hepatocellular carcinoma between patients with hepatitis B and hepatitis C infection. Clin Imaging 2016; 40:352-6. [PMID: 27133666 DOI: 10.1016/j.clinimag.2016.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/21/2015] [Accepted: 01/26/2016] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare MRI features of pathologically-proven hepatocellular carcinoma (HCC) between patients with hepatitis B (HBV) and hepatitis C (HCV) infection. METHODS Two radiologists assessed 51 confirmed HCCs on MRI in HBV (n=18) or HCV (n=33) patients; a third, more experienced, radiologist resolved discrepancies. RESULTS Arterial hyperenhancement occurred more frequently in HCV (90.9% vs. 66.7%; P=.032), DWI/T2WI hyperintensity more frequently in HBV [(DWI: 78.6% vs. 45.8%, T2WI: 77.8% vs. 48.5%; P=.073-0.088)]. Tumors were larger in HBV (P≤.016). Washout, pseudocapsule, homogeneity, circumscribed margins, lipid, iron, and visually low ADC were not different. CONCLUSION Larger studies are required to confirm these preliminary findings.
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Affiliation(s)
- Diane Dunst
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016.
| | - Justin M Ream
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016.
| | - Victoria Khalef
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016.
| | - Cristina H Hajdu
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016.
| | - Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016.
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Rosenkrantz AB, Pinnamaneni N, Kierans AS, Ream JM. Hypovascular hepatic nodules at gadoxetic acid-enhanced MRI: whole-lesion hepatobiliary phase histogram metrics for prediction of progression to arterial-enhancing hepatocellular carcinoma. Abdom Radiol (NY) 2016; 41:63-70. [PMID: 26830613 DOI: 10.1007/s00261-015-0610-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To explore whole-lesion histogram analysis of the hepatobiliary phase (HBP) defect in indeterminate hypovascular liver lesions for predicting progression to arterial-enhancing hepatocellular carcinoma (HCC). METHODS Twenty patients undergoing gadoxetic acid-enhanced MRI for HCC screening with 12° and 25° flip angle (FA) HBP acquisitions demonstrating an indeterminate lesion showing HBP hypointensity but no arterial enhancement were included. Volumes-of-interest were placed on HBP defects, from which histogram metrics were obtained. Associations between these metrics and progression to arterial-enhancing HCC on follow-up imaging were investigated. Lesions were also assessed for the presence of a signal abnormality on conventional sequences. RESULTS 40% of lesions progressed to arterial-enhancing HCC; 60% were stable at ≥6 months follow-up. Neither T2-hyperintensity increased diffusion signal nor portal/equilibrium phase washout was different between progressing and nonprogressing lesions (p = 1.0). Among direct signal intensity-based measures (overall mean; mean of bottom 10th, 10-25th, and 25-50th percentiles), area-under-the-curve (AUC) for prediction of progression to arterial-enhancing HCC was consistently higher at 25° (range 0.619-0.657) than at 12° (range 0.512-0.548). However, at both FAs, the four measures with highest AUC were measures related to lesion texture and heterogeneity [standard deviation (SD), coefficient of variation (CV), skewness, and entropy], having AUC of 0.655-0.750 at 12° and 0.686-0.800 at 25. The metric with highest AUC at 12° was SD (AUC = 0.750) and at 25° was CV (AUC = 0.800). CONCLUSION Whole-lesion histogram HBP measures of indeterminate hypovascular liver lesions may help predict progression to arterial-enhancing HCC by reflecting greater lesion heterogeneity, particularly at higher FA. Larger studies are therefore warranted.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA.
| | - Niveditha Pinnamaneni
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
| | - Andrea S Kierans
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
| | - Justin M Ream
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY, 10016, USA
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Parikh N, Ream JM, Zhang HC, Block KT, Chandarana H, Rosenkrantz AB. Performance of simultaneous high temporal resolution quantitative perfusion imaging of bladder tumors and conventional multi-phase urography using a novel free-breathing continuously acquired radial compressed-sensing MRI sequence. Magn Reson Imaging 2015; 34:694-8. [PMID: 26740058 DOI: 10.1016/j.mri.2015.12.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 12/18/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE To investigate the feasibility of high temporal resolution quantitative perfusion imaging of bladder tumors performed simultaneously with conventional multi-phase MR urography (MRU) using a novel free-breathing continuously acquired radial MRI sequence with compressed-sensing reconstruction. METHODS 22 patients with bladder lesions underwent MRU using GRASP (Golden-angle RAdial Sparse Parallel) acquisition. Multi-phase contrast-enhanced abdominopelvic GRASP was performed during free-breathing (1.4×1.4×3.0mm(3) voxel size; 3:44min acquisition). Two dynamic datasets were retrospectively reconstructed by combining different numbers of sequentially acquired spokes into each dynamic frame: 110 spokes per frame for 25-s temporal resolution (serving as conventional MRU for clinical interpretation) and 8 spokes per frame for 1.7-s resolution. Using 1.7-s resolution images, ROIs were placed within bladder lesions and normal bladder wall, a femoral artery arterial input function was generated, and the Generalized Kinetic Model was applied. RESULTS Biopsy/cystectomy demonstrated 16 bladder tumors (13 stage≥T2, 3 stage≤T1) and 6 benign lesions. All lesions were well visualized using 25-s clinical multi-phase images. Using 1.7-s resolution images, K(trans) was significantly higher in tumors (0.38±0.24) than normal bladder (0.12±0.02=8, p<0.001) or benign lesions (0.15±0.04, p=0.033). Ratio between K(trans) of lesions and normal bladder was nearly double for tumors than benign lesions (4.3±3.4 vs. 2.2±1.6), and K(trans) was nearly double in stage≥T2 than stage≤T1 tumors (0.44±0.24 vs. 0.24±0.24), although these did not approach significance (p=0.180-0.209), possibly related to small sample size. CONCLUSION GRASP allows simultaneous quantitative high temporal resolution perfusion of bladder lesions during clinical MRU examinations using only one contrast injection and without additional scan time.
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Affiliation(s)
- Nainesh Parikh
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Justin M Ream
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Hoi Cheung Zhang
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Kai Tobias Block
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Hersh Chandarana
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
| | - Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, 550 First Avenue, New York, NY 10016.
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Rosenkrantz AB, Meng X, Ream JM, Babb JS, Deng FM, Rusinek H, Huang WC, Lepor H, Taneja SS. Likert score 3 prostate lesions: Association between whole-lesion ADC metrics and pathologic findings at MRI/ultrasound fusion targeted biopsy. J Magn Reson Imaging 2015; 43:325-32. [PMID: 26131965 DOI: 10.1002/jmri.24983] [Citation(s) in RCA: 24] [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: 04/24/2015] [Accepted: 06/04/2015] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND To assess associations between whole-lesion apparent diffusion coefficient (ADC) metrics and pathologic findings of Likert score 3 prostate lesions at MRI/ultrasound fusion targeted biopsy. METHODS This retrospective Institutional Review Board-approved study received a waiver of consent. We identified patients receiving a highest lesion score of 3 on 3 Tesla multiparametric MRI reviewed by a single experienced radiologist using a 5-point Likert scale and who underwent fusion biopsy. A total of 188 score 3 lesions in 158 patients were included. Three-dimensional volumes-of-interest encompassing each lesion were traced on ADC maps. Logistic regression was used to predict biopsy results based on whole-lesion ADC metrics and patient biopsy history. Biopsy yield was compared between metrics. RESULTS By lesion, targeted biopsy identified tumor in 22.3% and Gleason score (GS) > 6 tumor in 8.5%, although results varied by biopsy history: biopsy-naïve (n = 80), 20.0%/8.8%; prior negative biopsy (n = 53), 9.4%/1.9%; prior positive biopsy (n = 55): 40.0%/14.5%. Biopsy history, whole-lesion mean ADC, whole-lesion ADC10-25 , and whole-lesion ADC25-50 were each significantly associated with tumor or GS > 6 tumor at fusion biopsy (P ≤ 0.047). In men without prior negative prostate biopsy, whole-lesion ADC25-50 ≤ 1.04*10(-3) mm2 /s achieved 90.0% sensitivity and 50.0% specificity for GS > 6 tumor, which was significantly higher (P < 0.001) than specificity of PSA (17.5%) at identical sensitivity. CONCLUSION For score 3 lesions in patients without prior negative biopsy, whole-lesion ADC metrics help detect GS > 6 cancer while avoiding negative biopsies. However, deferral of fusion biopsy may be considered for score 3 lesions in patients with prior negative biopsy (without applying whole-lesion ADC metrics) given exceedingly low (∼ 2%) frequency of GS > 6 tumor in this group.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Xiaosong Meng
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Justin M Ream
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - James S Babb
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Fang-Ming Deng
- Department of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Henry Rusinek
- Department of Radiology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - William C Huang
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Herbert Lepor
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
| | - Samir S Taneja
- Department of Urology, Division of Urologic Oncology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA
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Rosenkrantz AB, Geppert C, Grimm R, Block TK, Glielmi C, Feng L, Otazo R, Ream JM, Romolo MM, Taneja SS, Sodickson DK, Chandarana H. Dynamic contrast-enhanced MRI of the prostate with high spatiotemporal resolution using compressed sensing, parallel imaging, and continuous golden-angle radial sampling: preliminary experience. J Magn Reson Imaging 2014; 41:1365-73. [PMID: 24833417 DOI: 10.1002/jmri.24661] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/24/2014] [Accepted: 04/28/2014] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To demonstrate dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) of the prostate with both high spatial and temporal resolution via a combination of golden-angle radial k-space sampling, compressed sensing, and parallel-imaging reconstruction (GRASP), and to compare image quality and lesion depiction between GRASP and conventional DCE in prostate cancer patients. MATERIALS AND METHODS Twenty prostate cancer patients underwent two 3T prostate MRI examinations on separate dates, one using standard DCE (spatial resolution 3.0 × 1.9 × 1.9 mm, temporal resolution 5.5 sec) and the other using GRASP (spatial resolution 3.0 × 1.1 × 1.1 mm, temporal resolution 2.3 sec). Two radiologists assessed measures of image quality and dominant lesion size. The experienced reader recorded differences in contrast arrival times between the dominant lesion and benign prostate. RESULTS Compared with standard DCE, GRASP demonstrated significantly better clarity of the capsule, peripheral/transition zone boundary, urethra, and periprostatic vessels; image sharpness; and lesion conspicuity for both readers (P < 0.001-0.020). GRASP showed improved interreader correlation for lesion size (GRASP: r = 0.691-0.824, standard: r = 0.495-0.542). In 8/20 cases, only GRASP showed earlier contrast arrival in tumor than benign; in no case did only standard DCE show earlier contrast arrival in tumor. CONCLUSION High spatiotemporal resolution prostate DCE is possible with GRASP, which has the potential to improve image quality and lesion depiction as compared with standard DCE.
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Elsayes KM, Ellis JH, Elkhouly T, Ream JM, Bowerson M, Khan A, Caoili EM. Diagnostic yield of percutaneous image-guided tissue biopsy of focal hepatic lesions in cancer patients. Cancer 2011; 117:4041-8. [DOI: 10.1002/cncr.25980] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 12/03/2010] [Accepted: 12/15/2010] [Indexed: 11/08/2022]
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Abstract
Studies examining thought processes have focused upon the deliberate, goal-directed mental processes occurring during complex cognitive tasks. Spontaneously occurring thought processes have, on the other hand, received much less attention. Such spontaneous thought processes occur frequently when no task is present or when task demands are low. Although their existence has been recognised, their study has been difficult due to lack of direct behavioural measures. Nevertheless, a number of behavioural methods based on subjects' verbal reports have been developed. Findings derived using such behavioural methods suggest that spontaneous thought processes share common cognitive mechanisms with purposeful, task-related thought processes. Furthermore, evidence from neuroimaging observations is accumulating suggesting similar conclusions about the neural basis of spontaneous thought processes. These neuroimaging findings demonstrate an overlap in the pattern of activation between various cognitive tasks and rest, with a number of higher cortical regions activated in common, including visual areas, medial temporal lobe, and lateral cortical association areas. Many of these observations have, however, been based upon comparisons between rest and tasks posing relatively high cognitive demands. In contrast, here we report an fMRI study in which rest was compared to a simple left/right response task of minimal cognitive demands. Rest was associated with greater activation in temporopolar cortex, parahippocampus, rostrolateral prefrontal cortex, parietal and visual cortical areas. Activation of temporal lobe structures was particularly extensive and robust, suggesting that long-term memory processes may form the core of spontaneous thought. By considering such long-term memory processes as an essential part of thought mechanisms, it may be possible to gain better understanding into spontaneous thought phenomena that have remained unaccounted for until now.
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Wegesin DJ, Ream JM, Stern Y. Explicit Contamination Contributes to Aging Effects in Episodic Priming: Behavioral and ERP Evidence. J Gerontol B Psychol Sci Soc Sci 2004; 59:P317-24. [PMID: 15576859 DOI: 10.1093/geronb/59.6.p317] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We examined the impact of explicit contamination on age-related changes in episodic priming. We recorded event-related brain potentials (ERPs) from older and younger adults to primed and unprimed nouns tested in a recognition memory task. Results revealed that the magnitude of priming was greater in the younger adults. ERPs revealed a priming effect in the younger adults that was absent in older adults. Findings suggest that explicit contamination may account for the reported aging effect: Item memory was correlated with episodic priming and ERP priming in younger adults, but not older adults; item memory was associated with episodic priming after aging effects were controlled for; and the topographies of the young's priming and item memory effects were indistinguishable. Given the apparent vulnerability to contamination by explicit memory, we suggest caution when researchers use an episodic priming paradigm to assess aging effects in implicit memory.
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Affiliation(s)
- Domonick J Wegesin
- Department of Neurology, Columbia University, G.H. Sergievsky Center, 19th Floor, 630 West 168 Street, New York, NY 10032, USA.
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Abstract
The anterior or rostrolateral prefrontal cortex (RLPFC) is frequently recruited during complex cognitive tasks across a wide range of domains, including reasoning, long-term memory retrieval, and working memory. The authors report an event-related functional MRI study, indicating that the RLPFC is specifically involved in the evaluation of internally generated information--or information that cannot be readily perceived from the external environment but has to be inferred or self-generated. The findings are consistent with a hierarchical model of lateral prefrontal organization, with RLPFC contributing only at the highest orders of cognitive transformations. This characterization of RLPFC function may help explain seemingly disparate findings across multiple cognitive domains and could provide a unified account of this region's contribution to human cognition.
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Affiliation(s)
- Kalina Christoff
- Cognition and Brain Sciences Unit, Medical Research Council, Cambridge, United Kingdom.
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