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Nikpanah M, Dehghani Firouzabadi F, Farhadi F, Mirmomen SM, Ahlman MA, Huda F, Millo C, Saboury B, Paschall AK, Gahl WA, Estrada-Veras JI, Turkbey E, Jones EC, O'Brien K, Malayeri AA. Skeletal involvement in Erdheim-Chester disease: Multimodality imaging features and association with the BRAF V600E mutation. Clin Imaging 2024; 106:110067. [PMID: 38128404 DOI: 10.1016/j.clinimag.2023.110067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/01/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The aim of this study was to characterize the distribution of skeletal involvement in Erdheim-Chester disease (ECD) by using radiography, computed tomography (CT), 18F-FDG positron emission tomography/computed tomography (PET/CT), and bone scans, as well as looking for associations with the BRAFV600E mutation. MATERIAL AND METHODS Prospective study of 50 consecutive patients with biopsy-confirmed ECD who had radiographs, CT, 18F-FDG PET/CT, and Tc-99m MDP bone scans. At least two experienced radiologists with expertise in the relevant imaging studies analyzed the images. Summary statistics were expressed as the frequency with percentages for categorical data. Fisher's exact test, as well as odds ratios (OR) with 95 % confidence intervals (CI), were used to link imaging findings to BRAFV600E mutation. The probability for co-occurrence of bone involvement at different locations was calculated and graphed as a heat map. RESULTS All 50 cases revealed skeletal involvement at different regions of the skeleton. The BRAFV600E mutation, which was found in 24 patients, was correlated with femoral and tibial involvement on 18F-FDG PET/CT and bone scan. The appearance of changes on the femoral, tibial, fibular, and humeral involvement showed correlation with each other based on heat maps of skeletal involvement on CT. CONCLUSION This study reports the distribution of skeletal involvement in a cohort of patients with ECD. CT is able to detect the majority of ECD skeletal involvement. Considering the complementary nature of information from different modalities, imaging of ECD skeletal involvement is optimized by using a multi-modality strategy.
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Affiliation(s)
- Moozhan Nikpanah
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Fatemeh Dehghani Firouzabadi
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Faraz Farhadi
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - S Mojdeh Mirmomen
- Department of Radiology, UC San Diego School of Medicine, San Diego, CA, USA
| | - Mark A Ahlman
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Fahimul Huda
- Department of Radiology, University of Louisville School of Medicine, KY, USA
| | - Corina Millo
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Babak Saboury
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Anna K Paschall
- Duke University Health System, School of Medicine, Durham, NC, USA
| | - William A Gahl
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health, Bethesda, MD, USA
| | - Juvianee I Estrada-Veras
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health, Bethesda, MD, USA
| | - Evrim Turkbey
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth C Jones
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Kevin O'Brien
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health, Bethesda, MD, USA.
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA.
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Sirajuddin A, Mirmomen SM, Henry TS, Kandathil A, Kelly AM, King CS, Kuzniewski CT, Lai AR, Lee E, Martin MD, Mehta P, Morris MF, Raptis CA, Roberge EA, Sandler KL, Donnelly EF. ACR Appropriateness Criteria® Suspected Pulmonary Hypertension: 2022 Update. J Am Coll Radiol 2022; 19:S502-S512. [PMID: 36436973 DOI: 10.1016/j.jacr.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
Pulmonary hypertension may be idiopathic or related to a large variety of diseases. Various imaging examinations may be helpful in diagnosing and determining the etiology of pulmonary hypertension. Imaging examinations discussed in this document include chest radiography, ultrasound echocardiography, ventilation/perfusion scintigraphy, CT, MRI, right heart catheterization, and pulmonary angiography. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer-reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer-reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | | | - Travis S Henry
- Panel Chair, University of California San Francisco, San Francisco, California; Co-Director, ACR Education Center High Resolution CT of the Chest Course; Division Chief of Cardiothoracic Imaging, Duke University
| | - Asha Kandathil
- University of Texas Southwestern Medical Center, Dallas, Texas; Associate Program Director, Cardiothoracic Radiology Fellowship, The University of Texas Southwestern Medical Center
| | - Aine Marie Kelly
- Emory University Hospital, Atlanta, Georgia; Assistant Program Director Radiology Residency
| | - Christopher S King
- Inova Fairfax Hospital, Falls Church, Virginia; American College of Chest Physicians; Associate Medical Director, Advanced Lung Disease and Transplant Program; Associate Medical Director, Pulmonary Hypertension Program; System Director, Respiratory Therapy; Pulmonary Fibrosis Foundation
| | | | - Andrew R Lai
- University of California San Francisco, San Francisco, California; Primary care physician; former Director of the University of California San Francisco Hospitalist Procedure Service; former Director of the University of California San Francisco Division of Hospital Medicine's Case Review Committee, and former Director of procedures/quality improvement rotation for for the UCSF Internal Medicince residency
| | - Elizabeth Lee
- University of Michigan Health System, Ann Arbor, Michigan; Director M1Radiology Education University of Michigan Medical School, Associated Program Director Diagnostic Radiology Michigan Medicine, Director of Residency Education Cardiothoracic Division Michigan
| | - Maria D Martin
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Director Diversity and Inclusion, Department of Radiology, University of Wisconsin School of Medicine and Public Health
| | - Parth Mehta
- University of Illinois at Chicago College of Medicine, Chicago, Illinois; American College of Physicians
| | - Michael F Morris
- University of Arizona College of Medicine, Phoenix, Arizona; Director of Cardiac CT and MRI
| | | | - Eric A Roberge
- Uniformed Services University of the Health Sciences-Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Kim L Sandler
- Vanderbilt University Medical Center, Nashville, Tennessee; Imaging Chair Thoracic Committee ECOG-ACRIN; Co-Chair Lung Screening 2.0 Steering Committee; Co-Director Vanderbilt Lung Screening Program
| | - Edwin F Donnelly
- Specialty Chair, The Ohio State University Wexner Medical Center, Columbus, Ohio; Ohio State University Medical Center: Chief of Thoracic Radiology, Interim Vice Chair of Academic Affairs, Department of Radiology
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Nikpanah M, Paschall AK, Ahlman MA, Civelek AC, Farhadi F, Mirmomen SM, Li X, Saboury B, Ball MW, Merino MJ, Srinivasan R, Jones EC, Linehan WM, Malayeri AA. 18Fluorodeoxyglucose-positron emission tomography/computed tomography for differentiation of renal tumors in hereditary kidney cancer syndromes. Abdom Radiol (NY) 2021; 46:3301-3308. [PMID: 33688985 DOI: 10.1007/s00261-021-02999-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To assess differences in FDG-PET/CT uptake among four subtypes of renal tumors: clear cell RCC (ccRCC), papillary type I and II RCC (pRCC), and oncocytoma. METHODS This retrospective study investigated 33 patients with 98 hereditary renal tumors. Lesions greater than 1 cm and patients with a timeframe of less than 18 months between preoperative imaging and surgery were considered. FDG-PET/CT images were independently reviewed by two nuclear medicine physicians, blinded to clinical information. Volumetric lesion SUVmean was measured and used to calculate a target-to-background ratio respective to liver (TBR). The Shrout-Fleiss intra-class correlation coefficient was used to assess reliability between readers. A linear mixed effects model, accounting for within-patient correlations, was used to compare TBR values of primary renal lesions with and without distant metastasis. RESULTS The time interval between imaging and surgery for all tumors had a median of 77 (Mean: 139; Range: 1-512) days. Intra-class reliability of mean TBR resulted in a mean κ score of 0.93, indicating strong agreement between the readers. The mixed model showed a significant difference in mean TBR among the subtypes (p < 0.0001). Pairwise comparison showed significant differences between pRCC type II and ccRCC (p < 0.0001), pRCC type II and pRCC type I (p = 0.0001), and pRCC type II and oncocytoma (p = 0.0016). Furthermore, a significant difference in FDG uptake was present between primary pRCC type II renal lesions with and without distant metastasis (p = 0.023). CONCLUSION pRCC type II lesions demonstrated significantly higher FDG activity than ccRCC, pRCC type I, or oncocytoma. These findings indicate that FDG may prove useful in studying the metabolic activity of renal neoplasms, identifying lesions of highest clinical concern, and ultimately optimizing active surveillance, and personalizing management plans.
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Sirajuddin A, Mirmomen SM, Kligerman SJ, Groves DW, Burke AP, Kureshi F, White CS, Arai AE. Ischemic Heart Disease: Noninvasive Imaging Techniques and Findings. Radiographics 2021; 41:990-1021. [PMID: 34019437 PMCID: PMC8262179 DOI: 10.1148/rg.2021200125] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/07/2023]
Abstract
Ischemic heart disease is a leading cause of death worldwide and comprises a large proportion of annual health care expenditure. Management of ischemic heart disease is now best guided by the physiologic significance of coronary artery stenosis. Invasive coronary angiography is the standard for diagnosing coronary artery stenosis. However, it is expensive and has risks including vascular access site complications and contrast material–induced nephropathy. Invasive coronary angiography requires fractional flow reserve (FFR) measurement to determine the physiologic significance of a coronary artery stenosis. Multiple noninvasive cardiac imaging modalities can also anatomically delineate or functionally assess for significant coronary artery stenosis, as well as detect the presence of myocardial infarction (MI). While coronary CT angiography can help assess the degree of anatomic stenosis, its inability to assess the physiologic significance of lesions limits its specificity. Physiologic significance of coronary artery stenosis can be determined by cardiac MR vasodilator or dobutamine stress imaging, CT stress perfusion imaging, FFR CT, PET myocardial perfusion imaging (MPI), SPECT MPI, and stress echocardiography. Clinically unrecognized MI, another clear indicator of physiologically significant coronary artery disease, is relatively common and is best evaluated with cardiac MRI. The authors illustrate the spectrum of imaging findings of ischemic heart disease (coronary artery disease, myocardial ischemia, and MI); highlight the advantages and disadvantages of the various noninvasive imaging methods used to assess ischemic heart disease, as illustrated by recent clinical trials; and summarize current indications and contraindications for noninvasive imaging techniques for detection of ischemic heart disease. Online supplemental material is available for this article. Published under a CC BY 4.0 license.
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Affiliation(s)
- Arlene Sirajuddin
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - S Mojdeh Mirmomen
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Seth J Kligerman
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Daniel W Groves
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Allen P Burke
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Faraz Kureshi
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Charles S White
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
| | - Andrew E Arai
- From the Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (A.S., S.M.M., A.E.A.); Department of Radiology, University of California San Diego, San Diego, Calif (S.J.K.); Departments of Medicine and Radiology, Divisions of Cardiology and Cardiothoracic Imaging, University of Colorado Anschutz Medical Campus, Aurora, Colo (D.W.G.); Department of Pathology (A.P.B.) and Department of Radiology and Nuclear Medicine (C.S.W.), School of Medicine, University of Maryland, Baltimore, Md; and St David's Healthcare and Austin Heart, Austin, Tex (F.K.)
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Mirmomen SM, Arai AE, Turkbey EB, Bradley AJ, Sapp JC, Biesecker LG, Sirajuddin A. Cardiothoracic imaging findings of Proteus syndrome. Sci Rep 2021; 11:6577. [PMID: 33753828 PMCID: PMC7985501 DOI: 10.1038/s41598-021-86029-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/08/2021] [Indexed: 12/12/2022] Open
Abstract
In this work, we sought to delineate the prevalence of cardiothoracic imaging findings of Proteus syndrome in a large cohort at our institution. Of 53 individuals with a confirmed diagnosis of Proteus syndrome at our institution from 10/2001 to 10/2019, 38 individuals (men, n = 23; average age = 24 years) underwent cardiothoracic imaging (routine chest CT, CT pulmonary angiography and/or cardiac MRI). All studies were retrospectively and independently reviewed by two fellowship-trained cardiothoracic readers. Disagreements were resolved by consensus. Differences between variables were analyzed via parametric and nonparametric tests based on the normality of the distribution. The cardiothoracic findings of Proteus syndrome were diverse, but several were much more common and included: scoliosis from bony overgrowth (94%), pulmonary venous dilation (62%), band-like areas of lung scarring (56%), and hyperlucent lung parenchyma (50%). In addition, of 20 individuals who underwent cardiac MRI, 9/20 (45%) had intramyocardial fat, mostly involving the endocardial surface of the left ventricular septal wall. There was no statistically significant difference among the functional cardiac parameters between individuals with and without intramyocardial fat. Only one individual with intramyocardial fat had mildly decreased function (LVEF = 53%), while all others had normal ejection fraction.
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Affiliation(s)
- S Mojdeh Mirmomen
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D416, 10 Center Drive, Bethesda, MD, 20814, USA
| | - Andrew E Arai
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D416, 10 Center Drive, Bethesda, MD, 20814, USA
| | - Evrim B Turkbey
- Radiology and Imaging Sciences, National Institutes of Health, Building 10, Room 1C336, Bethesda, MD, 20814, USA
| | - Andrew J Bradley
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D416, 10 Center Drive, Bethesda, MD, 20814, USA
| | - Julie C Sapp
- Genetic Disease Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 10, Room 8D47E, Bethesda, MD, 20814, USA
| | - Leslie G Biesecker
- Genetic Disease Research Branch, National Human Genome Research Institute, National Institutes of Health, Building 10, Room 8D47E, Bethesda, MD, 20814, USA
| | - Arlene Sirajuddin
- Cardiovascular and Pulmonary Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10, Room B1D416, 10 Center Drive, Bethesda, MD, 20814, USA.
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Mirmomen SM, Matthew TL, Arai AE, Sirajuddin A. Pericardial Perivascular Epithelioid Cell Neoplasm. Radiol Cardiothorac Imaging 2021; 3:e200532. [PMID: 33969310 DOI: 10.1148/ryct.2021200532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 11/11/2022]
Abstract
Supplemental material is available for this article.
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Affiliation(s)
- S Mojdeh Mirmomen
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (S.M.M., A.E.A., A.S.); and Department of Cardiac Surgery, Suburban Hospital, Bethesda, Md (T.L.M.)
| | - Thomas L Matthew
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (S.M.M., A.E.A., A.S.); and Department of Cardiac Surgery, Suburban Hospital, Bethesda, Md (T.L.M.)
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (S.M.M., A.E.A., A.S.); and Department of Cardiac Surgery, Suburban Hospital, Bethesda, Md (T.L.M.)
| | - Arlene Sirajuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, 10 Center Dr, Building 10, Room B1D416, Bethesda, MD 20814 (S.M.M., A.E.A., A.S.); and Department of Cardiac Surgery, Suburban Hospital, Bethesda, Md (T.L.M.)
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Do HM, Spear LG, Nikpanah M, Mirmomen SM, Machado LB, Toscano AP, Turkbey B, Bagheri MH, Gulley JL, Folio LR. Augmented Radiologist Workflow Improves Report Value and Saves Time: A Potential Model for Implementation of Artificial Intelligence. Acad Radiol 2020; 27:96-105. [PMID: 31818390 DOI: 10.1016/j.acra.2019.09.014] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/12/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES Our primary aim was to improve radiology reports by increasing concordance of target lesion measurements with oncology records using radiology preprocessors (RP). Faster notification of incidental actionable findings to referring clinicians and clinical radiologist exam interpretation time savings with RPs quantifying tumor burden were also assessed. MATERIALS AND METHODS In this prospective quality improvement initiative, RPs annotated lesions before radiologist interpretation of CT exams. Clinical radiologists then hyperlinked approved measurements into interactive reports during interpretations. RPs evaluated concordance with our tumor measurement radiologist, the determinant of tumor burden. Actionable finding detection and notification times were also deduced. Clinical radiologist interpretation times were calculated from established average CT chest, abdomen, and pelvis interpretation times. RESULTS RPs assessed 1287 body CT exams with 812 follow-up CT chest, abdomen, and pelvis studies; 95 (11.7%) of which had 241 verified target lesions. There was improved concordance (67.8% vs. 22.5%) of target lesion measurements. RPs detected 93.1% incidental actionable findings with faster clinician notification by a median time of 1 hour (range: 15 minutes-16 hours). Radiologist exam interpretation times decreased by 37%. CONCLUSIONS This workflow resulted in three-fold improved target lesion measurement concordance with oncology records, earlier detection and faster notification of incidental actionable findings to referring clinicians, and decreased exam interpretation times for clinical radiologists. These findings demonstrate potential roles for automation (such as AI) to improve report value, worklist prioritization, and patient care.
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Mirmomen SM, Shinagare AB, Williams KE, Silverman SG, Malayeri AA. Preoperative imaging for locoregional staging of bladder cancer. Abdom Radiol (NY) 2019; 44:3843-3857. [PMID: 31377833 DOI: 10.1007/s00261-019-02168-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Bladder cancer is the ninth most common cancer, expected to lead to an estimated 17,670 deaths in the United States in 2019. Clinical management and prognosis of bladder cancer mainly depend on the extent of locoregional disease, particularly whether bladder muscle is involved. Therefore, bladder cancer is often divided into superficial, non-muscle-invasive bladder cancer and muscle-invasive bladder cancer; the latter often prompts consideration for cystectomy. While precise staging prior to cystectomy is crucial, the optimal preoperative imaging modality used to stage the disease remains controversial. Transurethral resection of bladder tumor (TURBT) followed by computed tomography (CT) urography is the current recommended approach for staging bladder cancer but suffers from a high rate of understaging. We review the recent literature and compare different imaging modalities for assessing the presence of muscle invasion and lymph node involvement prior to cystectomy and highlight the advantages of each modality.
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Tadayoni A, Farhadi F, Mirmomen SM, Shafiei A, Berman KF, Bagheri M, Martinez PE, Schmidt PJ, Yanovski JA, Malayeri AA. Evaluation of incidental pelvic fluid in relation to physiological changes in healthy pubescent children using pelvic magnetic resonance imaging. Pediatr Radiol 2019; 49:784-790. [PMID: 30859244 PMCID: PMC6530573 DOI: 10.1007/s00247-019-04355-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/19/2018] [Accepted: 02/14/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Peritoneal free fluid can indicate an underlying disease process; however detection of minimal peritoneal free fluid in healthy children is not uncommon. OBJECTIVE To assess the significance of incidental peritoneal free fluid within healthy children by MRI and its relation to physiological changes during puberty. MATERIALS AND METHODS This prospective study was performed on 32 healthy volunteers (20 boys) between the ages of 8 years and 13 years, with consecutive follow-ups every 8-10 months for an average of 3 years. Body mass index (BMI) z-score, pubertal status, C-reactive protein and sex hormone concentrations were assessed prior to MRI studies. We reviewed a total of 120 pelvic MRI studies (61 boys) and measured the quantity of peritoneal free fluid. For statistical analysis we used linear mixed-model accounting for within-patient correlations. RESULTS The mean ± standard deviation volume of peritoneal free fluid was 4.7±5.7 mL in girls and 1.9±3.1 mL in boys, with a maximum volume of 25 mL and 17 mL, respectively. The prevalence of peritoneal free fluid was significantly higher in girls (91%) compared to boys (67%; P=0.0035). In 15% of the girls and 3% of the boys the fluid was greater than 10 mL. The mean volume of peritoneal free fluid in the fourth stage of puberty was higher and significantly different from the mean volume in the first stage of puberty (P=0.01). CONCLUSION Among healthy pubescent children, the prevalence of peritoneal free fluid is significantly higher in girls. The volume of peritoneal free fluid can reach volumes greater than 10 mL during normal puberty, especially in the fourth stage, and can be assumed normal in the absence of active disease.
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Affiliation(s)
- Ashkan Tadayoni
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Faraz Farhadi
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - S. Mojdeh Mirmomen
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ahmad Shafiei
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Karen F. Berman
- Clinical Translational Neuroscience Branch at the National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Mohammadhadi Bagheri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Pedro E. Martinez
- Section on Behavioral Endocrinology, National Institute of Mental Health, Department of Health and Human Services, National Institutes of Health, Bethesda, MD, USA
| | - Peter J. Schmidt
- Section on Behavioral Endocrinology, National Institute of Mental Health, Department of Health and Human Services, National Institutes of Health, Bethesda, MD, USA
| | - Jack A. Yanovski
- Clinical Translational Neuroscience Branch at the National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Ashkan A. Malayeri
- Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Hoang UN, Mojdeh Mirmomen S, Meirelles O, Yao J, Merino M, Metwalli A, Marston Linehan W, Malayeri AA. Assessment of multiphasic contrast-enhanced MR textures in differentiating small renal mass subtypes. Abdom Radiol (NY) 2018; 43:3400-3409. [PMID: 29858935 DOI: 10.1007/s00261-018-1625-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE This study seeks to evaluate the use of quantitative texture parameters extracted from multiphasic contrast-enhanced magnetic resonance (MR) imaging in differentiating between benign and malignant masses (oncocytoma vs. clear cell and papillary RCC) and between common subtypes of renal cell carcinoma (clear cell vs. papillary RCC) in small renal masses (< 4 cm). METHOD One-hundred and forty-two renal lesions (90 clear cell and 22 papillary RCCs; 30 oncocytomas) were identified in a cohort of 41 patients (18 men, 23 women: mean age, 52.8 ± 14.4 years) who underwent preoperative multiphasic contrast-enhanced MR with four phases (unenhanced, arterial, venous, and delayed) between 2015 and 2016. In this study, texture features were extracted from entire cross-sectional tumoral region in three consecutive slices containing the largest cross-sectional area from each of the four phases. The change in imaging feature between precontrast imaging and each postcontrast phase was calculated. Data dimension reduction and feature selection were performed by conducting (1) pairwise Wilcoxon rank test followed by modified false discovery rate adjustment, and (2) Lasso regression. Multivariate modeling incorporating the selected features was performed using random forest classification method. RESULTS Histogram imaging features were informative variables in differentiating between benign and malignant masses, while textures imaging features were of added value in differentiating between subtypes of RCCs. Papillary RCCs were distinguished from clear cell RCCs (sensitivity 65.5%, specificity 88%, and accuracy 77.9%), oncocytomas from clear cell RCCs (sensitivity 67.3%, specificity 88.9%, and accuracy 79.3%), and oncocytomas from papillary and clear cell RCCs (sensitivity 64.7%, specificity 85.9%, and accuracy 77.9%). CONCLUSIONS A combination of histogram and texture imaging features on multiphasic MR can help differentiate histologic cell types in common small renal masses (< 4 cm).
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Affiliation(s)
- Uyen N Hoang
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA.
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA.
- , 10 Center Dr, Bethesda, MD, 20814, USA.
| | - S Mojdeh Mirmomen
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Osorio Meirelles
- Neuroepidemiology Section, National Institute of Aging, Bethesda, MD, 20892, USA
| | - Jianhua Yao
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Maria Merino
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA
| | - Adam Metwalli
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA
| | - W Marston Linehan
- Neuroepidemiology Section, National Institute of Aging, Bethesda, MD, 20892, USA
| | - Ashkan A Malayeri
- Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
- Urologic Oncology Branch, National Cancer Institute, Bethesda, MD, 20892, USA
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11
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Paschall AK, Mirmomen SM, Symons R, Pourmorteza A, Gautam R, Sahai A, Dwyer AJ, Merino MJ, Metwalli AR, Linehan WM, Malayeri AA. Differentiating papillary type I RCC from clear cell RCC and oncocytoma: application of whole-lesion volumetric ADC measurement. Abdom Radiol (NY) 2018. [PMID: 29520425 DOI: 10.1007/s00261-017-1453-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To determine whether objective volumetric whole-lesion apparent diffusion coefficient (ADC) distribution analysis improves upon the capabilities of conventional subjective small region-of-interest (ROI) ADC measurements for prediction of renal cell carcinoma (RCC) subtype. METHODS This IRB-approved study retrospectively enrolled 55 patients (152 tumors). Diffusion-weighted imaging DWI was acquired at b values of 0, 250, and 800 s/mm2 on a 1.5T system (Aera, Siemens Healthcare). Whole-lesion measurements were performed by a research fellow and reviewed by a fellowship-trained radiologist. Mean, median, skewness, kurtosis, and every 5th percentile ADCs were determined from the whole-lesion histogram. Linear mixed models that accounted for within-subject correlation of lesions were used to compare ADCs among RCC subtypes. Receiver-operating characteristic (ROC) curve analysis with optimal cutoff points from the Youden index was used to test the ability of ADCs to differentiate clear cell RCC (ccRCC), papillary RCC (pRCC), and oncocytoma subtypes. RESULTS Whole-lesion ADC values were significantly different between pRCC and ccRCC, and between pRCC and oncocytoma, demonstrating strong ability to differentiate subtypes across the quantiles (both P < 0.001). Best percentile ROC analysis demonstrated AUC values of 95.2 for ccRCC vs. pRCC; 67.6 for oncocytoma vs. ccRCC; and 95.8 for oncocytoma vs. pRCC. Best percentile ROC analysis further indicated model sensitivities/specificities of 84.5%/93.1% for ccRCC vs. pRCC; 100.0%/10.3% for oncocytoma vs. ccRCC; and 88.5%/93.1% for oncocytoma vs. pRCC. CONCLUSION The objective methodology of whole-lesion volumetric ADC measurements maintains the sensitivity/specificity of conventional expert-based ROI analysis, provides information on lesion heterogeneity, and reduces observer bias.
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12
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Haroutunian SG, O'Brien KJ, Estrada-Veras JI, Yao J, Boyd LC, Mathur K, Gahl WA, Mirmomen SM, Malayeri AA, Kleiner DE, Jaffe ES, Gochuico BR. Clinical and Histopathologic Features of Interstitial Lung Disease in Erdheim⁻Chester Disease. J Clin Med 2018; 7:jcm7090243. [PMID: 30154360 PMCID: PMC6162862 DOI: 10.3390/jcm7090243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 08/17/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022] Open
Abstract
Limited information is available regarding interstitial lung disease (ILD) in Erdheim⁻Chester disease (ECD), a rare multisystemic non-Langerhans cell histiocytosis. Sixty-two biopsy-confirmed ECD patients were divided into those with no ILD (19.5%), minimal ILD (32%), mild ILD (29%), and moderate/severe ILD (19.5%), based on computed tomography (CT) findings. Dyspnea affected at least half of the patients with mild or moderate/severe ILD. Diffusion capacity was significantly reduced in ECD patients with minimal ILD. Disease severity was inversely correlated with pulmonary function measurements; no correlation with BRAF V600E mutation status was seen. Reticulations and ground-glass opacities were the predominant findings on CT images. Automated CT scores were significantly higher in patients with moderate/severe ILD, compared to those in other groups. Immunostaining of lung biopsies was consistent with ECD. Histopathology findings included subpleural and septal fibrosis, with areas of interspersed normal lung, diffuse interstitial fibrosis, histiocytes with foamy cytoplasm embedded in fibrosis, lymphoid aggregates, and focal type II alveolar cell hyperplasia. In conclusion, ILD of varying severity may affect a high proportion of ECD patients. Histopathology features of ILD in ECD can mimic interstitial fibrosis patterns observed in idiopathic ILD.
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Affiliation(s)
- Sara G Haroutunian
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Kevin J O'Brien
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Juvianee I Estrada-Veras
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Jianhua Yao
- Radiology and Imaging Sciences, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Louisa C Boyd
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Kavya Mathur
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - William A Gahl
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - S Mojdeh Mirmomen
- Laboratory of Diagnostic Radiology Research, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Ashkan A Malayeri
- Laboratory of Diagnostic Radiology Research, Warren Grant Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA.
| | - David E Kleiner
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Elaine S Jaffe
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
| | - Bernadette R Gochuico
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Mirmomen SM, Sirajuddin A, Nikpanah M, Symons R, Paschall AK, Papageorgiou I, Gahl WA, O'Brien K, Estrada-Veras JI, Malayeri AA. Thoracic involvement in Erdheim-Chester disease: computed tomography imaging findings and their association with the BRAF V600E mutation. Eur Radiol 2018; 28:4635-4642. [PMID: 29736852 DOI: 10.1007/s00330-018-5421-3] [Citation(s) in RCA: 12] [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: 10/04/2017] [Revised: 02/20/2018] [Accepted: 03/08/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate the computed tomography (CT) thoracic findings in Erdheim-Chester disease (ECD) and evaluate the association of these findings with the BRAFV600E mutation. METHODS This was a prospective study of patients with ECD (n=61, men=46) who underwent thoracic CT imaging. CT examinations were independently interpreted by two experienced radiologists. Association of imaging findings with BRAFV600E was achieved via the Chi-square or Fisher's exact test and odds ratios (OR) with 95% confidence intervals (CI), as appropriate. RESULTS Fifty-five ECD patients (90%) showed pulmonary findings, which included interlobular septal thickening (69%), pulmonary nodules (62%), airway thickening (13%) and ground glass opacities (36%). Pulmonary nodules were classified by the pattern of distribution: subpleural regions (36%), lung parenchyma (13%) and both regions (13%). Pleural and mediastinal involvement were present in 15% and 62% of cases, respectively. The most common mediastinal finding was sheathing of the right coronary artery (34%), followed by sheathing of the thoracic aorta (30%). The BRAFV600E mutation, positive in 31 patients, was associated with the frequency of sheathing of the coronary arteries (p = 0.01). CONCLUSIONS Of the thoracic findings reported in this study, we found a statistically significant positive association between the BRAFV600E mutation and presence of coronary artery sheathing. KEY POINTS • To assess the degree of thoracic involvement in ECD with CT. • BRAF V600E mutation has a high association with right coronary artery sheathing. • BRAF V600E genetic testing detects patients at high risk of developing RCA sheathing.
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Affiliation(s)
- S Mojdeh Mirmomen
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Arlene Sirajuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Moozhan Nikpanah
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Rolf Symons
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Anna K Paschall
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bethesda, MD, 20892, USA
| | - Ioannis Papageorgiou
- Magnetic Resonance Imaging of Epirus (Magnitiki Tomografia Ipirou), Ioannina, Greece
| | - William A Gahl
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kevin O'Brien
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Juvianee I Estrada-Veras
- National Human Genome Research Institute, Medical Genetics Branch, Office of the Clinical Director, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Ashkan A Malayeri
- Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bethesda, MD, 20892, USA.
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