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Cao J, Srinivas-Rao S, Mroueh N, Anand R, Kongboonvijit S, Sertic M, Shenoy-Bhangle AS, Kambadakone A. Cholangiocarcinoma imaging: from diagnosis to response assessment. Abdom Radiol (NY) 2024:10.1007/s00261-024-04267-y. [PMID: 38578323 DOI: 10.1007/s00261-024-04267-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 04/06/2024]
Abstract
Cholangiocarcinoma (CCA), a highly aggressive primary liver cancer arising from the bile duct epithelium, represents a substantial proportion of hepatobiliary malignancies, posing formidable challenges in diagnosis and treatment. Notably, the global incidence of intrahepatic CCA has seen a rise, necessitating a critical examination of diagnostic and management strategies, especially due to presence of close imaging mimics such as hepatocellular carcinoma (HCC) and combined hepatocellular carcinoma-cholangiocarcinoma (cHCC-CCA). Hence, it is imperative to understand the role of various imaging modalities such as ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), elucidating their strengths, and limitations in diagnostic precision and staging accuracy. Beyond conventional approaches, there is emerging significance of functional imaging tools including positron emission tomography (PET)-CT and diffusion-weighted (DW)-MRI, providing pivotal insights into diagnosis, therapeutic assessment, and prognostic evaluation. This comprehensive review explores the risk factors, classification, clinical features, and role of imaging in the holistic spectrum of diagnosis, staging, management, and restaging for CCA, hence serving as a valuable resource for radiologists evaluating CCA.
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Affiliation(s)
- Jinjin Cao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Shravya Srinivas-Rao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Nayla Mroueh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Roshni Anand
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Sasiprang Kongboonvijit
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
- Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Madeleine Sertic
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Anuradha S Shenoy-Bhangle
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA.
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Anderson MA, Mercaldo S, Cao J, Mroueh N, Furtado FS, Cochran RL, Chung R, Goiffon RJ, Sertic M, Pierce TT, Kilcoyne A, Mojtahed A, Shenoy-Bhangle AS, Catalano OA, Kambadakone A. Society of Radiologists in Ultrasound Consensus Conference Recommendations for Incidental Gallbladder Polyp Management: Interreader Agreement Among Ten Radiologists. AJR Am J Roentgenol 2024. [PMID: 38353447 DOI: 10.2214/ajr.23.30720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Background: The 2022 Society of Radiologists in Ultrasound (SRU) consensus conference recommendations support less-aggressive management of small gallbladder polyps on ultrasound versus earlier approaches and may help standardize polyp evaluation by radiologists. Objective: To assess radiologists' interreader agreement in applying the SRU recommendations for management of incidental gallbladder polyps on ultrasound. Methods: This retrospective study included 105 patients (median age, 52 years; 75 women, 27 men) with a gallbladder polyp on ultrasound (without features highly suspicious for invasive or malignant tumor) who underwent cholecystectomy between January 1, 2003 and January 1, 2021. Ten abdominal radiologists independently reviewed ultrasound examinations and, using SRU recommendations, assessed one polyp per patient for risk category (extremely low-risk, low-risk, or indeterminate risk) and possible recommendation for surgical consultation. Five radiologists were considered less-experienced (<5 years), and five more-experienced (≥5 years). Interreader agreement was evaluated. Polyps were classified pathologically as nonneoplastic or neoplastic. Results: For risk category assignments, interreader agreement was substantial among all readers (k=0.710), less-experienced readers (k=0.705), and more-experienced readers (k=0.692). For surgical consultation recommendations, interreader agreement was substantial among all readers (k=0.795) and more-experienced readers (kappa=0.740), and almost perfect among less-experienced readers (k=0.811). Of ten readers, a median of 5 (IQR, 2-8), 4 (IQR, 2-7), and 0 (IQR, 0-0) classified polyps as extremely low risk, low risk, and indeterminate risk, respectively. Across readers, the fraction of polyps classified as extremely low risk ranged from 32-72%, as low risk from 24-65%, and as indeterminate risk from 0-8%. Of ten readers, a median of 0 (IQR, 0-1) recommended surgical consultation; the fraction of polyps receiving a surgical consultation recommendation ranged from 4-22%. A total of 102/105 polyps were nonneoplastic; 3/105 were neoplastic (all benign). Based on readers' most-common assessments for the nonneoplastic polyps, the risk category was extremely low risk in 53, low risk in 48, and indeterminate risk in 1; surgical consultation was recommended in 16. Conclusion: Ten abdominal radiologists showed substantial agreement for polyp risk categorizations and surgical consultation recommendations, although areas of reader variability were identified. Clinical Impact: The findings support overall reproducibility of the SRU recommendations, while indicating opportunity for improvement.
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Affiliation(s)
- Mark A Anderson
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Sarah Mercaldo
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jinjin Cao
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Nayla Mroueh
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Felipe S Furtado
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Rory L Cochran
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Ryan Chung
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Reece J Goiffon
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Madeleine Sertic
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Theodore T Pierce
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Aoife Kilcoyne
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Amirkasra Mojtahed
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Anuradha S Shenoy-Bhangle
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Onofrio A Catalano
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Abdominal Imaging Division, Massachusetts General Hospital, Boston, MA, Harvard Medical School, Boston, MA, 02114, USA
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Nassar L, Nakad S, Abou Zeid F, Farah Z, Saheb G, Mroueh N, Debs P, Berjawi G. Additional occult cancers identified on staging breast MRI: imaging appearances and pathologic characteristics. J Med Radiat Sci 2023; 70:360-368. [PMID: 37340705 PMCID: PMC10715349 DOI: 10.1002/jmrs.694] [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: 05/18/2022] [Accepted: 05/30/2023] [Indexed: 06/22/2023] Open
Abstract
INTRODUCTION Breast magnetic resonance imaging (MRI) is increasingly being used for staging of patients with breast cancer due to its high sensitivity in detecting additional cancers (ACs). However, the clinical impact of diagnosing and treating these cancers remains unclear. METHODS A retrospective study was undertaken of patients with newly diagnosed breast cancer who underwent staging MRI at The American University of Beirut Medical Centre (AUBMC) between 2012 and 2020. Pathology reports and breast MRI examinations were reviewed. Eighteen breast cancer patients with 19 pathology-proven index cancers (ICs) and 19 pathology-proven MRI-detected ACs were included. Chi-square and Fisher's exact tests for categorical variables and Wilcoxon signed rank test for numerical variables were used to compare ICs to ACs. RESULTS The ICs consisted of four ductal carcinoma in situ (DCIS), 13 invasive ductal carcinomas (IDC), of which five with associated DCIS, and two invasive lobular carcinomas, (ILC) of which one with associated DCIS. ACs comprised 12 DCIS, five IDC, two with associated DCIS and two ILC, one with associated DCIS. Interval cancers were more frequently invasive whereas ACs were more frequently in situ (P = 0.021). ACs were more frequently nuclear grade 2 (P = 0.009). There was no statistically significant difference between ICs and ACs in lesion type (P = 0.062), shape (P = 0.073), initial enhancement (P = 1), delayed enhancement (P = 0.732), hormonal receptor profile (P = 0.68) and Ki67 (P = 0.388). Among ACs, ten (53%) were larger than 10 mm of which five (26%) were invasive cancers, and five (26%) were larger than the ICs. CONCLUSIONS ACs detected by breast MRI were more likely to be in situ and to show a nuclear grade 2. Although not reaching statistical significance, some ACs tend to be clinically significant by their type, size or nuclear grade. The impact on clinical management remains to be determined.
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Affiliation(s)
- Lara Nassar
- Department of Diagnostic RadiologyAmerican University of Beirut Medical CenterBeirutLebanon
| | - Sanaa Nakad
- Department of Obstetrics and Gynecology/Division of Gynecologic OncologyThe University of ChicagoChicagoIllinoisUSA
| | - Farah Abou Zeid
- Department of Diagnostic RadiologyAmerican University of Beirut Medical CenterBeirutLebanon
| | - Zeina Farah
- Ministry of Public Health‐Epidemiological Surveillance ProgramBeirutLebanon
| | - Ghida Saheb
- Department of Diagnostic RadiologyAmerican University of Beirut Medical CenterBeirutLebanon
| | - Nayla Mroueh
- Department of Radiology/Division of Abdominal ImagingMassachusetts General HospitalBostonMassachusettsUSA
| | - Patrick Debs
- The Russel H. Morgan Department of Radiology and Radiological ScienceThe Johns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Ghina Berjawi
- Department of Diagnostic RadiologyAmerican University of Beirut Medical CenterBeirutLebanon
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Cao J, Mroueh N, Pisuchpen N, Parakh A, Lennartz S, Pierce TT, Kambadakone AR. Can 1.25 mm thin-section images generated with Deep Learning Image Reconstruction technique replace standard-of-care 5 mm images in abdominal CT? Abdom Radiol (NY) 2023; 48:3253-3264. [PMID: 37369922 DOI: 10.1007/s00261-023-03992-0] [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: 09/24/2022] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND CT image reconstruction has evolved from filtered back projection to hybrid- and model-based iterative reconstruction. Deep learning-based image reconstruction is a relatively new technique that uses deep convolutional neural networks to improve image quality. OBJECTIVE To evaluate and compare 1.25 mm thin-section abdominal CT images reconstructed with deep learning image reconstruction (DLIR) with 5 mm thick images reconstructed with adaptive statistical iterative reconstruction (ASIR-V). METHODS This retrospective study included 52 patients (31 F; 56.9±16.9 years) who underwent abdominal CT scans between August-October 2019. Image reconstruction was performed to generate 5 mm images at 40% ASIR-V and 1.25 mm DLIR images at three strengths (low [DLIR-L], medium [DLIR-M], and high [DLIR-H]). Qualitative assessment was performed to determine image noise, contrast, visibility of small structures, sharpness, and artifact based on a 5-point-scale. Image preference determination was based on a 3-point-scale. Quantitative assessment included measurement of attenuation, image noise, and contrast-to-noise ratios (CNR). RESULTS Thin-section images reconstructed with DLIR-M and DLIR-H yielded better image quality scores than 5 mm ASIR-V reconstructed images. Mean qualitative scores of DLIR-H for noise (1.77 ± 0.71), contrast (1.6 ± 0.68), small structure visibility (1.42 ± 0.66), sharpness (1.34 ± 0.55), and image preference (1.11 ± 0.34) were the best (p<0.05). DLIR-M yielded intermediate scores. All DLIR reconstructions showed superior ratings for artifacts compared to ASIR-V (p<0.05), whereas each DLIR group performed comparably (p>0.05, 0.405-0.763). In the quantitative assessment, there were no significant differences in attenuation values between all reconstructions (p>0.05). However, DLIR-H demonstrated the lowest noise (9.17 ± 3.11) and the highest CNR (CNRliver = 26.88 ± 6.54 and CNRportal vein = 7.92 ± 3.85) (all p<0.001). CONCLUSION DLIR allows generation of thin-section (1.25 mm) abdominal CT images, which provide improved image quality with higher inter-reader agreement compared to 5 mm thick images reconstructed with ASIR-V. CLINICAL IMPACT Improved image quality of thin-section CT images reconstructed with DLIR has several benefits in clinical practice, such as improved diagnostic performance without radiation dose penalties.
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Affiliation(s)
- Jinjin Cao
- Abdominal Radiology Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Nayla Mroueh
- Abdominal Radiology Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Nisanard Pisuchpen
- Abdominal Radiology Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
- Department of Radiology, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Anushri Parakh
- Abdominal Radiology Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Simon Lennartz
- Abdominal Radiology Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Theodore T Pierce
- Abdominal Radiology Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Avinash R Kambadakone
- Abdominal Radiology Division, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA.
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Elias C, Younis N, Allam J, Helou M, Sacca L, Sabbagh A, Mroueh N, Chalfoun M, Bardawil T, Kurban M, Eid E. Prevalence of Cosmetic Procedures among Lebanese Women. Skinmed 2022; 20:422-427. [PMID: 36537674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Lebanese women have been portrayed as conceited and obsessed with physical appearance and its beautification through cosmetic procedures. Despite the pervasiveness of this notion, no formal studies have been conducted to assess the true prevalence of cosmetic procedures among Lebanese women. Additionally, no data exist to elucidate trends in popularity of cosmetic procedures over time. A cross-sectional study was conducted across Lebanese universities where surveys were distributed to women aged 18-31 years to estimate the prevalence of surgical, noninvasive, and dental cosmetic procedures in young Lebanese women. The collected survey data were analyzed using the Statistical Package for the Social Sciences (SPSS). In a sample of 877 women, 44% reported having undergone at least one cosmetic procedure in their lifetime. The most popular procedures performed were laser hair removal (32%), teeth whitening (14%), and rhinoplasty (9.3%). The obtained results revealed an increasing prevalence of cosmetic procedures, mirroring global trends. A variety of factors have contributed to the increasing popularity of cosmetic procedures, namely, higher availability, better affordability, and wider social acceptance over time. (SKINmed. 2022;20:422-427).
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Affiliation(s)
- Charbel Elias
- Faculty of medicine, American University of Beirut, Beirut, Lebanon
| | - Nour Younis
- Faculty of medicine, American University of Beirut, Beirut, Lebanon
| | - Joelle Allam
- Faculty of medicine, American University of Beirut, Beirut, Lebanon
| | - Mario Helou
- Faculty of medicine, American University of Beirut, Beirut, Lebanon
| | - Lea Sacca
- Department of Health Promotion and Behavioral Science, University of Texas, Houston, TX
| | - Ali Sabbagh
- Faculty of medicine, American University of Beirut, Beirut, Lebanon
| | - Nayla Mroueh
- Faculty of medicine, American University of Beirut, Beirut, Lebanon
| | - Maria Chalfoun
- Faculty of medicine, American University of Beirut, Beirut, Lebanon
| | - Tara Bardawil
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
| | - Mazen Kurban
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon;
| | - Edward Eid
- Department of Dermatology, American University of Beirut, Beirut, Lebanon
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Singh R, Rai R, Mroueh N, Kambadakone A. Role of Dual Energy Computed Tomography in Inflammatory Bowel Disease. Semin Ultrasound CT MR 2022; 43:320-332. [PMID: 35738817 DOI: 10.1053/j.sult.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Dual-energy computed tomography (DECT), which allows material-based differential X-ray absorption behavior from near simultaneously acquired low- and high-kilovolt datasets is finding increasing applications in the evaluation of bowel diseases. In patients with inflammatory bowel disease, DECT techniques permit both qualitative and quantitative assessment. Particularly in patients with Crohn's disease, monoenergetic and iodine specific images have been explored. This article focuses on the principles and applications of DECT in inflammatory bowel disease along with review of its limitations and challenges.
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Affiliation(s)
- Ramandeep Singh
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Rubal Rai
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Nayla Mroueh
- Department of Radiology, Massachusetts General Hospital, Boston, MA
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Mroueh N, Cao J, Kambadakone A. Dual-Energy CT in the Pancreas. Journal of Gastrointestinal and Abdominal Radiology 2022. [DOI: 10.1055/s-0042-1744494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractDual-energy computed tomography (DECT) is an evolving imaging technology that is gaining popularity, particularly in different abdominopelvic applications. Essentially, DECT uses two energy spectra simultaneously to acquire CT attenuation data which is used to distinguish among structures with different tissue composition. The wide variety of reconstructed image data sets makes DECT especially attractive in pancreatic imaging. This article reviews the current literature on DECT as it applies to imaging the pancreas, focusing on pancreatitis, trauma, pancreatic ductal adenocarcinoma, and other solid and cystic neoplasms. The advantages of DECT over conventional CT are highlighted, including improved lesion detection, radiation dose reduction, and enhanced image contrast. Additionally, data exploring the ideal protocol for pancreatic imaging using DECT is reviewed. Finally, limitations of DECT in pancreatic imaging as well as recommendations for future research are provided.
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Affiliation(s)
- Nayla Mroueh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jinjin Cao
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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