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Lennartz S, Cao J, Pisuchpen N, Srinivas-Rao S, Locascio JJ, Parakh A, Hahn PF, Mileto A, Sahani D, Kambadakone A. Intra-patient variability of iodine quantification across different dual-energy CT platforms: assessment of normalization techniques. Eur Radiol 2024:10.1007/s00330-023-10560-z. [PMID: 38189979 DOI: 10.1007/s00330-023-10560-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/18/2023] [Accepted: 12/08/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVES To investigate intra-patient variability of iodine concentration (IC) between three different dual-energy CT (DECT) platforms and to test different normalization approaches. METHODS Forty-four patients who underwent portal venous phase abdominal DECT on a dual-source (dsDECT), a rapid kVp switching (rsDECT), and a dual-layer detector platform (dlDECT) during cancer follow-up were retrospectively included. IC in the liver, pancreas, and kidneys and different normalized ICs (NICPV:portal vein; NICAA:abdominal aorta; NICALL:overall iodine load) were compared between the three DECT scanners for each patient. A longitudinal mixed effects analysis was conducted to elucidate the effect of the scanner type, scan order, inter-scan time, and contrast media amount on normalized iodine concentration. RESULTS Variability of IC was highest in the liver (dsDECT vs. dlDECT 28.96 (14.28-46.87) %, dsDECT vs. rsDECT 29.08 (16.59-62.55) %, rsDECT vs. dlDECT 22.85 (7.52-33.49) %), and lowest in the kidneys (dsDECT vs. dlDECT 15.76 (7.03-26.1) %, dsDECT vs. rsDECT 15.67 (8.86-25.56) %, rsDECT vs. dlDECT 10.92 (4.92-22.79) %). NICALL yielded the best reduction of IC variability throughout all tissues and inter-scanner comparisons, yet did not reduce the variability between dsDECT vs. dlDECT and rsDECT, respectively, in the liver. The scanner type remained a significant determinant for NICALL in the pancreas and the liver (F-values, 12.26 and 23.78; both, p < 0.0001). CONCLUSIONS We found tissue-specific intra-patient variability of IC across different DECT scanner types. Normalization mitigated variability by reducing physiological fluctuations in iodine distribution. After normalization, the scanner type still had a significant effect on iodine variability in the pancreas and liver. CLINICAL RELEVANCE STATEMENT Differences in iodine quantification between dual-energy CT scanners can partly be mitigated by normalization, yet remain relevant for specific tissues and inter-scanner comparisons, which should be taken into account at clinical routine imaging. KEY POINTS • Iodine concentration showed the least variability between scanner types in the kidneys (range 10.92-15.76%) and highest variability in the liver (range 22.85-29.08%). • Normalizing tissue-specific iodine concentrations against the overall iodine load yielded the greatest reduction of variability between scanner types for 2/3 inter-scanner comparisons in the liver and for all (3/3) inter-scanner comparisons in the kidneys and pancreas, respectively. • However, even after normalization, the dual-energy CT scanner type was found to be the factor significantly influencing variability of iodine concentration in the liver and pancreas.
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Affiliation(s)
- Simon Lennartz
- Department of Radiology, Abdominal Radiology Division, 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
| | - Jinjin Cao
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Nisanard Pisuchpen
- Department of Radiology, Abdominal Radiology Division, 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
| | - Shravya Srinivas-Rao
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Joseph J Locascio
- Harvard Catalyst Biostatistical Unit, Harvard Medical School/Massachusetts General Hospital, Boston, MA, USA
| | - Anushri Parakh
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Peter F Hahn
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA
| | - Achille Mileto
- Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA
| | - Dushyant Sahani
- Department of Radiology, University of Washington, UWMC Radiology RR218, 1959 NE Pacific St, Seattle, WA, 98195, USA
| | - Avinash Kambadakone
- Department of Radiology, Abdominal Radiology Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114-2696, USA.
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Furtado FS, Wu MZ, Esfahani SA, Ferrone CR, Blaszkowsky LS, Clark JW, Ryan DP, Goyal L, Franses JW, Wo JY, Hong TS, Qadan M, Tanabe KK, Weekes CD, Cusack JC, Crafa F, Mahmood U, Anderson MA, Mojtahed A, Hahn PF, Caravan P, Kilcoyne A, Vangel M, Striar RM, Rosen BR, Catalano OA. Positron Emission Tomography/Magnetic Resonance Imaging (PET/MRI) Versus the Standard of Care Imaging in the Diagnosis of Peritoneal Carcinomatosis. Ann Surg 2023; 277:e893-e899. [PMID: 35185121 DOI: 10.1097/sla.0000000000005418] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare positron emission tomography (PET)/magnetic resonance imaging (MRI) to the standard of care imaging (SCI) for the diagnosis of peritoneal carcinomatosis (PC) in primary abdominopelvic malignancies. SUMMARY BACKGROUND DATA Identifying PC impacts prognosis and management of multiple cancer types. METHODS Adult subjects were prospectively and consecutively enrolled from April 2019 to January 2021. Inclusion criteria were: 1) acquisition of whole-body contrast-enhanced (CE) 18F-fluorodeoxyglucose PET/MRI, 2) pathologically confirmed primary abdominopelvic malignancies. Exclusion criteria were: 1) greater than 4 weeks interval between SCI and PET/MRI, 2) unavailable follow-up. SCI consisted of whole-body CE PET/computed tomography (CT) with diagnostic quality CT, and/or CE-CT of the abdomen and pelvis, and/or CE-MRI of the abdomen±pelvis. If available, pathology or surgical findings served as the reference standard, otherwise, imaging followup was used. When SCI and PET/MRI results disagreed, medical records were checked for management changes. Follow-up data were collected until August 2021. RESULTS One hundred sixty-four subjects were included, 85 (52%) were female, and the median age was 60 years (interquartile range 50-69). At a subject level, PET/MRI had higher sensitivity (0.97, 95% CI 0.86-1.00) than SCI (0.54, 95% CI 0.37-0.71), P < 0.001, without a difference in specificity, of 0.95 (95% CI 0.90-0.98) for PET/MRI and 0.98 (95% CI 0.93-1.00) for SCI, P ¼ 0.250. PET/MRI and SCI results disagreed in 19 cases. In 5/19 (26%) of the discordant cases, PET/MRI findings consistent with PC missed on SCI led to management changes. CONCLUSION PET/MRI improves detection of PC compared with SCI which frequently changes management.
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Affiliation(s)
- Felipe S Furtado
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA
| | - Mark Z Wu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Shadi A Esfahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lawrence S Blaszkowsky
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jeffrey W Clark
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - David P Ryan
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Lipika Goyal
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Joseph W Franses
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kenneth K Tanabe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Colin D Weekes
- Division of Hematology & Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - James C Cusack
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Umar Mahmood
- Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA
| | - Mark A Anderson
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Peter Caravan
- Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA
| | - Aoife Kilcoyne
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Mark Vangel
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Robin M Striar
- Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA
| | - Bruce R Rosen
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Athinoula A Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA
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Karaosmanoglu AD, Onder O, Kizilgoz V, Hahn PF, Kantarci M, Ozmen MN, Karcaaltincaba M, Akata D. Infarcts and ischemia in the abdomen: an imaging perspective with an emphasis on cross-sectional imaging findings. Abdom Radiol (NY) 2023; 48:2167-2195. [PMID: 36933024 PMCID: PMC10024022 DOI: 10.1007/s00261-023-03877-2] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
Infarcts and ischemia of abdominal organs may present with acute abdominal pain, and early diagnosis is crucial to prevent morbidity and mortality. Unfortunately, some of these patients present in poor clinical conditions to the emergency department, and imaging specialists are crucial for optimal outcomes. Although the radiological diagnosis of abdominal infarcts is often straightforward, it is vital to use the appropriate imaging modalities and correct imaging techniques for their detection. Additionally, some non-infarct-related abdominal pathologies may mimic infarcts, cause diagnostic confusion, and result in delayed diagnosis or misdiagnosis. In this article, we aimed to outline the general imaging approach, present cross-sectional imaging findings of infarcts and ischemia in several abdominal organs, including but not limited to, liver, spleen, kidneys, adrenals, omentum, and intestinal segments with relevant vascular anatomy, discuss possible differential diagnoses and emphasize important clinical/radiological clues that may assist radiologists in the diagnostic process.
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Affiliation(s)
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Volkan Kizilgoz
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Mecit Kantarci
- Department of Radiology, Erzincan Binali Yıldırım University School of Medicine, 24100, Erzincan, Turkey
- Department of Radiology, Atatürk University School of Medicine, 25240, Erzurum, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
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Pourvaziri A, Mojtahed A, Hahn PF, Gee MS, Kambadakone A, Sahani DV. Renal lesion characterization: clinical utility of single-phase dual-energy CT compared to MRI and dual-phase single-energy CT. Eur Radiol 2023; 33:1318-1328. [PMID: 36074261 DOI: 10.1007/s00330-022-09106-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/13/2022] [Accepted: 08/10/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To assess the impact of dual-energy CT (DECT) utilization in practice by measuring the readers' confidence, the need for additional image requests, and diagnostic performance in renal lesion assessment, compared to single-energy CT (SECT) using contrast-enhanced MRI to establish the reference standard. MATERIALS AND METHODS Sixty-nine patients (M/F = 47/22) who underwent a dual-phase renal SECT (n = 34) or DECT (n = 35) and had a contrast-enhanced MRI within 180 days were retrospectively collected. Three radiologists assessed images on different sessions (SECT, DECT, and MRI) for (1) likely diagnosis (enhancing/non-enhancing); (2) diagnostic confidence (5-point Likert scale); (3) need for additional imaging test (yes/no); and (4) need for follow-up imaging (yes/no). Diagnostic accuracy was compared using AUC; p value < 0.05 was considered significant. RESULTS One hundred fifty-six lesions consisting of 18% enhancing (n = 28/156, mean size: 30.37 mm, range: 9.9-94 mm) and 82% non-enhancing (n = 128/156, mean size: 23.91 mm, range: 5.0-94.2 mm) were included. The confidence level was significantly lower for SECT than their MRI (4.50 vs. 4.80, p value < 0.05) but not significantly different for DECT and the corresponding MRI (4.78 vs. 4.78, p > 0.05). There were significantly more requests for additional imaging in the SECT session than the corresponding MRI (20% vs. 4%), which was not significantly different between DECT and their MRI counterpart session (5.7% vs. 4.9%). Inter-reader agreement was almost perfect for DECT and MRI (kappa: 0.8-1) and substantial in SECT sessions (kappa: 0.6-0.8) with comparable diagnostic accuracy between SECT, DECT, and MRI (p value > 0.05). CONCLUSION Single-phase DECT allows confident and reproducible characterization of renal masses with fewer recommendation for additional and follow-up imaging tests than dual-phase SECT and a performance similar to MRI. KEY POINTS • DECT utilization leads to similar additional image requests to MRI (5.7% vs. 4.9%, p value > 0.05), whereas single-energy CT utilization leads to significantly higher image requests (20% vs. 4%, p value < 0.05). • DECT and MRI utilization bring highly reproducible results with almost perfect inter-reader agreement (kappa: 0.8-1), better than the inter-reader agreement in SECT utilization (kappa: 0.6-0.8). • Readers' confidence was not significantly altered between DECT and their MRI readout session (p value > 0.05). In contrast, confidence in the diagnosis was significantly lower in the SECT session than their MRI readout (p value < 0.05).
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Affiliation(s)
- Ali Pourvaziri
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA.
| | - Amirkasra Mojtahed
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA, 02114, USA
| | - Dushyant V Sahani
- Department of Radiology, University of Washington, Seattle, WA, 98195, USA
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Affiliation(s)
- Amy W Baughman
- From the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Massachusetts General Hospital, and the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Harvard Medical School - both in Boston
| | - Nancy J Wei
- From the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Massachusetts General Hospital, and the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Harvard Medical School - both in Boston
| | - Peter F Hahn
- From the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Massachusetts General Hospital, and the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Harvard Medical School - both in Boston
| | - Brenna W Casey
- From the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Massachusetts General Hospital, and the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Harvard Medical School - both in Boston
| | - M Lisa Zhang
- From the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Massachusetts General Hospital, and the Departments of Medicine (A.W.B., N.J.W., B.W.C.), Radiology (P.F.H.), and Pathology (M.L.Z.), Harvard Medical School - both in Boston
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Lennartz S, Pisuchpen N, Parakh A, Cao J, Baliyan V, Sahani D, Hahn PF, Kambadakone A. Virtual Unenhanced Images: Qualitative and Quantitative Comparison Between Different Dual-Energy CT Scanners in a Patient and Phantom Study. Invest Radiol 2022; 57:52-61. [PMID: 34162795 DOI: 10.1097/rli.0000000000000802] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
MATERIALS AND METHODS Forty-four patients with clinical contrast-enhanced abdominal examinations on each of the 3 DECT scanner types and a phantom scanned with the same protocols were included in this retrospective study. Qualitative and quantitative assessment was performed on VUE images. Quantitative evaluation included measurement of attenuation and image noise for various tissues and the phantom. Virtual unenhanced image attenuation and noise were compared between scanner types, and intrapatient interscanner reproducibility of virtual unenhanced image attenuation was calculated as the percentage of measurement pairs with an interscanner difference ≤ 10 HU. Image quality, noise, sharpness, and iodine elimination were assessed qualitatively by 2 radiologists. RESULTS Significant interscanner differences in VUE attenuation and noise were found in all tissues. dlDECT and rsDECT showed significantly higher VUE attenuation than dsDECT in the aorta, portal vein, and kidneys (P < 0.05). Conversely, VUE attenuation in dsDECT was significantly higher than in dlDECT/rsDECT for subcutaneous and retroperitoneal fat (both P < 0.05). A total of 91.9% (385/419) of measurements were reproducible between rsDECT and dlDECT, 70.9% (297/419) between dsDECT and rsDECT, and 66.8% (280/419) between dsDECT and dlDECT. Virtual unenhanced image attenuation in the contrast media-filled phantom cavity was 12.7 ± 4.7 HU in dlDECT, -5.3 ± 4.2 HU in rsDECT, and -4.0 ± 10.7 HU in dsDECT with significant differences between dlDECT and rsDECT/dsDECT, respectively (P < 0.05), between which attenuation was comparable in the unenhanced extraluminal phantom component (P = 0.11-0.62). Qualitatively, dsDECT yielded best iodine elimination, whereas sharpness, image noise, and overall image quality were rated higher in dlDECT and rsDECT. CONCLUSIONS There are significant interscanner differences in the attenuation measurements and qualitative assessment of VUE images, which should be acknowledged when using these images in patients that are being scanned on different DECT scanner types during imaging follow-up.
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Affiliation(s)
| | | | - Anushri Parakh
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Jinjin Cao
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Vinit Baliyan
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Dushyant Sahani
- Department of Radiology, University of Washington, Seattle, WA
| | - Peter F Hahn
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Avinash Kambadakone
- From the Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Karaosmanoglu AD, Uysal A, Onder O, Hahn PF, Akata D, Ozmen MN, Karcaaltıncaba M. Cross-sectional imaging findings of splenic infections: is differential diagnosis possible? Abdom Radiol (NY) 2021; 46:4828-4852. [PMID: 34047800 PMCID: PMC8160561 DOI: 10.1007/s00261-021-03130-8] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 01/31/2023]
Abstract
The spleen plays an important role in the immunological homeostasis of the body. Several neoplastic and non-neoplastic diseases may affect this organ, and imaging is of fundamental importance for diagnosis. Infectious diseases of the spleen can be encountered in daily radiology practice, and differential diagnosis may sometimes be challenging. Infectious involvement of the spleen can be primary or secondary to a different source outside the spleen. Despite the fact that different infectious diseases may cause similar imaging findings, we believe that differential diagnosis between different causes may also be possible in certain patients with imaging. Early diagnosis may potentially enhance patients’ treatment and outcome. In this review, we aimed to increase imaging specialists’ awareness of splenic infections by describing the multimodality imaging features of common and atypical infections of the spleen with their differential diagnoses.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, Ankara, 06010, Turkey
| | - Omer Onder
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
| | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, 06100, Turkey
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Noda Y, Tochigi T, Parakh A, Joseph E, Hahn PF, Kambadakone A. Low keV portal venous phase as a surrogate for pancreatic phase in a pancreatic protocol dual-energy CT: feasibility, image quality, and lesion conspicuity. Eur Radiol 2021; 31:6898-6908. [PMID: 33744992 DOI: 10.1007/s00330-021-07744-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 01/03/2021] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the feasibility of a proposed pancreatic protocol CT generated from portal-venous phase (PVP) dual-energy CT (DECT) acquisition and its impact on image quality, lesion conspicuity, and arterial visualization/involvement. METHODS We included 111 patients (mean age, 66.8 years) who underwent pancreatic protocol DECT (pancreatic phase, PP, and PVP). The original DECT acquisition was used to create two data sets-standard protocol (50 keV PP/65 keV PVP) and proposed protocol (40 keV/65 keV PVP). Three reviewers evaluated the two data sets for image quality, lesion conspicuity, and arterial visualization/involvement using a 5-point scale. The signal-to-noise ratio (SNR) of pancreas and lesion-to-pancreas contrast-to-noise ratio (CNR) was calculated. Qualitative scores, quantitative parameters, and dose-length product (DLP) were compared between standard and proposed protocols. RESULTS The image quality, SNR of pancreas, and lesion-to-pancreas CNR of the standard and proposed protocol were comparable (p = 0.11-1.00). Lesion conspicuity was comparable between the standard and proposed protocols for pancreatic ductal adenocarcinoma (p = 0.55) and pancreatic cysts (p = 0.28). The visualization of larger arteries and arterial involvement were comparable between the two protocols (p = 0.056-1.00) while the scores were higher for smaller vessels in the standard protocol (p < 0.0001-0.0015). DLP of the proposed protocol (670.4 mGy·cm) showed a projected 42% reduction than the standard protocol (1145.9 mGy·cm) (p < 0.0001). CONCLUSION Pancreatic protocol CT generated from a single PVP DECT acquisition is feasible and could potentially be an alternative to the standard pancreatic protocol with PP and PVP. KEY POINTS • The lesion conspicuity for focal pancreatic lesions was comparable between the proposed protocol and standard dual-phase pancreatic protocol CT. • Qualitative and quantitative image assessments were almost comparable between two protocols. • The radiation dose of a proposed protocol showed a projected 42% reduction from the conventional protocol.
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Affiliation(s)
- Yoshifumi Noda
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Department of Radiology, Gifu University, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Toru Tochigi
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA.,Department of Frontier Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba City, 260-8670, Japan
| | - Anushri Parakh
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Evita Joseph
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White 270, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
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Bhayana R, Som A, Li MD, Carey DE, Anderson MA, Blake MA, Catalano O, Gee MS, Hahn PF, Harisinghani M, Kilcoyne A, Lee SI, Mojtahed A, Pandharipande PV, Pierce TT, Rosman DA, Saini S, Samir AE, Simeone JF, Gervais DA, Velmahos G, Misdraji J, Kambadakone A. Abdominal Imaging Findings in COVID-19: Preliminary Observations. Radiology 2020; 297:E207-E215. [PMID: 32391742 PMCID: PMC7508000 DOI: 10.1148/radiol.2020201908] [Citation(s) in RCA: 215] [Impact Index Per Article: 53.8] [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] [Indexed: 02/06/2023]
Abstract
Background Angiotensin-converting enzyme 2, a target of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), demonstrates its highest surface expression in the lung, small bowel, and vasculature, suggesting abdominal viscera may be susceptible to injury. Purpose To report abdominal imaging findings in patients with coronavirus disease 2019. Materials and Methods In this retrospective cross-sectional study, patients consecutively admitted to a single quaternary care center from March 27 to April 10, 2020, who tested positive for SARS-CoV-2 were included. Abdominal imaging studies performed in these patients were reviewed, and salient findings were recorded. Medical records were reviewed for clinical data. Univariable analysis and logistic regression were performed. Results A total of 412 patients (average age, 57 years; range, 18 to >90 years; 241 men, 171 women) were evaluated. A total of 224 abdominal imaging studies were performed (radiography, n = 137; US, n = 44; CT, n = 42; MRI, n = 1) in 134 patients (33%). Abdominal imaging was associated with age (odds ratio [OR], 1.03 per year of increase; P = .001) and intensive care unit (ICU) admission (OR, 17.3; P < .001). Bowel-wall abnormalities were seen on 31% of CT images (13 of 42) and were associated with ICU admission (OR, 15.5; P = .01). Bowel findings included pneumatosis or portal venous gas, seen on 20% of CT images obtained in patients in the ICU (four of 20). Surgical correlation (n = 4) revealed unusual yellow discoloration of the bowel (n = 3) and bowel infarction (n = 2). Pathologic findings revealed ischemic enteritis with patchy necrosis and fibrin thrombi in arterioles (n = 2). Right upper quadrant US examinations were mostly performed because of liver laboratory findings (87%, 32 of 37), and 54% (20 of 37) revealed a dilated sludge-filled gallbladder, suggestive of bile stasis. Patients with a cholecystostomy tube placed (n = 4) had negative bacterial cultures. Conclusion Bowel abnormalities and gallbladder bile stasis were common findings on abdominal images of patients with coronavirus disease 2019. Patients who underwent laparotomy often had ischemia, possibly due to small-vessel thrombosis. © RSNA, 2020
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Affiliation(s)
- Rajesh Bhayana
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Avik Som
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Matthew D Li
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Denston E Carey
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Mark A Anderson
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Michael A Blake
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Onofrio Catalano
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Michael S Gee
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Peter F Hahn
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Mukesh Harisinghani
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Aoife Kilcoyne
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Susanna I Lee
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Amirkasra Mojtahed
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Pari V Pandharipande
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Theodore T Pierce
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - David A Rosman
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Sanjay Saini
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Anthony E Samir
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Joseph F Simeone
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Debra A Gervais
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - George Velmahos
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Joseph Misdraji
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
| | - Avinash Kambadakone
- From the Division of Abdominal Imaging, Department of Radiology (R.B., A.S., M.D.L., M.A.A., M.A.B., O.C., M.S.G., P.F.H., M.H., A. Kilcoyne, S.I.L., A.M., P.V.P., T.T.P., D.A.R., S.S., A.E.S., J.F.S., D.A.G., A. Kambadakone), Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of Surgery (G.V.), and Department of Pathology (J.M.), Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696; and Harvard Medical School, Boston, Mass (D.E.C.)
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Karaosmanoglu AD, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Kraeft J, Hahn PF. Imaging findings of infectious and inflammatory diseases of the urinary system mimicking neoplastic diseases. Abdom Radiol (NY) 2020; 45:1110-1121. [PMID: 31570959 DOI: 10.1007/s00261-019-02222-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neoplastic diseases affecting the urinary organs are common, and diagnosis by imaging is usually straightforward. However, infectious/inflammatory processes also commonly affect these organs and can be mistaken for a neoplasm. Familiarity with these potential mimickers and awareness of their imaging presentations are key for correct diagnosis. We present the imaging findings of non-neoplastic infectious/inflammatory diseases that can mimic a neoplastic process.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
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Karaosmanoglu AD, Uysal A, Karcaaltincaba M, Akata D, Ozmen MN, Kraeft J, Hahn PF. Non-neoplastic hepatopancreatobiliary lesions simulating malignancy: can we differentiate? Insights Imaging 2020; 11:21. [PMID: 32040641 PMCID: PMC7010905 DOI: 10.1186/s13244-019-0813-8] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 01/12/2023] Open
Abstract
Despite the success of cross-sectional imaging in evaluating hepatopancreatobiliary system malignancies, several non-malignant disease processes may closely mimic malignancy. Differentiating these benign diseases from malignancy may be difficult, or even impossible, even in the hands of experienced imagers. In this manuscript, we present benign mimics involving the hepatopancreatobiliary system and try to increase awareness of these potential pitfalls.
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Affiliation(s)
| | - Aycan Uysal
- Department of Radiology, Gulhane Training and Research Hospital, 06010, Ankara, Turkey
| | | | - Deniz Akata
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Mustafa Nasuh Ozmen
- Department of Radiology, Hacettepe University School of Medicine, 06100, Ankara, Turkey
| | - Jessica Kraeft
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Karaosmanoglu AD, Uysal A, Onur MR, Hahn PF, Ayhan AS, Ozmen MN, Akata D, Karcaaltincaba M. Primary lymphomas of the intraabdominal solid organs and the gastrointestinal tract: spectrum of imaging findings with histopathological confirmation. Abdom Radiol (NY) 2019; 44:2988-3005. [PMID: 31209544 DOI: 10.1007/s00261-019-02100-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Unlike nodal lymphoma, primary lymphomas of the intraabdominal organs are uncommon neoplasms whose diagnosis may be challenging in certain clinical circumstances. Despite this difficulty for imaging diagnosis, there are several imaging features on ultrasonography, computed tomography, magnetic resonance imaging, and positron emission tomography that may suggest the correct diagnosis. The scope of this review is to describe and illustrate the imaging features of primary lymphoma of intraabdominal organs providing clues to the diagnosis, together with their pathological correlations.
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Dhyani M, Grajo JR, Rodriguez D, Chen Z, Feldman A, Tambouret R, Gervais DA, Arellano RS, Hahn PF, Samir AE. Aorta-Lesion-Attenuation-Difference (ALAD) on contrast-enhanced CT: a potential imaging biomarker for differentiating malignant from benign oncocytic neoplasms. Abdom Radiol (NY) 2017; 42:1734-1743. [PMID: 28197683 DOI: 10.1007/s00261-017-1061-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To evaluate whether the Aorta-Lesion-Attenuation-Difference on contrast-enhanced CT can aid in the differentiation of malignant and benign oncocytic renal neoplasms. MATERIALS AND METHODS Two independent cohorts-an initial (biopsy) dataset and a validation (surgical) dataset-with oncocytomas and chromophobe renal cell carcinomas (chRCC) were included in this IRB-approved retrospective study. A region of interest was placed on the renal mass and abdominal aorta on the same CT image slice to calculate an Aorta-Lesion-Attenuation-Difference (ALAD). ROC curves were plotted for different enhancement phases, and diagnostic performance of ALAD for differentiating chRCC from oncocytomas was calculated. RESULTS Seventy-nine renal masses (56 oncocytomas, 23 chRCC) were analyzed in the initial (biopsy) dataset. Thirty-six renal masses (16 oncocytomas, 20 chRCC) were reviewed in the validation (surgical) cohort. ALAD showed a statistically significant difference between oncocytomas and chromophobes during the nephrographic phase (p < 0.001), early excretory phase (p < 0.001), and excretory phase (p = 0.029). The area under the ROC curve for the nephrographic phase was 1.00 (95% CI: 1.00-1.00) for the biopsy dataset and showed the narrowest confidence interval. At a threshold value of 25.5 HU, sensitivity was 100 (82.2%-100%) and specificity was 81.5 (61.9%-93.7%). When tested on the validation dataset on measurements made by an independent reader, the AUROC was 0.93 (95% CI: 0.84-1.00) with a sensitivity of 100 (80.0%-100%) and a specificity of 87.5 (60.4%-97.8%). CONCLUSIONS Nephrographic phase ALAD has potential to differentiate benign and malignant oncocytic renal neoplasms on contrast-enhanced CT if histologic evaluation on biopsy is indeterminate.
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Catalano OA, Coutinho AM, Sahani DV, Vangel MG, Gee MS, Hahn PF, Witzel T, Soricelli A, Salvatore M, Catana C, Mahmood U, Rosen BR, Gervais D. Colorectal cancer staging: comparison of whole-body PET/CT and PET/MR. Abdom Radiol (NY) 2017; 42:1141-1151. [PMID: 27891551 DOI: 10.1007/s00261-016-0985-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE Correct staging is imperative for colorectal cancer (CRC) since it influences both prognosis and management. Several imaging methods are used for this purpose, with variable performance. Positron emission tomography-magnetic resonance (PET/MR) is an innovative imaging technique recently employed for clinical application. The present study was undertaken to compare the staging accuracy of whole-body positron emission tomography-computed tomography (PET/CT) with whole-body PET/MR in patients with both newly diagnosed and treated colorectal cancer. METHODS Twenty-six patients, who underwent same day whole-body (WB) PET/CT and WB-PET/MR, were evaluated. PET/CT and PET/MR studies were interpreted by consensus by a radiologist and a nuclear medicine physician. Correlations with prior imaging and follow-up studies were used as the reference standard. Correct staging was compared between methods using McNemar's Chi square test. RESULTS The two methods were in agreement and correct for 18/26 (69%) patients, and in agreement and incorrect for one patient (3.8%). PET/MR and PET/CT stages for the remaining 7/26 patients (27%) were discordant, with PET/MR staging being correct in all seven cases. PET/MR significantly outperformed PET/CT overall for accurate staging (P = 0.02). CONCLUSION PET/MR outperformed PET/CT in CRC staging. PET/MR might allow accurate local and distant staging of CRC patients during both at the time of diagnosis and during follow-up.
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Affiliation(s)
- Onofrio A Catalano
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA.
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA.
| | - Artur M Coutinho
- Department of Nuclear Medicine, University of São Paulo Medical School (FMUSP) and Hospital Sirio-Libanes, Sao Paulo, 01308-050, Brazil
| | - Dushyant V Sahani
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA
| | - Mark G Vangel
- Department of Radiology, MGH Biostatistics Center and MGH Martinos Center, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Michael S Gee
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA
- Department of Radiology, Pediatric Imaging, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Peter F Hahn
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA
| | - Thomas Witzel
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Andrea Soricelli
- Department of Radiology, University of Naples Parthenope, Via F. Acton 38, 80143, Naples, Italy
| | - Marco Salvatore
- Department of Nuclear Medicine, SDN IRCCS, Via Gianturco 113, 80143, Naples, Italy
| | - Ciprian Catana
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Umar Mahmood
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
- Department of Radiology, Nuclear Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA
| | - Bruce R Rosen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard University Medical School, 149 Thirteenth Street, Charlestown, MA, 02129, USA
| | - Debra Gervais
- Department of Radiology, Abdominal Imaging, Massachusetts General Hospital, Harvard Medical School, WHT 270, 55 Fruit St, Boston, MA, 02114, USA
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Patino M, Prochowski A, Agrawal MD, Simeone FJ, Gupta R, Hahn PF, Sahani DV. Material Separation Using Dual-Energy CT: Current and Emerging Applications. Radiographics 2017; 36:1087-105. [PMID: 27399237 DOI: 10.1148/rg.2016150220] [Citation(s) in RCA: 184] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Dual-energy (DE) computed tomography (CT) offers the opportunity to generate material-specific images on the basis of the atomic number Z and the unique mass attenuation coefficient of a particular material at different x-ray energies. Material-specific images provide qualitative and quantitative information about tissue composition and contrast media distribution. The most significant contribution of DE CT-based material characterization comes from the capability to assess iodine distribution through the creation of an image that exclusively shows iodine. These iodine-specific images increase tissue contrast and amplify subtle differences in attenuation between normal and abnormal tissues, improving lesion detection and characterization in the abdomen. In addition, DE CT enables computational removal of iodine influence from a CT image, generating virtual noncontrast images. Several additional materials, including calcium, fat, and uric acid, can be separated, permitting imaging assessment of metabolic imbalances, elemental deficiencies, and abnormal deposition of materials within tissues. The ability to obtain material-specific images from a single, contrast-enhanced CT acquisition can complement the anatomic knowledge with functional information, and may be used to reduce the radiation dose by decreasing the number of phases in a multiphasic CT examination. DE CT also enables generation of energy-specific and virtual monochromatic images. Clinical applications of DE CT leverage both material-specific images and virtual monochromatic images to expand the current role of CT and overcome several limitations of single-energy CT. (©)RSNA, 2016.
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Affiliation(s)
- Manuel Patino
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Andrea Prochowski
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Mukta D Agrawal
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Frank J Simeone
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Rajiv Gupta
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Peter F Hahn
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
| | - Dushyant V Sahani
- From the Division of Abdominal Imaging, Department of Radiology (M.P., A.P., M.D.A., F.J.S., R.G., D.V.S.), and Department of Abdominal Imaging and Intervention (P.F.H.), Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114
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Abstract
Kidney neoplasms are common diseases with varying prognoses depending on the subtype of the tumor. The most common solid lesion of the kidney is renal cell carcinoma, and the treatment is typically surgical removal. With increasing use of cross-sectional imaging in the last two decades, the detection of renal lesions has significantly increased, especially in asymptomatic patients who are scanned for other reasons. In this article, we present the imaging findings of rare solid benign primary kidney neoplasms including renal leiomyoma, reninoma, carcinoid tumor, metanephric adenoma, solitary fibrous tumor of the kidney, lipomatous hemangiopericytoma of the kidney, renal schwannoma, inflammatory myofibroblastic tumor of the kidney, extramedullary hematopoiesis in the kidney, and extranodal renal Rosai-Dorfman disease. Accurate preoperative or prebiopsy diagnoses of these lesions are unusual; however, informed radiologists may sometimes be able to favorably change the patient management and treatment.
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Guimaraes AR, Siqueira L, Uppal R, Alford J, Fuchs BC, Yamada S, Tanabe K, Chung RT, Lauwers G, Chew ML, Boland GW, Sahani DV, Vangel M, Hahn PF, Caravan P. T2 relaxation time is related to liver fibrosis severity. Quant Imaging Med Surg 2016; 6:103-14. [PMID: 27190762 DOI: 10.21037/qims.2016.03.02] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The grading of liver fibrosis relies on liver biopsy. Imaging techniques, including elastography and relaxometric, techniques have had varying success in diagnosing moderate fibrosis. The goal of this study was to determine if there is a relationship between the T2-relaxation time of hepatic parenchyma and the histologic grade of liver fibrosis in patients with hepatitis C undergoing both routine, liver MRI and liver biopsy, and to validate our methodology with phantoms and in a rat model of liver fibrosis. METHODS This study is composed of three parts: (I) 123 patients who underwent both routine, clinical liver MRI and biopsy within a 6-month period, between July 1999 and January 2010 were enrolled in a retrospective study. MR imaging was performed at 1.5 T using dual-echo turbo-spin echo equivalent pulse sequence. T2 relaxation time of liver parenchyma in patients was calculated by mono-exponential fit of a region of interest (ROI) within the right lobe correlating to histopathologic grading (Ishak 0-6) and routine serum liver inflammation [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)]. Statistical comparison was performed using ordinary logistic and ordinal logistic regression and ANOVA comparing T2 to Ishak fibrosis without and using AST and ALT as covariates; (II) a phantom was prepared using serial dilutions of dextran coated magnetic iron oxide nanoparticles. T2 weighed imaging was performed by comparing a dual echo fast spin echo sequence to a Carr-Purcell-Meigboom-Gill (CPMG) multi-echo sequence at 1.5 T. Statistical comparison was performed using a paired t-test; (III) male Wistar rats receiving weekly intraperitoneal injections of phosphate buffer solution (PBS) control (n=4 rats); diethylnitrosamine (DEN) for either 5 (n=5 rats) or 8 weeks (n=4 rats) were MR imaged on a Bruker Pharmascan 4.7 T magnet with a home-built bird-cage coil. T2 was quantified by using a mono-exponential fitting algorithm on multi-slice multi echo T2 weighted data. Statistical comparison was performed using ANOVA. RESULTS (I) Histopathologic evaluation of both rat and human livers demonstrated no evidence of steatosis or hemochromatosis There was a monotonic increase in mean T2 value with increasing degree of fibrosis (control 65.4±2.9 ms, n=6 patients); mild (Ishak 1-2) 66.7±1.9 ms (n=30); moderate (Ishak 3-4) 71.6±1.7 ms (n=26); severe (Ishak 5-6) 72.4±1.4 ms (n=61); with relatively low standard error (~2.9 ms). There was a statistically significant difference between degrees of mild (Ishak <4) vs. moderate to severe fibrosis (Ishak >4) (P=0.03) based on logistic regression of T2 and Ishak, which became insignificant (P=0.07) when using inflammatory markers as covariates. Expanding on this model using ordinal logistic regression, there was significance amongst all 4 groups comparing T2 to Ishak (P=0.01), with significance using inflammation as a covariate (P=0.03) and approaching statistical significance amongst all groups by ANOVA (P=0.07); (II) there was a monotonic increase in T2 and statistical significance (ANOVA P<0.0001) between each rat subgroup [phosphate buffer solution (PBS) 25.2±0.8, DEN 5-week (31.1±1.5), and DEN 9-week (49.4±0.4) ms]; (III) the phantoms that had T2 values within the relevant range for the human liver (e.g., 20-100 ms), demonstrated no statistical difference between two point fits on turbo spin echo (TSE) data and multi-echo CPMG data (P=0.9). CONCLUSIONS The finding of increased T2 with liver fibrosis may relate to inflammation that may be an alternative or adjunct to other noninvasive MR imaging based approaches for assessing liver fibrosis.
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Affiliation(s)
- Alexander R Guimaraes
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Luiz Siqueira
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ritika Uppal
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jamu Alford
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Bryan C Fuchs
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Suguru Yamada
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Kenneth Tanabe
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Raymond T Chung
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Gregory Lauwers
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Michael L Chew
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Giles W Boland
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Duhyant V Sahani
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Mark Vangel
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter F Hahn
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Peter Caravan
- 1 Division of Abdominal Imaging and Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA ; 2 Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA ; 3 Section for Body Imaging, Department of Radiology, Oregon Health & Sciences University, Portland, OR 97239, USA ; 4 Division of Surgical Oncology, Department of Surgery, 5 Division of Hepatology, Department of Medicine, 6 Department of Pathology, 7 Department of Biostatistics, Massachusetts General Hospital, Boston, MA 02114, USA
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Cruz-Romero C, Agarwal S, Abujudeh HH, Thrall J, Hahn PF. Spleen volume on CT and the effect of abdominal trauma. Emerg Radiol 2016; 23:315-23. [DOI: 10.1007/s10140-016-1402-5] [Citation(s) in RCA: 10] [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] [Received: 02/29/2016] [Accepted: 04/29/2016] [Indexed: 01/05/2023]
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Hedgire S, Tonyushkin A, Kilcoyne A, Efstathiou JA, Hahn PF, Harisinghani M. Quantitative study of prostate cancer using three dimensional fiber tractography. World J Radiol 2016; 8:397-402. [PMID: 27158426 PMCID: PMC4840197 DOI: 10.4329/wjr.v8.i4.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 11/17/2015] [Accepted: 02/16/2016] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate feasibility of a quantitative study of prostate cancer using three dimensional (3D) fiber tractography.
METHODS: In this institutional review board approved retrospective study, 24 men with biopsy proven prostate cancer underwent prostate magnetic resonance imaging (MRI) with an endorectal coil on a 1.5 T MRI scanner. Single shot echo-planar diffusion weighted images were acquired with b = 0.600 s/mm2, six gradient directions. Open-source available software TrackVis and its Diffusion Toolkit were used to generate diffusion tensor imaging (DTI) map and 3D fiber tracts. Multiple 3D spherical regions of interest were drawn over the areas of tumor and healthy prostatic parenchyma to measure tract density, apparent diffusion coefficient (ADC) and fractional anisotropy (FA), which were statistically analyzed.
RESULTS: DTI tractography showed rich fiber tract anatomy with tract heterogeneity. Mean tumor region and normal parenchymal tract densities were 2.53 and 3.37 respectively (P < 0.001). In the tumor, mean ADC was 0.0011 × 10-3 mm2/s vs 0.0014 × 10-3 mm2/s in the normal parenchyma (P < 0.001). The FA values for tumor and normal parenchyma were 0.2047 and 0.2259 respectively (P = 0.3819).
CONCLUSION: DTI tractography of the prostate is feasible and depicts congregate fibers within the gland. Tract density may offer new biomarker to distinguish tumor from normal tissue.
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Agarwal S, Grajo JR, Fuentes-Orrego JM, Abtahi SM, Harisinghani MG, Saini S, Hahn PF. Distinguishing hemangiomas from metastases on liver MRI performed with gadoxetate disodium: Value of the extended washout sign. Eur J Radiol 2016; 85:635-40. [DOI: 10.1016/j.ejrad.2015.12.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 12/07/2015] [Accepted: 12/29/2015] [Indexed: 12/11/2022]
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Huang SY, Seethamraju RT, Patel P, Hahn PF, Kirsch JE, Guimaraes AR. Body MR Imaging: Artifacts, k-Space, and Solutions-Erratum. Radiographics 2015; 35:1624. [PMID: 26371587 DOI: 10.1148/rg.2015154016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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22
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Fagenholz PJ, Peev MP, Thabet A, Michailidou M, Chang Y, Mueller PR, Hahn PF, Velmahos GC. Abscess due to perforated appendicitis: factors associated with successful percutaneous drainage. Am J Surg 2015; 212:794-798. [PMID: 26499054 DOI: 10.1016/j.amjsurg.2015.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 04/03/2015] [Revised: 07/06/2015] [Accepted: 07/19/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous drainage is the standard treatment for perforated appendicitis with abscess. We studied factors associated with complete resolution (CR) with percutaneous drainage alone. METHODS Ninety-eight patients underwent percutaneous drainage for acute appendicitis complicated by abscess (October 1990 to September 2010). CR was defined as clinical recovery, resolution of the abscess on imaging, and drain removal without recurrence. Patients achieving CR were compared with patients not achieving CR. RESULTS The rate of CR was 78.6% (n = 77). Abscess grade was the only radiological factor associated with CR (P = .007). The CR rate was higher with transgluteal drainage (90.9% vs 79.2%) than with other anatomic approaches (P = .018) and higher with computed tomography-guided drainage than with ultrasound-guided drainage (82.7% vs 64.3%, P = .046). CONCLUSION CR was more likely to be achieved in patients with lower abscess grade, computed tomography-guided drainage, and a transgluteal approach.
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Affiliation(s)
- Peter J Fagenholz
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA.
| | - Miroslav P Peev
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Ashraf Thabet
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Maria Michailidou
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Yuchiao Chang
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Peter R Mueller
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter F Hahn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA
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23
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Niska JR, Keane FK, Wolfgang JA, Hahn PF, Wo JY, Zhu AX, Hong TS. Impact of intravenous contrast enhancement phase on target definition for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC): Observations from patients enrolled on a prospective phase 2 trial. Pract Radiat Oncol 2015; 6:e9-16. [PMID: 26598907 DOI: 10.1016/j.prro.2015.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [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: 05/05/2015] [Revised: 08/17/2015] [Accepted: 08/22/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The safety and efficacy of radiation therapy for hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC) depend on accurate definition of gross tumor volume (GTV), but GTV often varies between phases of multiphasic computed tomography (CT) imaging. METHODS We contoured GTVs on arterial, portal venous, and delayed phases of multiphasic CT scans for 32 patients treated on an institutional review board-approved prospective trial of proton therapy for primary liver tumors and determined which phase provided optimal GTV visualization. We assessed agreement between individual phase GTVs to determine if GTV for each phase was encompassed in a 5-mm expansion of either the smallest or the best-visualized GTV. RESULTS There were 19 HCC lesions and 14 IHC lesions. HCC lesions were best identified on the arterial phase in 42% (n = 8), portal venous phase in 32% (n = 6), and delayed phase in 26% (n = 5). IHC lesions were best identified on portal venous phase in 64% (n = 9) and the arterial phase in 29% (n = 4), with 1 case equally visualized on arterial and portal venous phases. In all 33 lesions, a 5-mm expansion around the smallest GTV failed to cover GTVs defined on other available phases. A 5-mm expansion around the best-visualized GTV provided satisfactory coverage of all available phases' GTVs in 6/18 HCC cases and 2/9 IHC cases. CONCLUSIONS Variability between GTVs on multiphasic CT scans could not be overcome with a 5-mm expansion of either the smallest GTV or the best-visualized GTV. Assessment of all available intravenous contrast phases is essential to accurately define the GTV.
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Affiliation(s)
- Joshua R Niska
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona
| | - Florence K Keane
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - John A Wolfgang
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew X Zhu
- Department of Medicine, Division of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
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Abstract
Body magnetic resonance (MR) imaging is challenging because of the complex interaction of multiple factors, including motion arising from respiration and bowel peristalsis, susceptibility effects secondary to bowel gas, and the need to cover a large field of view. The combination of these factors makes body MR imaging more prone to artifacts, compared with imaging of other anatomic regions. Understanding the basic MR physics underlying artifacts is crucial to recognizing the trade-offs involved in mitigating artifacts and improving image quality. Artifacts can be classified into three main groups: (a) artifacts related to magnetic field imperfections, including the static magnetic field, the radiofrequency (RF) field, and gradient fields; (b) artifacts related to motion; and (c) artifacts arising from methods used to sample the MR signal. Static magnetic field homogeneity is essential for many MR techniques, such as fat saturation and balanced steady-state free precession. Susceptibility effects become more pronounced at higher field strengths and can be ameliorated by using spin-echo sequences when possible, increasing the receiver bandwidth, and aligning the phase-encoding gradient with the strongest susceptibility gradients, among other strategies. Nonuniformities in the RF transmit field, including dielectric effects, can be minimized by applying dielectric pads or imaging at lower field strength. Motion artifacts can be overcome through respiratory synchronization, alternative k-space sampling schemes, and parallel imaging. Aliasing and truncation artifacts derive from limitations in digital sampling of the MR signal and can be rectified by adjusting the sampling parameters. Understanding the causes of artifacts and their possible solutions will enable practitioners of body MR imaging to meet the challenges of novel pulse sequence design, parallel imaging, and increasing field strength.
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Affiliation(s)
- Susie Y Huang
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (S.Y.H., P.F.H., A.R.G.); Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Mass (S.Y.H., A.R.G.);Department of Radiology, University of Chicago, Chicago, Ill (P.P.); and Siemens Healthcare USA, Malvern, Pa (R.T.S., J.E.K.)
| | - Ravi T Seethamraju
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (S.Y.H., P.F.H., A.R.G.); Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Mass (S.Y.H., A.R.G.);Department of Radiology, University of Chicago, Chicago, Ill (P.P.); and Siemens Healthcare USA, Malvern, Pa (R.T.S., J.E.K.)
| | - Pritesh Patel
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (S.Y.H., P.F.H., A.R.G.); Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Mass (S.Y.H., A.R.G.);Department of Radiology, University of Chicago, Chicago, Ill (P.P.); and Siemens Healthcare USA, Malvern, Pa (R.T.S., J.E.K.)
| | - Peter F Hahn
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (S.Y.H., P.F.H., A.R.G.); Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Mass (S.Y.H., A.R.G.);Department of Radiology, University of Chicago, Chicago, Ill (P.P.); and Siemens Healthcare USA, Malvern, Pa (R.T.S., J.E.K.)
| | - John E Kirsch
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (S.Y.H., P.F.H., A.R.G.); Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Mass (S.Y.H., A.R.G.);Department of Radiology, University of Chicago, Chicago, Ill (P.P.); and Siemens Healthcare USA, Malvern, Pa (R.T.S., J.E.K.)
| | - Alexander R Guimaraes
- From the Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114 (S.Y.H., P.F.H., A.R.G.); Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Mass (S.Y.H., A.R.G.);Department of Radiology, University of Chicago, Chicago, Ill (P.P.); and Siemens Healthcare USA, Malvern, Pa (R.T.S., J.E.K.)
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Hahn PF, Guimaraes AR, Arellano RS, Mueller PR, Gervais DA. Nonvascular Interventional Procedures in an Urban General Hospital: Analysis of 2001-2010 with Comparison to the Previous Decade. Acad Radiol 2015; 22:904-8. [PMID: 25704589 DOI: 10.1016/j.acra.2015.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To determine trends in nonvascular image-guided procedures at an urban general hospital over a 10-year period and to compare utilization of nonvascular interventional radiology (IR) over the decade 2001-2010 to a previously reported analysis for 1991-2000. METHODS With institutional review board approval, a 20-year quality assurance database verified against the radiology information system was queried for procedure location (eg, pleura, liver, bowel, and abdomen) and type (eg, biopsy, catheter insertion, and transient drainage), demographics, and change over time. Yearly admissions and new hospital numbers assigned each year served to normalize for overall hospital activity. RESULTS A total of 50,195 IR procedures were performed in 24,309 distinct patients (male:female, 12,625:11,684; average age, 60 years), 940 procedures performed in age <20 years, and 571 procedures performed in patients aged ≥90 years. A total of 15345, 4377, and 1754 patients had one, two, or three procedures, respectively; 470 had ≥10 procedures. Twenty-seven supervising radiologists and 277 individuals participated as operators, double the previous decade. Biopsy (4.8% average yearly increase), abdominal drainage (7.3%), paracentesis (12.9%), tube manipulation (13.0%), suprapubic bladder tube insertion (21.0%), and gastrostomy (44.6%) all increased strongly (P < .001) over 120 months but not biliary drainage, nephrostomy, or chest tubes. Procedures increased faster than either admissions or new hospital numbers (P < .001). For each 1000 new hospital numbers, IR service performed 48 procedures versus 31 the previous decade (P < .0005). CONCLUSIONS Referrals for nonvascular IR procedures have doubled over 2 decades, outpacing growth in new hospital patients and requiring increased resource allocation.
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Affiliation(s)
- Peter F Hahn
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 220, 55 Fruit Street, Boston, MA, 02114.
| | - Alexander R Guimaraes
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 220, 55 Fruit Street, Boston, MA, 02114
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 220, 55 Fruit Street, Boston, MA, 02114
| | - Peter R Mueller
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 220, 55 Fruit Street, Boston, MA, 02114
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 220, 55 Fruit Street, Boston, MA, 02114
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Karaosmanoğlu AD, Onur MR, Shirkhoda A, Ozmen M, Hahn PF. Unusual Malignant Solid Neoplasms of the Kidney: Cross-Sectional Imaging Findings. Korean J Radiol 2015; 16:853-9. [PMID: 26175585 PMCID: PMC4499550 DOI: 10.3348/kjr.2015.16.4.853] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 05/04/2015] [Indexed: 01/16/2023] Open
Abstract
Malignant kidney neoplasms are the most frequently encountered solid kidney masses. Although renal cell carcinoma is the major renal malignancy, other solid malignant renal masses should be considered in the differential diagnosis of solid renal masses that do not contain a macroscopic fatty component. In this pictorial essay, we present the imaging findings of a primitive neuroectodermal tumor, primary liposarcoma of the kidney, primary neuroendocrine tumor, leiomyosarcoma, synovial sarcoma, malignant fibrous histiocytoma, sclerosing fibrosarcoma and renal metastasis of osteosarcoma.
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Affiliation(s)
- Ali Devrim Karaosmanoğlu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mehmet Ruhi Onur
- Department of Radiology, University of Hacettepe School of Medicine, Ankara 06100, Turkey
| | - Ali Shirkhoda
- Department of Radiology, University of California School of Medicine, Irvine, CA 92697, USA
| | - Mustafa Ozmen
- Department of Radiology, University of Hacettepe, Faculty of Medicine, Ankara 06100, Turkey
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
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Abstract
Dual-energy computed tomographic (DECT) technology offers enhanced capabilities that may benefit oncologic imaging in the abdomen. By using two different energies, dual-energy CT allows material decomposition on the basis of energy-dependent attenuation profiles of specific materials. Although image acquisition with dual-energy CT is similar to that with single-energy CT, comprehensive postprocessing is able to generate not only images that are similar to single-energy CT (SECT) images, but a variety of other images, such as virtual unenhanced (VUE), virtual monochromatic (VMC), and material-specific iodine images. An increase in the conspicuity of iodine on low-energy VMC images and material-specific iodine images may aid detection and characterization of tumors. Use of VMC images of a desired energy level (40-140 keV) improves lesion-to-background contrast and the quality of vascular imaging for preoperative planning. Material-specific iodine images enable differentiation of hypoattenuating tumors from hypo- or hyperattenuating cysts and facilitate detection of isoattenuating tumors, such as pancreatic masses and peritoneal disease, thereby defining tumor targets for imaging-guided therapy. Moreover, quantitative iodine mapping may serve as a surrogate biomarker for monitoring effects of the treatment. Dual-energy CT is an innovative imaging technique that enhances the capabilities of CT in evaluating oncology patients.
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Affiliation(s)
- Mukta D Agrawal
- From the Department of Abdominal and Interventional Radiology, Massachusetts General Hospital, 55 Fruit St, White Building, Room 270, Boston, MA 02114-2696
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Thabet A, Somarouthu B, Oliva E, Gervais DA, Hahn PF, Lee SI. Image-guided ovarian mass biopsy: efficacy and safety. J Vasc Interv Radiol 2014; 25:1922-1927.e1. [PMID: 25241300 DOI: 10.1016/j.jvir.2014.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Image-guided needle biopsy represents a minimally invasive method for pathologic diagnosis of a mass. This study evaluates the diagnostic yield, accuracy, and safety of ovarian mass biopsy with combined core and fine-needle technique. MATERIALS AND METHODS Medical records of all women at least 18 years of age, referred from gynecologic oncology, who underwent image-guided ovarian mass biopsy from 2001 through 2011 were reviewed. Among 27 patients, ultrasound guidance was used in 13 (48%), six transabdominal and seven transvaginal; computed tomography guidance was used in 14 (52%), nine transabdominal and five transgluteal. Biopsy indications were suspected metastasis (n = 15; 56%), suspected ovarian cancer to be treated with neoadjuvant chemotherapy (n = 10; 37%), and relative contraindication to surgery (n = 2; 7%). Mean maximum lesion dimension was 9.9 cm (range, 2-23 cm), with solid composition in nine (33%), cystic in six (22%), and mixed in 12 (44%). Biopsy pathologic findings were compared versus those of the surgical specimen or, for masses that were not resected, versus the stability of benign masses and response to chemotherapy of malignant masses on follow-up. RESULTS All biopsies yielded a diagnosis. No biopsy-related complications were noted. Eleven patients (41%) did not undergo lesion resection and were followed for an average of 28.8 months (range, 0.3-118.4 mo). In no patient did malignancy develop during clinical follow-up after a benign biopsy diagnosis. Sensitivity and specificity for diagnosis of malignancy were 100% ± 0 (19 of 19) and 88% ± 26 (seven of eight), respectively, for cancer detection. In nine patients (33%) with final pathologic diagnosis of epithelial ovarian cancer, tumor seeding was not observed during a mean follow-up of 44.6 months (range, 1.3-110.2 mo). CONCLUSIONS Image-guided ovarian mass core needle biopsy results in a pathologic diagnosis of benign and malignant masses with high yield, accuracy, and safety.
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Affiliation(s)
- Ashraf Thabet
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114
| | - Bhanusupriya Somarouthu
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114.
| | - Esther Oliva
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114
| | - Debra A Gervais
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114
| | - Peter F Hahn
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114
| | - Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 25 New Chardon St., Suite 501, Boston, MA 02114
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O'Connor OJ, Diver E, McDermott S, Covarrubias DA, Shelly MJ, Growdon W, Hahn PF, Mueller PR. Palliative Gastrostomy in the Setting of Voluminous Ascites. J Palliat Med 2014; 17:811-21. [DOI: 10.1089/jpm.2013.0397] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- Owen J. O'Connor
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elizabeth Diver
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Martin J. Shelly
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Whitfield Growdon
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter F. Hahn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Peter R. Mueller
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Zondervan RL, Hahn PF, Sadow CA, Lee SI. Response. Radiology 2014; 270:308. [PMID: 24501751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Fuentes-Orrego JM, Hayano K, Kambadakone AR, Hahn PF, Sahani DV. Dose-modified 256-MDCT of the abdomen using low tube current and hybrid iterative reconstruction. Acad Radiol 2013; 20:1405-12. [PMID: 24119353 DOI: 10.1016/j.acra.2013.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/06/2013] [Accepted: 08/06/2013] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the performance of hybrid iterative reconstruction technique (h-IRT) on image quality (IQ) in abdominal dose-modified (DM) scans in phantom and in patients in comparison to filtered back projection (FBP). MATERIALS AND METHODS An anthropomorphic phantom was scanned using various kVp (80-140) and mAs (25-100) settings. Images were reconstructed with FBP and h-IRT levels (1-6). In 69 adults (59.6 ± 13.54 years; 20 male, 49 female), DM computed tomography (CT) scans were performed using 120 kVp and 100-120 mAs. In 25/69, 5-mm FBP and h-IRT (levels 1-4 and 5) images were analyzed to validate IQ. The subsequent 44/69 had FBP and h-IRT (level 4) images reconstructed. Two readers evaluated 188 image series for IQ, noise, and artifacts. Objective and subjective data were analyzed using t-test and Wilcoxon signed-rank test, respectively. In 46/69 patients, prior dose CT was available for dose comparison. RESULTS In the phantom, noise reduction ranged from 12% (h-IRT level 1) to 50% (level 6). In patients, h-IRT level 4 images were rated diagnostic in 69/69 exams but DM-FBP images were found nondiagnostic in 20/69 patients. The size-specific dose estimate (SSDE) was reduced by 55% in the dose-modified CT group, (SSDE:4.55 ± 1.15 mGy) over the prior dose protocol (SSDE:10.21 ± 3.5 mGy, P < .0001). CONCLUSION h-IRT improved IQ in abdominal DM-CT scans in phantom and in patients. Dose improvements were greater in smaller patients than larger ones.
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Catalano OA, Rosen BR, Sahani DV, Hahn PF, Guimaraes AR, Vangel MG, Nicolai E, Soricelli A, Salvatore M. Clinical impact of PET/MR imaging in patients with cancer undergoing same-day PET/CT: initial experience in 134 patients--a hypothesis-generating exploratory study. Radiology 2013; 269:857-69. [PMID: 24009348 DOI: 10.1148/radiol.13131306] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare the clinical impact of combined positron emission tomography (PET) and magnetic resonance (MR) imaging to that of combined PET and computed tomography (CT) performed on the same day in patients with cancer. MATERIALS AND METHODS This HIPAA-compliant retrospective study was approved by the institutional review board. Patients gave written informed consent for study enrollment, including the possibility to use their imaging and clinical data in future evaluations. A total of 134 patients with cancer with a non-central nervous system primary neoplasm underwent same-day fluorodeoxyglucose (FDG) PET/CT and FDG PET/MR imaging. PET/CT and PET/MR studies were independently interpreted by teams of radiologists and nuclear medicine physicians. Four readers, divided into two teams composed of one radiologist and one nuclear medicine physician each, read all 134 studies. The referring physician classified discordance between PET/CT and PET/MR observations either as findings affecting clinical management or as findings not affecting clinical management. Data were compared with the χ(2) test. RESULTS Findings affecting clinical management were noted for PET/CT studies but not for PET/MR studies in two (1.5%) of 134 patients and for PET/MR studies but not for PET/CT studies in 24 (17.9%) of 134 patients. The discrepancies between findings affecting clinical management detected with PET/MR imaging over those detected with PET/CT were significant (P < .001). CONCLUSION In these patients, PET/MR imaging alone contributed to clinical management more often than did PET/CT alone. PET/MR imaging provides information that affects the care of patients with cancer and is unavailable from PET/CT. Online supplemental material is available for this article.
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Affiliation(s)
- Onofrio A Catalano
- From the Departments of Radiology (O.A.C.) and Nuclear Medicine (E.N., A.S.), SDN Istituto Ricerca Diagnostica Nucleare, Via Gianturco 113, Naples 80143, Italy; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging (B.R.R., A.R.G., M.G.V.), and Biostatistics Center (M.G.V.), Massachusetts General Hospital, Harvard University Medical School, Charlestown, Mass; Department of Radiology, Massachusetts General Hospital, Harvard University Medical School, Boston, Mass (D.V.S., P.F.H.); and Department of Radiology, University of Naples Federico II, Naples, Italy (M.S.)
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Perez-Johnston R, Hahn PF, Shenoy-Bhangle AS, Shelly MJ, Gervais DA, Arellano RS. Percutaneous biopsy of focal lesions of the gastrointestinal tract. ACTA ACUST UNITED AC 2013; 38:1197-202. [DOI: 10.1007/s00261-013-0023-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Elmi A, Hedgire SS, Covarrubias D, Abtahi SM, Hahn PF, Harisinghani M. Apparent diffusion coefficient as a non-invasive predictor of treatment response and recurrence in locally advanced rectal cancer. Clin Radiol 2013; 68:e524-31. [PMID: 23830776 DOI: 10.1016/j.crad.2013.05.094] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 05/08/2013] [Accepted: 05/15/2013] [Indexed: 12/25/2022]
Abstract
AIM To evaluate the role of pretreatment apparent diffusion coefficient (ADC) as a predictor of treatment response and local recurrence in patients with locally advanced rectal cancer who underwent neoadjuvant therapy. MATERIALS AND METHODS Forty-nine patients who underwent preoperative diffusion-weighted magnetic resonance imaging (MRI) followed by neoadjuvant chemoradiation and surgery were enrolled in the study. The mean tumour ADC was measured independently from multiple, non-overlapping regions of interest (ROIs) to cover the entire tumour area on a single section by two radiologists and patients were followed postoperatively for a median of 16.4 months. Diagnostic accuracy of ADC for predicting treatment response and recurrence was evaluated using the area under the receiver-operating characteristic (ROC) curve, sensitivity, specificity, and predictive values. Univariate and multivariate analyses including clinical tumour (cT) staging, carcinoembryonic antigen (CEA) level, lymph-node involvement, tumour grade, surgical margin, vascular involvement, and ADC were performed with respect to recurrence. Interobserver agreement of ADC values was assessed. RESULTS Twenty patients showed response to neoadjuvant therapy and recurrence was noted in 17 patients. Low pretreatment ADC, MRI findings of cT4 staging, and node involvement were significantly related to poor treatment response. Sensitivity and specificity of ADC = 0.833 × 10(-3) mm(2)/s for prediction of treatment response was 75 and 48% for reader 1 and 65 and 52% for reader 2, respectively. Univariate and multivariate analyses identified pretreatment tumour ADC as the only predictive factor for recurrence. Sensitivity and specificity of ADC = 0.833 × 10(-3) mm(2)/s for prediction of recurrence was 86 and 77% for reader 1 and 80 and 69% for reader 2, respectively. Interobserver agreement for measuring ADC was good with a kappa value of 0.70. CONCLUSION Pretreatment rectal tumour ADC values may be an early biomarker for predicting treatment response and local recurrence in patients who underwent neoadjuvant chemoradiation.
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Affiliation(s)
- A Elmi
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Zondervan RL, Hahn PF, Sadow CA, Liu B, Lee SI. Body CT scanning in young adults: examination indications, patient outcomes, and risk of radiation-induced cancer. Radiology 2013; 267:460-9. [PMID: 23386731 DOI: 10.1148/radiol.12121324] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To quantify patient outcome and predicted cancer risk from body computed tomography (CT) in young adults and identify common indications for the imaging examination. MATERIALS AND METHODS This retrospective multicenter study was HIPAA compliant and approved by the institutional review boards of three institutions, with waiver of informed consent. The Research Patient Data Registry containing patient medical and billing records of three university-affiliated hospitals in a single metropolitan area was queried for patients 18-35 years old with a social security record who underwent chest or abdominopelvic CT from 2003 to 2007. Patients were analyzed according to body part imaged and scanning frequency. Mortality status and follow-up interval were recorded. The Biologic Effects of Ionizing Radiation VII method was used to calculate expected cancer incidence and death. Examination indication was determined with associated ICD-9 diagnostic code; 95% confidence intervals for percentages were calculated, and the binomial test was used to compare the difference between percentages. RESULTS In 21 945 patients, 16 851 chest and 24 112 abdominopelvic CT scans were obtained. During the average 5.5-year (± 0.1 [standard deviation]) follow-up, 7.1% (575 of 8057) of chest CT patients and 3.9% (546 of 13 888) of abdominal CT patients had died. In comparison, the predicted risk of dying from CT-induced cancer was 0.1% (five of 8057, P < .01) and 0.1% (eight of 12 472, P < .01), respectively. The most common examination indications were cancer and trauma for chest CT and abdominal pain, trauma, and cancer for abdominopelvic CT. Among patients without a cancer diagnosis in whom only one or two scans were obtained, mortality and predicted risk of radiation-induced cancer death were 3.6% (215 of 5914) and 0.05% (three of 5914, P < .01) for chest CT and 1.9% (219 of 11 291) and 0.1% (six of 11 291, P < .01) for abdominopelvic CT. CONCLUSION Among young adults undergoing body CT, risk of death from underlying morbidity is more than an order of magnitude greater than death from long-term radiation-induced cancer.
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Affiliation(s)
- Robert L Zondervan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA.
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Hedgire SS, Sainani NI, McDermott S, Hahn PF, Harisinghani MG. Mono-belly and beyond: spectrum of imaging manifestations of EBV infection in the abdomen. Clin Imaging 2013; 37:711-7. [PMID: 23317894 DOI: 10.1016/j.clinimag.2012.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 10/12/2012] [Accepted: 10/22/2012] [Indexed: 11/27/2022]
Abstract
Epstein-Barr virus (EBV) is a DNA virus from the herpes virus group affecting only humans. More than 90% adults are infected by the virus, but very few ever have symptoms. Within the abdomen, both solid and hollow viscera can be involved in symptomatic disease. Awareness of the spectrum of imaging findings, high index of suspicion, and appropriate clinical and laboratory information can help in the early and accurate diagnosis in these cases.
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Affiliation(s)
- Sandeep S Hedgire
- Department of abdominal Imaging and Intervention, Massachusetts General Hospital, Boston, MA 02114, USA.
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Abstract
In the spleen, image-guided interventional procedures such as biopsy and catheter drainage have not been widely performed because of the perceived increased risk of complications. The ability of image-guided biopsy to allow tissue diagnosis of a focal splenic mass without the need for splenectomy is the driving force behind use of this procedure in oncology patients. The literature on image-guided splenic biopsy suggests that the highest biopsy yield is achieved with core biopsy and the lowest complication rate is achieved with fine-needle aspiration. Image-guided catheter drainage is an effective alternative to splenectomy for management of infected splenic collections. In clinical practice, image-guided splenic biopsy, fluid aspiration, and catheter drainage have high success rates. Image-guided alcohol ablation is effective in treatment of splenic cysts. The literature on splenic radiofrequency ablation (RFA) is sparse; therefore, further studies are needed to determine the role of RFA in management of splenic neoplasms and hypersplenism. Image-guided percutaneous thrombin injection can be used to treat splenic artery pseudoaneurysms. Awareness of the correct interventional techniques and their limitations is important for safe performance of image-guided percutaneous splenic interventions.
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Affiliation(s)
- Ajay K Singh
- Department of Radiology, Division of Emergency Radiology, Massachusetts General Hospital, 55 Fruit St, White 270, Boston, MA 02114, USA.
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Gupta S, Singh AH, Shabbir A, Hahn PF, Harris G, Sahani D. Assessing renal parenchymal volume on unenhanced CT as a marker for predicting renal function in patients with chronic kidney disease. Acad Radiol 2012; 19:654-60. [PMID: 22578224 DOI: 10.1016/j.acra.2012.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [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: 09/10/2011] [Revised: 02/10/2012] [Accepted: 02/13/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To estimate renal volume in chronic kidney disease (CKD) patients using a semiautomated software and compare them with split renal function estimates from radionuclide renogram (RR). We proposed that renal volume from unenhanced computed tomography (CT) scans may serve as surrogate marker for assessing renal function in CKD patients. MATERIALS AND METHODS Unenhanced multidetector CT scans of 26 patients with CKD (estimated glomerular filtration rate [eGFR] <60 mL/kg/body surface area [BSA]) and 10 controls (eGFR >60 mL/kg/BSA) were analyzed to calculate renal volumes using a semiautomated software (AMIRAV5.2.0). Volumes obtained were then correlated with corresponding eGFR and split renal function estimates from RR. Volumes were also compared with those obtained on enhanced scans in 10 cases (five disease group, five controls). Bland-Altman analysis was used to assess agreement between methods. RESULTS A moderately positive correlation was found between renal volume obtained on unenhanced CT and eGFR (r = 0.65, P < .0001), whereas a significantly high correlation with split function estimates from RR (r = 0.95, P < .001) was found. Bland-Altman analysis revealed a good agreement between renal volume from CT and renal function from RR (34/36 observations were within 95% CI and there were two outliers). Correlation between volumes obtained from unenhanced and enhanced CT scans was also significant (r = 0.96). CONCLUSION In patients with CKD, renal volume derived from unenhanced CT can possibly serve as a surrogate marker for assessing and monitoring renal function reserves to plan further management.
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Affiliation(s)
- Supriya Gupta
- Department of Abdominal and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA.
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Zalis ME, Blake MA, Cai W, Hahn PF, Halpern EF, Kazam IG, Keroack M, Magee C, Näppi JJ, Perez-Johnston R, Saltzman JR, Vij A, Yee J, Yoshida H. Diagnostic accuracy of laxative-free computed tomographic colonography for detection of adenomatous polyps in asymptomatic adults: a prospective evaluation. Ann Intern Med 2012; 156:692-702. [PMID: 22586008 DOI: 10.7326/0003-4819-156-10-201205150-00005] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [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: 12/13/2022] Open
Abstract
BACKGROUND Colon screening by optical colonoscopy (OC) or computed tomographic colonography (CTC) requires a laxative bowel preparation, which inhibits screening participation. OBJECTIVE To assess the performance of detecting adenomas 6 mm or larger and patient experience of laxative-free, computer-aided CTC. DESIGN Prospective test comparison of laxative-free CTC and OC. The CTC included electronic cleansing and computer-aided detection. Optical colonoscopy examinations were initially blinded to CTC results, which were subsequently revealed during colonoscope withdrawal; this method permitted reexamination to resolve discrepant findings. Unblinded OC served as a reference standard. (ClinicalTrials.gov registration number: NCT01200303) SETTING Multicenter ambulatory imaging and endoscopy centers. PARTICIPANTS 605 adults aged 50 to 85 years at average to moderate risk for colon cancer. MEASUREMENTS Per-patient sensitivity and specificity of CTC and first-pass OC for detecting adenomas at thresholds of 10 mm or greater, 8 mm or greater, and 6 mm or greater; per-lesion sensitivity and survey data describing patient experience with preparations and examinations. RESULTS For adenomas 10 mm or larger, per-patient sensitivity of CTC was 0.91 (95% CI, 0.71 to 0.99) and specificity was 0.85 (CI, 0.82 to 0.88); sensitivity of OC was 0.95 (CI, 0.77 to 1.00) and specificity was 0.89 (CI, 0.86 to 0.91). Sensitivity of CTC was 0.70 (CI, 0.53 to 0.83) for adenomas 8 mm or larger and 0.59 (CI, 0.47 to 0.70) for those 6 mm or larger; sensitivity of OC for adenomas 8 mm or larger was 0.88 (CI, 0.73 to 0.96) and 0.76 (CI, 0.64 to 0.85) for those 6 mm or larger. The specificity of OC at the threshold of 8 mm or larger was 0.91 and at 6 mm or larger was 0.94. Specificity for OC was greater than that for CTC, which was 0.86 at the threshold of 8 mm or larger and 0.88 at 6 mm or larger (P= 0.02). Reported participant experience for comfort and difficulty of examination preparation was better with CTC than OC. LIMITATIONS There were 3 CTC readers. The survey instrument was not independently validated. CONCLUSION Computed tomographic colonography was accurate in detecting adenomas 10 mm or larger but less so for smaller lesions. Patient experience was better with laxative-free CTC. These results suggest a possible role for laxative-free CTC as an alternate screening method.
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Affiliation(s)
- Michael E Zalis
- Department of Imaging, Massachusetts General Hospital, Suite 400A, 25 New Chardon Street, Boston, MA 02114, USA.
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Samir AE, Vij A, Seale MK, Desai G, Halpern E, Faquin WC, Parangi S, Hahn PF, Daniels GH. Ultrasound-guided percutaneous thyroid nodule core biopsy: clinical utility in patients with prior nondiagnostic fine-needle aspirate. Thyroid 2012; 22:461-7. [PMID: 22304390 PMCID: PMC3733134 DOI: 10.1089/thy.2011.0061] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Five percent to 20% of thyroid nodule fine-needle aspiration (FNA) samples are nondiagnostic. The objective of this study was to determine whether a combination of FNA and core biopsy (CFNACB) would yield a higher proportion of diagnostic readings compared with FNA alone in patients with a history of one or more prior nondiagnostic FNA readings. METHODS We conducted a retrospective study of 90 core biopsies (CBs) performed in 82 subjects (55 women and 27 men) between 2006 and 2008 in an outpatient clinic. RESULTS CFNACB yielded a diagnostic reading in 87%. The diagnostic reading yield of the CB component of CFNACB was significantly superior to the concurrent FNA component, with CB yielding a diagnosis in 77% of cases and FNA yielding a diagnosis in 47% (p<0.0001). The combination of CB and FNA had a higher diagnostic reading yield than either alone. In 69 nodules that had only one prior nondiagnostic FNA, CB was diagnostic in 74%, FNA was diagnostic in 52%, CFNACB was diagnostic in 87%, and CB performed significantly better than FNA (p=0.0135). In 21 nodules with two or more prior nondiagnostic FNAs, CFNACB and CB were diagnostic in 86%, FNA was diagnostic in 29%, and CB was significantly better than FNA (p=0.0005). Clinical, ultrasound, or histopathologic follow-up was available for 81% (73/90) of the CFNACB procedures. No subject with a benign CFNACB reading was diagnosed with thyroid malignancy in the follow-up period (range 4-37 months, mean 18 months), although one subject had minimal increase in nodule size and was awaiting repeat sonography at study conclusion. CONCLUSION Thyroid nodule CFNACB is safe and clinically useful in selected patients when a prior FNA reading is nondiagnostic. CFNACB is superior to either CB or FNA alone. CFNACB should be strongly considered as an alternative to surgery in individuals with two prior nondiagnostic FNAs.
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Affiliation(s)
- Anthony E Samir
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
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McDermott S, Hedgire SS, Hahn PF, Mueller PR, Harisinghani MG. Image-guided Biopsy of Suspicious Lymph Nodes in Patients with Known Primary Malignancies. J Vasc Interv Radiol 2012; 23:371-6. [DOI: 10.1016/j.jvir.2011.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/21/2011] [Accepted: 11/24/2011] [Indexed: 11/25/2022] Open
Affiliation(s)
- Shaunagh McDermott
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Zondervan RL, Hahn PF, Sadow CA, Liu B, Lee SI. Frequent body CT scanning of young adults: indications, outcomes, and risk for radiation-induced cancer. J Am Coll Radiol 2011; 8:501-7. [PMID: 21723488 DOI: 10.1016/j.jacr.2010.12.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 12/29/2010] [Indexed: 01/03/2023]
Abstract
PURPOSE The aims of this study were to define the magnitude of frequent body CT scanning of young adults and to determine associated patient diagnoses, examination indications, short-term outcomes, and estimated radiation-induced cancer risk. METHODS Patients aged 18 to 35 years who underwent chest or abdominopelvic CT between 2003 and 2007 at any of 3 hospitals were identified and categorized by total number of scans per body part as rarely (<5), intermediately (>5 and <15), or frequently (>15) scanned. Medical records of the frequently scanned were reviewed. Cumulative radiation exposure, calculated from typical effective doses, was used to estimate cancer risk. Cancer incidence and mortality were estimated using the Biological Effects of Ionizing Radiation method. RESULTS A total of 25,104 patients underwent 45,632 scans, of whom 23,851 (95%) and 70 (0.3%) were rarely and frequently scanned, respectively. Among frequently scanned patients, the most common diagnoses were cancer (19 of 36 [52.8%]) and cystic fibrosis with lung transplantation (11 of 36 [30.5%]) for chest CT and cancer (25 of 34 [73.5%]) for abdominopelvic CT. During the mean 5.4 years (range, 0.9-7.6 years) of follow-up, 46% of frequently scanned patients (32 of 70) died. Of the 47 cancers predicted in the entire cohort, 36 (77%) and 2 (3%) were expected in the rarely and frequently scanned. CONCLUSIONS The majority of CT-induced cancers are predicted to result from sporadic rather than frequent scanning. Frequent scanning confers a significant cancer risk but occurs in severely ill patients, a large proportion of who die before any radiation-induced cancer would be a factor in their health.
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Affiliation(s)
- Robert L Zondervan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Lee SI, Krishnaraj A, Chatterji M, Dreyer KJ, Thrall JH, Hahn PF. When does a radiologist's recommendation for follow-up result in high-cost imaging? Radiology 2011; 262:544-9. [PMID: 22084210 DOI: 10.1148/radiol.11111091] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To measure the proportion of high-cost imaging generated by a radiologist's recommendation and to identify the imaging findings resulting in follow-up. MATERIALS AND METHODS This retrospective HIPAA-compliant study had institutional review board approval, with waiver of informed consent. A recommended examination was defined as one performed within a single episode of care (defined as fewer than 60 days after the initial imaging) following a radiologist's recommendation in a prior examination report. Chest and abdominal computed tomography (CT), brain and lumbar spine magnetic resonance (MR) imaging, and body positron emission tomography were included for analysis. From a database of all radiology examinations (approximately 200,000) at one institution over a 6-month period, a computerized search identified all high-cost examinations that were preceded by an examination containing a radiologist recommendation. Medical records were reviewed to verify accuracy of the recommending-recommended examination pairs and to determine the reason for the radiologist's recommendation. For proportions, 95% confidence intervals were calculated. RESULTS Overall, 1558 of 29,232 (5.3%) high-cost examinations followed a radiologist's recommendation. Chest CT was the high-cost examination most often resulting from a radiologist's recommendation (878 of 9331, 9.4%), followed by abdominal CT (390 of 10,258, 3.8%) and brain MR imaging (222 of 6436, 3.4%). The examination types with the highest numbers of follow-up examinations were chest radiography (n=431), chest CT (n=410), abdominal CT (n=214), and abdominal ultrasonography (n=120). The most common findings resulting in follow-up were pulmonary nodules or masses (559 of 1558, 35.9%), other pulmonary abnormalities (150 of 1558, 9.6%), adenopathy (103 of 1558, 6.6%), renal lesions (101 of 1558, 6.5%), and negative examination findings (101 of 1558, 6.5%). CONCLUSION Radiologists' recommendations account for only a small proportion of outpatient high-cost imaging examinations. Pulmonary nodule follow-up is the most common cause for radiologist-generated examinations.
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Affiliation(s)
- Susanna I Lee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA 02114, USA.
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Konstas AA, Digumarthy SR, Avery LL, Wallace KL, Lisovsky M, Misdraji J, Hahn PF. Congenital portosystemic shunts: Imaging findings and clinical presentations in 11 patients. Eur J Radiol 2011; 80:175-81. [DOI: 10.1016/j.ejrad.2009.12.031] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 12/30/2009] [Indexed: 11/26/2022]
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Saokar A, Arellano RS, Gervais DA, Mueller PR, Hahn PF, Lee SI. Image-guided drainage of tuboovarian abscesses of gastrointestinal or genitourinary origin: a retrospective analysis. J Vasc Interv Radiol 2011; 22:678-86. [PMID: 18941068 DOI: 10.1016/j.jvir.2010.10.032] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [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: 02/09/2010] [Revised: 09/21/2010] [Accepted: 10/11/2010] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To analyze the authors' success with image-guided drainage of tuboovarian abscesses (TOAs). MATERIALS AND METHODS Retrospective analysis of patients with image-guided TOA drainage from 1999 to 2008 was performed. Patient recovery without salpingo-oophorectomy was considered clinical success. A total of 57 TOAs were drained in 49 female patients (mean age, 43; range, 12 to > 89). RESULTS Thirty-three (58%) TOAs were drained percutaneously using computed tomography guidance and 24 were ultrasound guided (21 transvaginally, three transabdominally). Fifty-three TOAs were drained with catheter placement, and four were drained with aspiration alone. Abscess etiologies include pelvic inflammatory disease (n = 21, 37%), gastrointestinal conditions related (n = 21, 37%), gynecologic surgery (n = 8, 14%), and other (12%). Image-guided drainage resolved TOAs without salpingo-oophorectomy in 74% of cases overall (42 of 57) and 88% (29 of 33) of gynecologic-related cases, including 95% (20 of 21) of pelvic inflammatory disease cases. Salpingo-oophorectomy was performed more often in gastrointestinal-related cases (10 of 21, 48%) than for all other causes (five of 36, 14%; P < .001), with concurrent bowel surgery performed in the majority of the gastrointestinal-related cases. Mean follow-up after image-guided drainage was 48 months (range, 1-113) in patients who did not have related surgery. In patients who underwent salpingo-oophorectomy, it was performed on average 2.2 months (range, 0.5-5) after initial drainage. Two minor complications occurred; both involved catheter transgression of the urinary bladder in patients with transvaginal ultrasound-guided drainages. The patients were successfully treated conservatively with Foley catheter bladder decompression, without prolonged hospitalization. CONCLUSIONS TOAs, especially of gynecologic origin, can often be managed successfully with image-guided drainage. After image-guided drainage, patients with gynecologic-related TOA were less likely to undergo salpingo-oophorectomy than patients with gastrointestinal-related TOAs.
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Affiliation(s)
- Anuradha Saokar
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
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Boland GWL, Dwamena BA, Jagtiani Sangwaiya M, Goehler AG, Blake MA, Hahn PF, Scott JA, Kalra MK. Characterization of adrenal masses by using FDG PET: a systematic review and meta-analysis of diagnostic test performance. Radiology 2011; 259:117-26. [PMID: 21330566 DOI: 10.1148/radiol.11100569] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE To perform a systematic review and meta-analysis of published data to determine the diagnostic utility of adrenal fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for distinguishing benign from malignant adrenal disease. MATERIALS AND METHODS Data on FDG PET assessment in MEDLINE and other electronic databases (from inception to November 2009) and in subject matter-specific journals were evaluated and compared with histologic diagnoses and/or established clinical and imaging follow-up results. Methodologic quality was assessed by using Quality Assessment of Diagnostic Accuracy Studies criteria. Bivariate random-effects meta-analytical methods were used to estimate summary and subgroup-specific sensitivity, specificity, and receiver operating characteristic curves and to investigate the effects of study design characteristics and imaging procedure elements on diagnostic accuracy. RESULTS A total of 1391 lesions (824 benign, 567 malignant) in 1217 patients from 21 eligible studies were evaluated. Qualitative (visual) analysis of 841 lesions (in 14 reports) and quantitative analyses based on standardized uptake values (SUVs) for 824 lesions (in 13 reports) and standardized uptake ratios (SURs) for 562 lesions (in eight reports) were performed. Resultant data were highly heterogeneous, with a model-based inconsistency index of 88% (95% confidence interval [CI]: 79%, 98%). Mean sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio values for differentiating between benign and malignant adrenal disease were 0.97 (95% CI: 0.93, 0.98), 0.91 (95% CI: 0.87, 0.94), 11.1 (95% CI: 7.5, 16.3), 0.04 (95% CI: 0.02, 0.08), and 294 (95% CI: 107, 805), respectively, with no significant differences in accuracy among the visual, SUV, and SUR analyses. CONCLUSION Meta-analysis of combination PET-computed tomography (CT) reports revealed that FDG PET was highly sensitive and specific for differentiating malignant from benign adrenal disease. Diagnostic accuracy was not influenced by the type of imaging device (PET vs PET/CT), but specificity was dependent on the clinical status (cancer vs no cancer).
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Affiliation(s)
- Giles W L Boland
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, White Building 270C, Boston, MA 02114, USA.
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Ma X, Arellano RS, Gervais DA, Hahn PF, Mueller PR, Sahani DV. Success of image-guided biopsy for small (≤ 3 cm) focal liver lesions in cirrhotic and noncirrhotic individuals. J Vasc Interv Radiol 2011; 21:1539-47; quiz 1547. [PMID: 20801683 DOI: 10.1016/j.jvir.2010.05.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 04/12/2010] [Accepted: 05/17/2010] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Imaging techniques can detect small liver lesions, although these are a challenge to biopsy, particularly in cirrhotic liver. The authors assessed the diagnostic success of image-guided biopsies collected from small (≤ 3 cm) focal liver lesions. MATERIALS AND METHODS This single-center, retrospective study included 374 patients (199 men; mean age, 62 ± 15). Eighteen-gauge core biopsy and 22-gauge fine needle aspiration (FNA) samples were collected from small focal liver lesions. Samples were compared by histology versus cytology, malignant versus benign, from lesions smaller versus larger than 1.5 cm, from livers with versus without cirrhosis, collected by computed tomography (CT) guidance versus ultrasound, and from different locations in the liver. RESULTS The combined accuracy of core biopsy plus FNA analysis was 95.5%; core biopsy alone characterized 93.3% of samples, and FNA alone characterized 72.5% (P < .001). Biopsy successfully characterized 94.5% of malignant lesions and 98.8% of benign lesions (P > .05). Biopsy characterized 95.3% (102 of 107) lesions ≤ 1.5 cm. The success in cirrhotic livers was 94.8%, for CT-guided biopsies was 95%, and for ultrasound-guided biopsies was 95.8% (P > .05). The success rate was lower in liver caudate lobe than in other locations (P < .05). CONCLUSIONS Image-guided biopsy of small (≤ 3 cm) focal liver lesions is highly reliable with the use of core biopsy alone. Neither size ≤ 1.5 cm nor presence of cirrhosis is an impediment to biopsy. CT and ultrasound guidance produce similar rates of success.
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Affiliation(s)
- Xiaozhou Ma
- Division of Abdominal Imaging and Interventional Radiology, Massachusetts General Hospital, 55 Fruit Street, White 270, Boston, MA 02114, USA
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Sangwaiya MJ, Boland GWL, Cronin CG, Blake MA, Halpern EF, Hahn PF. Incidental Adrenal Lesions: Accuracy of Characterization with Contrast-enhanced Washout Multidetector CT—10-minute Delayed Imaging Protocol Revisited in a Large Patient Cohort. Radiology 2010; 256:504-10. [DOI: 10.1148/radiol.10091386] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hahn PF, Bale WF, Lawrence EO, Whipple GH. RADIOACTIVE IRON AND ITS METABOLISM IN ANEMIA : ITS ABSORPTION, TRANSPORTATION, AND UTILIZATION. ACTA ACUST UNITED AC 2010; 69:739-53. [PMID: 19870874 PMCID: PMC2133749 DOI: 10.1084/jem.69.5.739] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Artificially produced radioactive iron is an extremely sensitive agent for use in following iron in the course of its changes in body metabolism, lending itself to studies of absorption, transport, exchange, mobilization, and excretion. The need of the body for iron in some manner determines the absorption of this element. In the normal dog when there is no need for the element, it is absorbed in negligible amounts. In the anemic animal iron is quite promptly assimilated. The plasma is clearly the means of transport of iron from the gastrointestinal tract to its point of mobilization for fabrication into hemoglobin. The speed of absorption and transfer of iron to the red cell is spectacular. The importance of the liver and bone marrow in iron metabolism is confirmed.
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Affiliation(s)
- P F Hahn
- Departments of Pathology and Medicine (Radiology), The University of Rochester School of Medicine and Dentistry, Rochester, New York, and the Radiation Laboratory, The University of California, Berkeley, California
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