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Braun M, Frieden IJ, Siegel DH, George E, Hess CP, Fox CK, Chamlin SL, Drolet BA, Metry D, Pope E, Powell J, Holland K, Ulschmid C, Liang MG, Barry KK, Ho T, Cotter C, Baselga E, Bosquez D, Jain SN, Bui JK, Lara-Corrales I, Funk T, Small A, Baghoomian W, Yan AC, Treat JR, Hogrogian GS, Huang C, Haggstrom A, List M, McCuaig CC, Barrio V, Mancini AJ, Lawley LP, Grunnet-Satcher K, Horii KA, Newell B, Nopper A, Garzon MC, Scollan ME, Mathes EF. Multicenter Study of Long-Term Outcomes and Quality of Life in PHACE Syndrome after Age 10. J Pediatr 2024; 267:113907. [PMID: 38218370 DOI: 10.1016/j.jpeds.2024.113907] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/23/2023] [Accepted: 01/09/2024] [Indexed: 01/15/2024]
Abstract
OBJECTIVE To characterize long-term outcomes of PHACE syndrome. STUDY DESIGN Multicenter study with cross-sectional interviews and chart review of individuals with definite PHACE syndrome ≥10 years of age. Data from charts were collected across multiple PHACE-related topics. Data not available in charts were collected from patients directly. Likert scales were used to assess the impact of specific findings. Patient-Reported Outcomes Measurement Information System (PROMIS) scales were used to assess quality of life domains. RESULTS A total of 104/153 (68%) individuals contacted participated in the study at a median of 14 years of age (range 10-77 years). There were infantile hemangioma (IH) residua in 94.1%. Approximately one-half had received laser treatment for residual IH, and the majority (89.5%) of participants were satisfied or very satisfied with the appearance. Neurocognitive manifestations were common including headaches/migraines (72.1%), participant-reported learning differences (45.1%), and need for individualized education plans (39.4%). Cerebrovascular arteriopathy was present in 91.3%, with progression identified in 20/68 (29.4%) of those with available follow-up imaging reports. Among these, 6/68 (8.8%) developed moyamoya vasculopathy or progressive stenoocclusion, leading to isolated circulation at or above the level of the circle of Willis. Despite the prevalence of cerebrovascular arteriopathy, the proportion of those with ischemic stroke was low (2/104; 1.9%). PROMIS global health scores were lower than population norms by at least 1 SD. CONCLUSIONS PHACE syndrome is associated with long-term, mild to severe morbidities including IH residua, headaches, learning differences, and progressive arteriopathy. Primary and specialty follow-up care is critical for PHACE patients into adulthood.
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Affiliation(s)
- Mitchell Braun
- University of California San Francisco, School of Medicine, San Francisco, CA; Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Ilona J Frieden
- Department of Dermatology, University of California San Francisco, San Francisco, CA
| | - Dawn H Siegel
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Elizabeth George
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA
| | - Christine K Fox
- Department of Neurology and Pediatrics, University of California San Francisco, San Francisco, CA
| | - Sarah L Chamlin
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Beth A Drolet
- Department of Dermatology, University of Wisconsin Madison, Madison, WI
| | - Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Elena Pope
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Julie Powell
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Kristen Holland
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Caden Ulschmid
- Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI
| | - Marilyn G Liang
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Kelly K Barry
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tina Ho
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Chantal Cotter
- Department of Dermatology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | - David Bosquez
- Department of Dermatology, Hospital de la Sant Pau, Barcelona, Spain
| | | | - Jordan K Bui
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Irene Lara-Corrales
- Division of Pediatric Dermatology, Hospital for Sick Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Tracy Funk
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Alison Small
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Wenelia Baghoomian
- Departments of Dermatology and Pediatrics, Oregon Health & Science University, Portland, OR
| | - Albert C Yan
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - James R Treat
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Griffin Stockton Hogrogian
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Charles Huang
- Department of Pediatrics and Dermatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Anita Haggstrom
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Mary List
- Department of Dermatology, Indiana University School of Medicine, Indianapolis, IN
| | - Catherine C McCuaig
- Division of Dermatology, Department of Pediatrics, Sainte-Justine University Hospital Center, University of Montreal, Montreal, Quebec, Canada
| | - Victoria Barrio
- Department of Dermatology, Rady Children's Hospital, University of California San Diego, San Diego, CA
| | - Anthony J Mancini
- Department of Dermatology, Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leslie P Lawley
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA
| | | | - Kimberly A Horii
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Brandon Newell
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Amy Nopper
- Division of Dermatology, Children's Mercy Hospital and Clinics, Kansas City, MO
| | - Maria C Garzon
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Margaret E Scollan
- Department of Dermatology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Erin F Mathes
- Department of Dermatology, University of California San Francisco, San Francisco, CA.
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Rudie JD, Saluja R, Weiss DA, Nedelec P, Calabrese E, Colby JB, Laguna B, Mongan J, Braunstein S, Hess CP, Rauschecker AM, Sugrue LP, Villanueva-Meyer JE. The University of California San Francisco Brain Metastases Stereotactic Radiosurgery (UCSF-BMSR) MRI Dataset. Radiol Artif Intell 2024; 6:e230126. [PMID: 38381038 PMCID: PMC10982817 DOI: 10.1148/ryai.230126] [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: 04/19/2023] [Revised: 01/11/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
Supplemental material is available for this article.
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Affiliation(s)
- Jeffrey D. Rudie
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | | | - David A. Weiss
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - Pierre Nedelec
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - Evan Calabrese
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - John B. Colby
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - Benjamin Laguna
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - John Mongan
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - Steve Braunstein
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - Christopher P. Hess
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - Andreas M. Rauschecker
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - Leo P. Sugrue
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
| | - Javier E. Villanueva-Meyer
- From the Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging (J.D.R., D.A.W., P.N., E.C., J.B.C., B.L., J.M., C.P.H., A.M.R., L.P.S., J.E.V.M.) and Department of Radiation Oncology (S.B.), University of California San Francisco, 513 Parnassus Ave, Rm S-261, Box 0628, San Francisco, CA 94143-0628; Department of Radiology, University of California San Diego, San Diego Calif (J.D.R.); Department of Radiology, University of Pennsylvania, Philadelphia, Pa (R.S.); and Department of Radiology, Duke University School of Medicine, Durham, NC (E.C.)
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Yao J, Morrison MA, Jakary A, Avadiappan S, Rowley P, Glueck J, Driscoll T, Geschwind MD, Nelson AB, Possin KL, Xu D, Hess CP, Lupo JM. Altered Iron and Microstructure in Huntington's Disease Subcortical Nuclei: Insight From 7T MRI. J Magn Reson Imaging 2024. [PMID: 38206986 DOI: 10.1002/jmri.29195] [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: 09/17/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Pathophysiological changes of Huntington's disease (HD) can precede symptom onset by decades. Robust imaging biomarkers are needed to monitor HD progression, especially before the clinical onset. PURPOSE To investigate iron dysregulation and microstructure alterations in subcortical regions as HD imaging biomarkers, and to associate such alterations with motor and cognitive impairments. STUDY TYPE Prospective. POPULATION Fourteen individuals with premanifest HD (38.0 ± 11.0 years, 9 females; far-from-onset N = 6, near-onset N = 8), 21 manifest HD patients (49.1 ± 12.1 years, 11 females), and 33 age-matched healthy controls (43.9 ± 12.2 years, 17 females). FIELD STRENGTH/SEQUENCE 7 T, T1 -weighted imaging, quantitative susceptibility mapping, and diffusion tensor imaging. ASSESSMENT Volume, susceptibility, fractional anisotropy (FA), and mean diffusivity (MD) within subcortical brain structures were compared across groups, used to establish HD classification models, and correlated to clinical measures and cognitive assessments. STATISTICAL TESTS Generalized linear model, multivariate logistic regression, receiver operating characteristics with the area under the curve (AUC), and likelihood ratio test comparing a volumetric model to one that also includes susceptibility and diffusion metrics, Wilcoxon paired signed-rank test, and Pearson's correlation. A P-value <0.05 after Benjamini-Hochberg correction was considered statistically significant. RESULTS Significantly higher striatal susceptibility and FA were found in premanifest and manifest HD preceding atrophy, even in far-from-onset premanifest HD compared to controls (putamen susceptibility: 0.027 ± 0.022 vs. 0.018 ± 0.013 ppm; FA: 0.358 ± 0.048 vs. 0.313 ± 0.039). The model with additional susceptibility, FA, and MD features showed higher AUC compared to volume features alone when differentiating premanifest HD from HC (0.83 vs. 0.66), and manifest from premanifest HD (0.94 vs. 0.83). Higher striatal susceptibility significantly correlated with cognitive deterioration in HD (executive function: r = -0.600; socioemotional function: r = -0.486). DATA CONCLUSION 7 T MRI revealed iron dysregulation and microstructure alterations with HD progression, which could precede volume loss, provide added value to HD differentiation, and might be associated with cognitive changes. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Jingwen Yao
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- Department of Radiological Sciences, UCLA, Los Angeles, California, USA
- Department of Bioengineering, UCLA, Los Angeles, California, USA
| | - Melanie A Morrison
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- UCSF/UC Berkeley Graduate Program in Bioengineering, San Francisco and Berkeley, California, USA
| | - Angela Jakary
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Sivakami Avadiappan
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Paul Rowley
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
| | - Julia Glueck
- Department of Neurology, UCSF, San Francisco, California, USA
| | | | | | | | | | - Duan Xu
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- UCSF/UC Berkeley Graduate Program in Bioengineering, San Francisco and Berkeley, California, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- Department of Neurology, UCSF, San Francisco, California, USA
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, California, USA
- UCSF/UC Berkeley Graduate Program in Bioengineering, San Francisco and Berkeley, California, USA
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Genc O, Morrison MA, Villanueva-Meyer J, Burns B, Hess CP, Banerjee S, Lupo JM. DeepSWI: Using Deep Learning to Enhance Susceptibility Contrast on T2*-Weighted MRI. J Magn Reson Imaging 2023; 58:1200-1210. [PMID: 36733222 PMCID: PMC10443940 DOI: 10.1002/jmri.28622] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/19/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although susceptibility-weighted imaging (SWI) is the gold standard for visualizing cerebral microbleeds (CMBs) in the brain, the required phase data are not always available clinically. Having a postprocessing tool for generating SWI contrast from T2*-weighted magnitude images is therefore advantageous. PURPOSE To create synthetic SWI images from clinical T2*-weighted magnitude images using deep learning and evaluate the resulting images in terms of similarity to conventional SWI images and ability to detect radiation-associated CMBs. STUDY TYPE Retrospective. POPULATION A total of 145 adults (87 males/58 females; 43.9 years old) with radiation-associated CMBs were used to train (16,093 patches/121 patients), validate (484 patches/4 patients), and test (2420 patches/20 patients) our networks. FIELD STRENGTH/SEQUENCE 3D T2*-weighted, gradient-echo acquired at 3 T. ASSESSMENT Structural similarity index (SSIM), peak signal-to-noise-ratio (PSNR), normalized mean-squared-error (nMSE), CMB counts, and line profiles were compared among magnitude, original SWI, and synthetic SWI images. Three blinded raters (J.E.V.M., M.A.M., B.B. with 8-, 6-, and 4-years of experience, respectively) independently rated and classified test-set images. STATISTICAL TESTS Kruskall-Wallis and Wilcoxon signed-rank tests were used to compare SSIM, PSNR, nMSE, and CMB counts among magnitude, original SWI, and predicted synthetic SWI images. Intraclass correlation assessed interrater variability. P values <0.005 were considered statistically significant. RESULTS SSIM values of the predicted vs. original SWI (0.972, 0.995, 0.9864) were statistically significantly higher than that of the magnitude vs. original SWI (0.970, 0.994, 0.9861) for whole brain, vascular structures, and brain tissue regions, respectively; 67% (19/28) CMBs detected on original SWI images were also detected on the predicted SWI, whereas only 10 (36%) were detected on magnitude images. Overall image quality was similar between the synthetic and original SWI images, with less artifacts on the former. CONCLUSIONS This study demonstrated that deep learning can increase the susceptibility contrast present in neurovasculature and CMBs on T2*-weighted magnitude images, without residual susceptibility-induced artifacts. This may be useful for more accurately estimating CMB burden from magnitude images alone. EVIDENCE LEVEL 3. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Ozan Genc
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Boğaziçi University, Istanbul, Turkey
| | - Melanie A. Morrison
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Javier Villanueva-Meyer
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Department of Neurological Surgery, University of California, San Francisco, CA
| | | | - Christopher P. Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Department of Neurology, University of California, San Francisco, CA
| | | | - Janine M. Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- UCSF/UC Berkeley Graduate Group of Bioengineering, University of California, Berkeley and San Francisco, CA
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Calabrese E, Wu Y, Scheffler AW, Wisnowski JL, McKinstry RC, Mathur A, Glass HC, Comstock BA, Heagerty PJ, Gillon S, Juul SE, Hess CP, Li Y. Correlating Quantitative MRI-based Apparent Diffusion Coefficient Metrics with 24-month Neurodevelopmental Outcomes in Neonates from the HEAL Trial. Radiology 2023; 308:e223262. [PMID: 37698478 PMCID: PMC10546287 DOI: 10.1148/radiol.223262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/10/2023] [Accepted: 07/18/2023] [Indexed: 09/13/2023]
Abstract
Background Multiple qualitative scoring systems have been created to capture the imaging severity of hypoxic ischemic brain injury. Purpose To evaluate quantitative volumes of acute brain injury at MRI in neonates with hypoxic ischemic brain injury and correlate these findings with 24-month neurodevelopmental outcomes and qualitative brain injury scoring by radiologists. Materials and Methods In this secondary analysis, brain diffusion-weighted MRI data from neonates in the High-dose Erythropoietin for Asphyxia and Encephalopathy trial, which recruited participants between January 2017 and October 2019, were analyzed. Volume of acute brain injury, defined as brain with apparent diffusion coefficient (ADC) less than 800 × 10-6 mm2/sec, was automatically computed across the whole brain and within the thalami and white matter. Outcomes of death and neurodevelopmental impairment (NDI) were recorded at 24-month follow-up. Associations between the presence and volume (in milliliters) of acute brain injury with 24-month outcomes were evaluated using multiple logistic regression. The correlation between quantitative acute brain injury volume and qualitative MRI scores was assessed using the Kendall tau-b test. Results A total of 416 neonates had available MRI data (mean gestational age, 39.1 weeks ± 1.4 [SD]; 235 male) and 113 (27%) showed evidence of acute brain injury at MRI. Of the 387 participants with 24-month follow-up data, 185 (48%) died or had any NDI. Volume of acute injury greater than 1 mL (odds ratio [OR], 13.9 [95% CI: 5.93, 32.45]; P < .001) and presence of any acute injury in the brain (OR, 4.5 [95% CI: 2.6, 7.8]; P < .001) were associated with increased odds of death or any NDI. Quantitative whole-brain acute injury volume was strongly associated with radiologists' qualitative scoring of diffusion-weighted images (Kendall tau-b = 0.56; P < .001). Conclusion Automated quantitative volume of brain injury is associated with death, moderate to severe NDI, and cerebral palsy in neonates with hypoxic ischemic encephalopathy and correlated well with qualitative MRI scoring of acute brain injury. Clinical trial registration no. NCT02811263 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Huisman in this issue.
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Affiliation(s)
- Evan Calabrese
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Yvonne Wu
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Aaron Wolfe Scheffler
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Jessica L. Wisnowski
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Robert C. McKinstry
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Amit Mathur
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Hannah C. Glass
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Bryan A. Comstock
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Patrick J. Heagerty
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Shivani Gillon
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Sandra E. Juul
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Christopher P. Hess
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
| | - Yi Li
- From the Department of Radiology, Duke University Medical Center, Durham, NC (E.C.); Department of Neurology and Weill Institute for Neuroscience (Y.W., H.C.G.), Department of Pediatrics, UCSF Benioff Children's Hospital (Y.W., H.C.G.), Department of Epidemiology and Biostatistics (A.W.S.), School of Medicine (S.G.), and Neuroradiology Section, Department of Radiology and Biomedical Imaging (C.P.H., Y.L.), University of California, San Francisco, 505 Parnassus Ave, M-391, San Francisco, CA 94143-0628; Department of Radiology, Children's Hospital of Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, Calif (J.L.W.); Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (R.C.M.); Department of Pediatrics, St Louis University, St Louis, Mo (A.M.); and Departments of Statistics (B.A.C., P.J.H.) and Pediatrics (S.E.J.), University of Washington, Seattle, Wash
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Hess CP. MRI of the Brain: What Is Driving Innovation in 2023? Radiology 2023; 308:e231657. [PMID: 37750776 DOI: 10.1148/radiol.231657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Affiliation(s)
- Christopher P Hess
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, 505 Parnassus Ave, Room M-391, San Francisco, CA 94143-0628
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Courtier J, Hess CP. Does Pediatric Radiology Need Faster Horses? Rethinking Strategies to Workforce and Workflow. Acad Radiol 2023; 30:2046-2049. [PMID: 37394413 DOI: 10.1016/j.acra.2023.05.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Affiliation(s)
- Jesse Courtier
- UCSF Department of Radiology and Biomedical Imaging, Pediatric Radiology UCSF Benioff Children's Hospital, 1975 4th Street, C1758 P, San Francisco, CA 94138.
| | - Christopher P Hess
- UCSF Department of Radiology and Biomedical Imaging, Pediatric Radiology UCSF Benioff Children's Hospital, 1975 4th Street, C1758 P, San Francisco, CA 94138
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Hawkins JR, Olson MP, Harouni A, Qin MM, Hess CP, Majumdar S, Crane JC. Implementation and prospective real-time evaluation of a generalized system for in-clinic deployment and validation of machine learning models in radiology. PLOS Digit Health 2023; 2:e0000227. [PMID: 37603542 PMCID: PMC10441783 DOI: 10.1371/journal.pdig.0000227] [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] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
The medical imaging community has embraced Machine Learning (ML) as evidenced by the rapid increase in the number of ML models being developed, but validating and deploying these models in the clinic remains a challenge. The engineering involved in integrating and assessing the efficacy of ML models within the clinical workflow is complex. This paper presents a general-purpose, end-to-end, clinically integrated ML model deployment and validation system implemented at UCSF. Engineering and usability challenges and results from 3 use cases are presented. A generalized validation system based on free, open-source software (OSS) was implemented, connecting clinical imaging modalities, the Picture Archiving and Communication System (PACS), and an ML inference server. ML pipelines were implemented in NVIDIA's Clara Deploy framework with results and clinician feedback stored in a customized XNAT instance, separate from the clinical record but linked from within PACS. Prospective clinical validation studies of 3 ML models were conducted, with data routed from multiple clinical imaging modalities and PACS. Completed validation studies provided expert clinical feedback on model performance and usability, plus system reliability and performance metrics. Clinical validation of ML models entails assessing model performance, impact on clinical infrastructure, robustness, and usability. Study results must be easily accessible to participating clinicians but remain outside the clinical record. Building a system that generalizes and scales across multiple ML models takes the concerted effort of software engineers, clinicians, data scientists, and system administrators, and benefits from the use of modular OSS. The present work provides a template for institutions looking to translate and clinically validate ML models in the clinic, together with required resources and expected challenges.
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Affiliation(s)
- James R. Hawkins
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States of America
| | - Marram P. Olson
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States of America
| | - Ahmed Harouni
- NVIDIA, Santa Clara, California, United States of America
| | | | - Christopher P. Hess
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States of America
| | - Sharmila Majumdar
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States of America
| | - Jason C. Crane
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, United States of America
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Woolen SA, Becker AE, Martin AJ, Knoerl R, Lam V, Folsom J, Eusemann C, Hess CP, Deshpande V. Erratum for: Ecodesign and Operational Strategies to Reduce the Carbon Footprint of MRI for Energy Cost Savings. Radiology 2023; 308:e239020. [PMID: 37489995 DOI: 10.1148/radiol.239020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
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Haas BM, Zhang L, Nichols H, Orwig N, Hess CP, Kolli KP. What referring clinicians value most: Accuracy of radiology results and personal interactions with radiologists. Clin Imaging 2023; 97:72-77. [PMID: 36907042 DOI: 10.1016/j.clinimag.2023.02.006] [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: 10/12/2022] [Revised: 01/28/2023] [Accepted: 02/06/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE We sought to identify which aspects of the referring clinician experience are most strongly correlated with overall satisfaction, and hence of greatest relevant importance to referring clinicians. METHODS A survey instrument assessing referring clinician satisfaction throughout 11 domains of the radiology process map was distributed 2720 clinicians. The survey contained sections assessing each process map domain, with each section including a question about satisfaction overall in that domain and multiple more granular questions. The final question on the survey was overall satisfaction with the department. Univariate logistic regression and multivariate logistic regression were performed to assess the association between individual survey questions and overall satisfaction with the department. RESULTS 729 referring clinicians (27%) completed the survey. Using univariate logistic regression nearly every question was associated with overall satisfaction. Amongst the 11 domains of the radiology process map multivariate logistic regression identified the following as mostly strongly associated with overall satisfaction: results/reporting overall (odds ratio 4.71; 95% confidence interval 2.15-10.23), section with which work most closely overall (3.39; 1.28-8.64), and inpatient radiology overall (2.39; 1.08-5.08). Other survey questions associated with overall satisfaction on multivariate logistic regression were attending radiologist interactions (odds ratio 3.71; 95% confidence interval 1.54-8.69), timeliness of inpatient radiology results (2.91; 1.01-8.09), technologist interactions (2.15; 0.99-4.40), appointment availability for urgent outpatient studies (2.01; 1.08-3.64), and guidance for selecting correct imaging study (1.88; 1.04-3.34). CONCLUSION Referring clinicians value most the accuracy of the radiology report and their interactions with attending radiologists, particularly within the section they work most closely.
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Affiliation(s)
- Brian M Haas
- University of California San Francisco, 1001 Potrero Ave 1X57, San Francisco, CA 94110, United States of America.
| | - Li Zhang
- University of California San Francisco, United States of America.
| | - Heather Nichols
- University of California San Francisco, United States of America.
| | - Nathan Orwig
- University of California Berkeley, United States of America.
| | | | - K Pallav Kolli
- University of California San Francisco, United States of America.
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Woolen SA, Becker AE, Martin AJ, Knoerl R, Lam V, Folsom J, Eusemann C, Hess CP, Deshpande V. Ecodesign and Operational Strategies to Reduce the Carbon Footprint of MRI for Energy Cost Savings. Radiology 2023; 307:e230441. [PMID: 37097133 DOI: 10.1148/radiol.230441] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Background Radiology is a major contributor to health care's climate footprint due to energy-intensive devices, particularly MRI which uses the most energy. Purpose To determine the energy, cost, and carbon savings that could be achieved through different scanner power management strategies. Materials and Methods In this retrospective evaluation, four outpatient MRI scanners from three vendors were individually equipped with power meters (1-Hz sampling rate). Power measurement logs were extracted over 39 days. Data were segmented into off, idle, prepared-to-scan, scan, or power-save modes for each scanner. Energy, cost (assuming a mean cost of $0.14 per kilowatt hour), and carbon savings were calculated for the lowest scanner activity modes. Data was summarized using descriptive statistics and 95% confidence intervals. Results Projected annual energy consumption per scanner ranged from 82.7-171.1 megawatt-hours (MWh), with 72-91% defined as nonproductive. Power draws for each mode were measured as 6.4 ± 0.1 kW (power-save), 7.3 ± 0.6 kW to 9.7 ± 0.2 kW (off), 9.5 ± 0.9 to 14.5 ± 0.5 kW (idle), 17.3 ± 0.5 to 25.6 ± 0.6 kW (prepared-to-scan), and 28.6 ± 8.6 to 48.3 ± 11.8 kW (scan). Switching MRIs from idle to off mode for 12 overnight hours reduced power consumption by 25-33%, translating to a potential annual savings of 12.3-21.0 MWh, $1717-$2943 U.S. dollars, and 8.7-14.9 metric tons of CO2-equivalent (MTCO2eq). The power-save mode further reduced consumption by 22-28% compared to off mode, potentially saving an additional 8.8-11.4 MWh, $1,226-$1,594 U.S. dollars, and 6.2-8.1 MTCO2eq per year for 12 hours overnight. Implementation of a power-save mode for 12 hours overnight on all U.S. outpatient MRI in the U.S. could save U.S. health care 58,863.2-76,288.2 MWh, $8.2-$10.7 million U.S. dollars, and 41,606.4-54,088.3 MTCO2eq. Conclusion Powering down MRIs can make radiology departments more energy-efficient and gain substantial sustainability and cost benefits. See also the editorial by Vosshenrich and Heye.
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Affiliation(s)
- Sean A Woolen
- Department of Radiology and Biomedical Imaging, UC San Francisco, United States
| | - Amy E Becker
- Department of Radiology and Biomedical Imaging, UC San Francisco, United States
| | - Alastair J Martin
- Department of Radiology and Biomedical Imaging, UC San Francisco, United States
| | | | | | | | | | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, UC San Francisco, United States
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Lin CT, Ghosh S, Hinkley LB, Dale CL, Souza ACS, Sabes JH, Hess CP, Adams ME, Cheung SW, Nagarajan SS. Multi-tasking deep network for tinnitus classification and severity prediction from multimodal structural MR images. J Neural Eng 2023; 20. [PMID: 36595270 DOI: 10.1088/1741-2552/acab33] [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: 07/13/2022] [Accepted: 12/13/2022] [Indexed: 12/15/2022]
Abstract
Objective:Subjective tinnitus is an auditory phantom perceptual disorder without an objective biomarker. Fast and efficient diagnostic tools will advance clinical practice by detecting or confirming the condition, tracking change in severity, and monitoring treatment response. Motivated by evidence of subtle anatomical, morphological, or functional information in magnetic resonance images of the brain, we examine data-driven machine learning methods for joint tinnitus classification (tinnitus or no tinnitus) and tinnitus severity prediction.Approach:We propose a deep multi-task multimodal framework for tinnitus classification and severity prediction using structural MRI (sMRI) data. To leverage complementary information multimodal neuroimaging data, we integrate two modalities of three-dimensional sMRI-T1 weighted (T1w) and T2 weighted (T2w) images. To explore the key components in the MR images that drove task performance, we segment both T1w and T2w images into three different components-cerebrospinal fluid, grey matter and white matter, and evaluate performance of each segmented image.Main results:Results demonstrate that our multimodal framework capitalizes on the information across both modalities (T1w and T2w) for the joint task of tinnitus classification and severity prediction.Significance:Our model outperforms existing learning-based and conventional methods in terms of accuracy, sensitivity, specificity, and negative predictive value.
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Affiliation(s)
- Chieh-Te Lin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Sanjay Ghosh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Leighton B Hinkley
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Corby L Dale
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Ana C S Souza
- Department of Telecommunication and Mechatronics Engineering, Federal University of Sao Joao del-Rei, Praca Frei Orlando, 170, Sao Joao del Rei 36307, MG, Brazil
| | - Jennifer H Sabes
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter St., San Francisco, CA 94115, United States of America
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America
| | - Meredith E Adams
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Phillips Wangensteen Building, 516 Delaware St., Minneapolis, MN 55455, United States of America
| | - Steven W Cheung
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter St., San Francisco, CA 94115, United States of America.,Surgical Services, Veterans Affairs, 4150 Clement St., San Francisco, CA 94121, United States of America
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 513 Parnassus Ave, San Francisco, CA 94143, United States of America.,Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, 2380 Sutter St., San Francisco, CA 94115, United States of America.,Surgical Services, Veterans Affairs, 4150 Clement St., San Francisco, CA 94121, United States of America
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Yao J, Morrison MA, Jakary A, Avadiappan S, Chen Y, Luitjens J, Glueck J, Driscoll T, Geschwind MD, Nelson AB, Villanueva-Meyer JE, Hess CP, Lupo JM. Comparison of quantitative susceptibility mapping methods for iron-sensitive susceptibility imaging at 7T: An evaluation in healthy subjects and patients with Huntington's disease. Neuroimage 2023; 265:119788. [PMID: 36476567 DOI: 10.1016/j.neuroimage.2022.119788] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 06/29/2022] [Revised: 10/08/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022] Open
Abstract
Quantitative susceptibility mapping (QSM) is a promising tool for investigating iron dysregulation in neurodegenerative diseases, including Huntington's disease (HD). Many diverse methods have been proposed to generate accurate and robust QSM images. In this study, we evaluated the performance of different dipole inversion algorithms for iron-sensitive susceptibility imaging at 7T on healthy subjects of a large age range and patients with HD. We compared an iterative least-squares-based method (iLSQR), iterative methods that use regularization, single-step approaches, and deep learning-based techniques. Their performance was evaluated by comparing: (1) deviations from a multiple-orientation QSM reference; (2) visual appearance of QSM maps and the presence of artifacts; (3) susceptibility in subcortical brain regions with age; (4) regional brain susceptibility with published postmortem brain iron quantification; and (5) susceptibility in HD-affected basal ganglia regions between HD subjects and healthy controls. We found that single-step QSM methods with either total variation or total generalized variation constraints (SSTV/SSTGV) and the single-step deep learning method iQSM generally provided the best performance in terms of correlation with iron deposition and were better at differentiating between healthy controls and premanifest HD individuals, while deep learning QSM methods trained with multiple-orientation susceptibility data created QSM maps that were most similar to the multiple orientation reference and with the best visual scores.
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Affiliation(s)
- Jingwen Yao
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Melanie A Morrison
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Angela Jakary
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Sivakami Avadiappan
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA
| | - Yicheng Chen
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA; UCSF/UC Berkeley Graduate Program in Bioengineering, San Francisco & Berkeley, CA, USA; Meta Platforms, Inc., Mountain View, CA, USA
| | - Johanna Luitjens
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Julia Glueck
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Theresa Driscoll
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Michael D Geschwind
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Alexandra B Nelson
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | | | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA; Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, UCSF, San Francisco, CA, USA; UCSF/UC Berkeley Graduate Program in Bioengineering, San Francisco & Berkeley, CA, USA.
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14
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Tran CBN, Nedelec P, Weiss DA, Rudie JD, Kini L, Sugrue LP, Glenn OA, Hess CP, Rauschecker AM. Development of Gestational Age-Based Fetal Brain and Intracranial Volume Reference Norms Using Deep Learning. AJNR Am J Neuroradiol 2023; 44:82-90. [PMID: 36549845 PMCID: PMC9835919 DOI: 10.3174/ajnr.a7747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/04/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND PURPOSE Fetal brain MR imaging interpretations are subjective and require subspecialty expertise. We aimed to develop a deep learning algorithm for automatically measuring intracranial and brain volumes of fetal brain MRIs across gestational ages. MATERIALS AND METHODS This retrospective study included 246 patients with singleton pregnancies at 19-38 weeks gestation. A 3D U-Net was trained to segment the intracranial contents of 2D fetal brain MRIs in the axial, coronal, and sagittal planes. An additional 3D U-Net was trained to segment the brain from the output of the first model. Models were tested on MRIs of 10 patients (28 planes) via Dice coefficients and volume comparison with manual reference segmentations. Trained U-Nets were applied to 200 additional MRIs to develop normative reference intracranial and brain volumes across gestational ages and then to 9 pathologic fetal brains. RESULTS Fetal intracranial and brain compartments were automatically segmented in a mean of 6.8 (SD, 1.2) seconds with median Dices score of 0.95 and 0.90, respectively (interquartile ranges, 0.91-0.96/0.89-0.91) on the test set. Correlation with manual volume measurements was high (Pearson r = 0.996, P < .001). Normative samples of intracranial and brain volumes across gestational ages were developed. Eight of 9 pathologic fetal intracranial volumes were automatically predicted to be >2 SDs from this age-specific reference mean. There were no effects of fetal sex, maternal diabetes, or maternal age on intracranial or brain volumes across gestational ages. CONCLUSIONS Deep learning techniques can quickly and accurately quantify intracranial and brain volumes on clinical fetal brain MRIs and identify abnormal volumes on the basis of a normative reference standard.
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Affiliation(s)
- C B N Tran
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - P Nedelec
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - D A Weiss
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - J D Rudie
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - L Kini
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - L P Sugrue
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - O A Glenn
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - C P Hess
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - A M Rauschecker
- From the Department of Radiology & Biomedical Imaging, University of California, San Francisco, San Francisco, California
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15
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Mossa-Basha M, Yuan C, Wasserman BA, Mikulis DJ, Hatsukami TS, Balu N, Gupta A, Zhu C, Saba L, Li D, DeMarco JK, Lehman VT, Qiao Y, Jager HR, Wintermark M, Brinjikji W, Hess CP, Saloner DA. Survey of the American Society of Neuroradiology Membership on the Use and Value of Extracranial Carotid Vessel Wall MRI. AJNR Am J Neuroradiol 2022; 43:1756-1761. [PMID: 36423951 DOI: 10.3174/ajnr.a7720] [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: 06/22/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Extracranial vessel wall MRI (EC-VWI) contributes to vasculopathy characterization. This survey study investigated EC-VWI adoption by American Society of Neuroradiology (ASNR) members and indications and barriers to implementation. MATERIALS AND METHODS The ASNR Vessel Wall Imaging Study Group survey on EC-VWI use, frequency, applications, MR imaging systems and field strength used, protocol development approaches, vendor engagement, reasons for not using EC-VWI, ordering provider interest, and impact on clinical care was distributed to the ASNR membership between April 2, 2019, to August 30, 2019. RESULTS There were 532 responses; 79 were excluded due to minimal, incomplete response and 42 due to redundant institutional responses, leaving 411 responses. Twenty-six percent indicated that their institution performed EC-VWI, with 66.3% performing it ≤1-2 times per month, most frequently on 3T MR imaging, with most using combined 3D and 2D protocols. Protocols most commonly included pre- and postcontrast T1-weighted imaging, TOF-MRA, and contrast-enhanced MRA. Inflammatory vasculopathy (63.3%), plaque vulnerability assessments (61.1%), intraplaque hemorrhage (61.1%), and dissection-detection/characterization (51.1%) were the most frequent applications. For those not performing EC-VWI, the reasons were a lack of ordering provider interest (63.9%), lack of radiologist time/interest (47.5%) or technical support (41.4%) for protocol development, and limited interpretation experience (44.9%) and knowledge of clinical applications (43.7%). Reasons given by 46.9% were that no providers approached radiology with interest in EC-VWI. If barriers were overcome, 51.1% of those not performing EC-VWI indicated they would perform it, and 40.6% were unsure; 48.6% did not think that EC-VWI had impacted patient management at their institution. CONCLUSIONS Only 26% of neuroradiology groups performed EC-VWI, most commonly due to limited clinician interest. Improved provider and radiologist education, protocols, processing techniques, technical support, and validation trials could increase adoption.
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Affiliation(s)
- M Mossa-Basha
- From the Department of Radiology (M.M.-B.), University of North Carolina, Chapel Hill, North Carolina .,Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - C Yuan
- Department of Radiology (C.Y.), University of Utah, Salt Lake City, Utah
| | - B A Wasserman
- Department of Radiology (B.A.W.), University of Maryland, Baltimore, Maryland.,Department of Radiology (B.A.W., Y.Q.), Johns Hopkins University, Baltimore, Maryland
| | - D J Mikulis
- Joint Department of Medical Imaging (D.J.M.), The University Health Network and the University of Toronto, Toronto, Ontario, Canada
| | - T S Hatsukami
- Surgery (T.S.H.), University of Washington, Seattle, Washington
| | - N Balu
- Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - A Gupta
- Department of Radiology (A.G.), Weill Cornell Medicine, New York, New York
| | - C Zhu
- Departments of Radiology (M.M.-B., N.B., C.Z.)
| | - L Saba
- Department of Radiology (L.S.), University of Cagliari, Cagliari, Sardinia, Italy
| | - D Li
- Biomedical Imaging Research Institute (D.L.), Cedars-Sinai Medical Center, Los Angeles, California
| | - J K DeMarco
- Department of Radiology (J.K.D.), Walter Reed National Military Medical Center, Bethesda, Maryland and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - V T Lehman
- Department of Radiology (V.T.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - Y Qiao
- Department of Radiology (B.A.W., Y.Q.), Johns Hopkins University, Baltimore, Maryland
| | - H R Jager
- Neuroradiological Academic Unit (H.R.J.), Department of Brain Repair and Rehabilitation, University College London, Queen Square Institute of Neurology, London, UK
| | - M Wintermark
- Department of Neuroradiology (M.W.), MD Anderson Cancer Institute, Houston, Texas
| | - W Brinjikji
- Department of Radiology (V.T.L., W.B.), Mayo Clinic, Rochester, Minnesota
| | - C P Hess
- Department of Radiology and Biomedical Imaging (C.P.H., D.A.S.), University of California, San Francisco, San Francisco, California
| | - D A Saloner
- Department of Radiology and Biomedical Imaging (C.P.H., D.A.S.), University of California, San Francisco, San Francisco, California
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16
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Calabrese E, Villanueva-Meyer JE, Rudie JD, Rauschecker AM, Baid U, Bakas S, Cha S, Mongan JT, Hess CP. The University of California San Francisco Preoperative Diffuse Glioma MRI Dataset. Radiol Artif Intell 2022; 4:e220058. [PMID: 36523646 PMCID: PMC9748624 DOI: 10.1148/ryai.220058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 03/23/2022] [Revised: 07/05/2022] [Accepted: 08/02/2022] [Indexed: 06/10/2023]
Abstract
Supplemental material is available for this article. Keywords: Informatics, MR Diffusion Tensor Imaging, MR Perfusion, MR Imaging, Neuro-Oncology, CNS, Brain/Brain Stem, Oncology, Radiogenomics, Radiology-Pathology Integration © RSNA, 2022.
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Affiliation(s)
- Evan Calabrese
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
| | - Javier E. Villanueva-Meyer
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
| | - Jeffrey D. Rudie
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
| | - Andreas M. Rauschecker
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
| | - Ujjwal Baid
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
| | - Spyridon Bakas
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
| | - Soonmee Cha
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
| | - John T. Mongan
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
| | - Christopher P. Hess
- From the Center for Intelligent Imaging (Ci), Department
of Radiology & Biomedical Imaging, University of California San
Francisco, 505 Parnassus Ave, San Francisco, CA 94143 (E.C., J.E.V.M., J.D.R.,
A.M.R., S.C., J.T.M., C.P.H.); and Center for Biomedical Image Computing and
Analytics (CBICA), University of Pennsylvania, Philadelphia, Pa (U.B.,
S.B.)
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17
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Morrison MA, Walter S, Mueller S, Felton E, Jakary A, Stoller S, Molinaro AM, Braunstein SE, Hess CP, Lupo JM. Functional network alterations in young brain tumor patients with radiotherapy-induced memory impairments and vascular injury. Front Neurol 2022; 13:921984. [PMID: 36172034 PMCID: PMC9511024 DOI: 10.3389/fneur.2022.921984] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 08/22/2022] [Indexed: 12/05/2022] Open
Abstract
Background Cognitive impairment and cerebral microbleeds (CMBs) are long-term side-effects of cranial radiation therapy (RT). Previously we showed that memory function is disrupted in young patients and that the rate of cognitive decline correlates with CMB development. However, vascular injury alone cannot explain RT-induced cognitive decline. Here we use resting-state functional MRI (rsfMRI) to further investigate the complex mechanisms underlying memory impairment after RT. Methods Nineteen young patients previously treated with or without focal or whole-brain RT for a brain tumor underwent cognitive testing followed by 7T rsfMRI and susceptibility-weighted imaging for CMB detection. Global brain modularity and efficiency, and rsfMRI signal variability within the dorsal attention, salience, and frontoparietal networks were computed. We evaluated whether MR metrics could distinguish age- and sex-matched controls (N = 19) from patients and differentiate patients based on RT exposure and aggressiveness. We also related MR metrics with memory performance, CMB burden, and risk factors for cognitive decline after RT. Results Compared to controls, patients exhibited widespread hyperconnectivity, similar modularity, and significantly increased efficiency (p < 0.001) and network variability (p < 0.001). The most abnormal values were detected in patients treated with high dose whole-brain RT, having supratentorial tumors, and who did not undergo RT but had hydrocephalus. MR metrics and memory performance were correlated (R = 0.34–0.53), though MR metrics were more strongly related to risk factors for cognitive worsening and CMB burden with evidence of functional recovery. Conclusions MR metrics describing brain connectivity and variability represent promising candidate imaging biomarkers for monitoring of long-term cognitive side-effects after RT.
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Affiliation(s)
- Melanie A. Morrison
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Melanie A. Morrison
| | - Sadie Walter
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, United States
| | - Sabine Mueller
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
| | - Erin Felton
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Angela Jakary
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Schuyler Stoller
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Annette M. Molinaro
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Steve E. Braunstein
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher P. Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Janine M. Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
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18
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Rudie JD, Calabrese E, Saluja R, Weiss D, Colby JB, Cha S, Hess CP, Rauschecker AM, Sugrue LP, Villanueva-Meyer JE. Longitudinal Assessment of Posttreatment Diffuse Glioma Tissue Volumes with Three-dimensional Convolutional Neural Networks. Radiol Artif Intell 2022; 4:e210243. [PMID: 36204543 PMCID: PMC9530762 DOI: 10.1148/ryai.210243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/17/2022] [Accepted: 07/15/2022] [Indexed: 12/30/2022]
Abstract
Neural networks were trained for segmentation and longitudinal assessment of posttreatment diffuse glioma. A retrospective cohort (from January 2018 to December 2019) of 298 patients with diffuse glioma (mean age, 52 years ± 14 [SD]; 177 men; 152 patients with glioblastoma, 72 patients with astrocytoma, and 74 patients with oligodendroglioma) who underwent two consecutive multimodal MRI examinations were randomly selected into training (n = 198) and testing (n = 100) samples. A posttreatment tumor segmentation three-dimensional nnU-Net convolutional neural network with multichannel inputs (T1, T2, and T1 postcontrast and fluid-attenuated inversion recovery [FLAIR]) was trained to segment three multiclass tissue types (peritumoral edematous, infiltrated, or treatment-changed tissue [ED]; active tumor or enhancing tissue [AT]; and necrotic core). Separate longitudinal change nnU-Nets were trained on registered and subtracted FLAIR and T1 postlongitudinal images to localize and better quantify and classify changes in ED and AT. Segmentation Dice scores, volume similarities, and 95th percentile Hausdorff distances ranged from 0.72 to 0.89, 0.90 to 0.96, and 2.5 to 3.6 mm, respectively. Accuracy rates of the posttreatment tumor segmentation and longitudinal change networks being able to classify longitudinal changes in ED and AT as increased, decreased, or unchanged were 76%-79% and 90%-91%, respectively. The accuracy levels of the longitudinal change networks were not significantly different from those of three neuroradiologists (accuracy, 90%-92%; κ, 0.58-0.63; P > .05). The results of this study support the potential clinical value of artificial intelligence-based automated longitudinal assessment of posttreatment diffuse glioma. Keywords: MR Imaging, Neuro-Oncology, Neural Networks, CNS, Brain/Brain Stem, Segmentation, Quantification, Convolutional Neural Network (CNN) Supplemental material is available for this article. © RSNA, 2022.
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19
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Chen JV, Chaudhari G, Hess CP, Glenn OA, Sugrue LP, Rauschecker AM, Li Y. Deep Learning to Predict Neonatal and Infant Brain Age from Myelination on Brain MRI Scans. Radiology 2022; 305:678-687. [DOI: 10.1148/radiol.211860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Joshua Vic Chen
- From the School of Medicine (J.V.C., G.C.) and Department of Radiology and Biomedical Imaging (C.P.H., O.A.G., L.P.S., A.M.R., Y.L.), University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
| | - Gunvant Chaudhari
- From the School of Medicine (J.V.C., G.C.) and Department of Radiology and Biomedical Imaging (C.P.H., O.A.G., L.P.S., A.M.R., Y.L.), University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
| | - Christopher P. Hess
- From the School of Medicine (J.V.C., G.C.) and Department of Radiology and Biomedical Imaging (C.P.H., O.A.G., L.P.S., A.M.R., Y.L.), University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
| | - Orit A. Glenn
- From the School of Medicine (J.V.C., G.C.) and Department of Radiology and Biomedical Imaging (C.P.H., O.A.G., L.P.S., A.M.R., Y.L.), University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
| | - Leo P. Sugrue
- From the School of Medicine (J.V.C., G.C.) and Department of Radiology and Biomedical Imaging (C.P.H., O.A.G., L.P.S., A.M.R., Y.L.), University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
| | - Andreas M. Rauschecker
- From the School of Medicine (J.V.C., G.C.) and Department of Radiology and Biomedical Imaging (C.P.H., O.A.G., L.P.S., A.M.R., Y.L.), University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
| | - Yi Li
- From the School of Medicine (J.V.C., G.C.) and Department of Radiology and Biomedical Imaging (C.P.H., O.A.G., L.P.S., A.M.R., Y.L.), University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143-0628
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20
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Reeder SB, Hess CP, Zaharchuk G, Moy L. Editorial for "Magnetic Resonance Imaging as an Alternative to Contrast-Enhanced Computed Tomography to Mitigate Iodinated Contrast Shortages in the United States: Recommendations From the International Society for Magnetic Resonance in Medicine". J Magn Reson Imaging 2022; 56:655-656. [PMID: 35652484 DOI: 10.1002/jmri.28282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/11/2022] Open
Affiliation(s)
- Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA.,Department of Medical Physics, University of Wisconsin, Madison, Wisconsin, USA.,Department of Biomedical Engineering, University of Wisconsin, Madison, Wisconsin, USA.,Department of Medicine, University of Wisconsin, Madison, Wisconsin, USA.,Department of Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, California, USA
| | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Linda Moy
- Department of Radiology, Langone Medical Center, New York University, New York, New York, USA
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21
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Chen Y, Genc O, Poynton CB, Banerjee S, Hess CP, Lupo JM. Comparison of quantitative susceptibility mapping methods on evaluating radiation-induced cerebral microbleeds and basal ganglia at 3T and 7T. NMR Biomed 2022; 35:e4666. [PMID: 35075701 PMCID: PMC10443943 DOI: 10.1002/nbm.4666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 06/14/2023]
Abstract
Quantitative susceptibility mapping (QSM) has the potential for being a biomarker for various diseases because of its ability to measure tissue susceptibility related to iron deposition, myelin, and hemorrhage from the phase signal of a T2 *-weighted MRI. Despite its promise as a quantitative marker, QSM is faced with many challenges, including its dependence on preprocessing of the raw phase data, the relatively weak tissue signal, and the inherently ill posed relationship between the magnetic dipole and measured phase. The goal of this study was to evaluate the effects of background field removal and dipole inversion algorithms on noise characteristics, image uniformity, and structural contrast for cerebral microbleed (CMB) quantification at both 3T and 7T. We selected four widely used background phase removal and five dipole field inversion algorithms for QSM and applied them to volunteers and patients with CMBs, who were scanned at two different field strengths, with ground truth QSM reference calculated using multiple orientation scans. 7T MRI provided QSM images with lower noise than did 3T MRI. QSIP and VSHARP + iLSQR achieved the highest white matter homogeneity and vein contrast, with QSIP also providing the highest CMB contrast. Compared with ground truth COSMOS QSM images, overall good correlations between susceptibility values of dipole inversion algorithms and the COSMOS reference were observed in basal ganglia regions, with VSHARP + iLSQR achieving the susceptibility values most similar to COSMOS across all regions. This study can provide guidance for selecting the most appropriate QSM processing pipeline based on the application of interest and scanner field strength.
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Affiliation(s)
- Yicheng Chen
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | - Ozan Genc
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Institute of Biomedical Engineering, Boğaziçi University, Istanbul, Turkey
| | - Clare B. Poynton
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
| | | | - Christopher P. Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
- Department of Neurology, University of California, San Francisco, CA
| | - Janine M. Lupo
- UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and San Francisco, CA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA
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22
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Rauschecker AM, Gleason TJ, Nedelec P, Duong MT, Weiss DA, Calabrese E, Colby JB, Sugrue LP, Rudie JD, Hess CP. Interinstitutional Portability of a Deep Learning Brain MRI Lesion Segmentation Algorithm. Radiol Artif Intell 2022; 4:e200152. [PMID: 35146430 DOI: 10.1148/ryai.2021200152] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 09/28/2021] [Accepted: 10/22/2021] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess how well a brain MRI lesion segmentation algorithm trained at one institution performed at another institution, and to assess the effect of multi-institutional training datasets for mitigating performance loss. MATERIALS AND METHODS In this retrospective study, a three-dimensional U-Net for brain MRI abnormality segmentation was trained on data from 293 patients from one institution (IN1) (median age, 54 years; 165 women; patients treated between 2008 and 2018) and tested on data from 51 patients from a second institution (IN2) (median age, 46 years; 27 women; patients treated between 2003 and 2019). The model was then trained on additional data from various sources: (a) 285 multi-institution brain tumor segmentations, (b) 198 IN2 brain tumor segmentations, and (c) 34 IN2 lesion segmentations from various brain pathologic conditions. All trained models were tested on IN1 and external IN2 test datasets, assessing segmentation performance using Dice coefficients. RESULTS The U-Net accurately segmented brain MRI lesions across various pathologic conditions. Performance was lower when tested at an external institution (median Dice score, 0.70 [IN2] vs 0.76 [IN1]). Addition of 483 training cases of a single pathologic condition, including from IN2, did not raise performance (median Dice score, 0.72; P = .10). Addition of IN2 training data with heterogeneous pathologic features, representing only 10% (34 of 329) of total training data, increased performance to baseline (Dice score, 0.77; P < .001). This final model produced total lesion volumes with a high correlation to the reference standard (Spearman r = 0.98). CONCLUSION For brain MRI lesion segmentation, adding a modest amount of relevant training data from an external institution to a previously trained model supported successful application of the model to this external institution.Keywords: Neural Networks, Brain/Brain Stem, Segmentation Supplemental material is available for this article. © RSNA, 2021.
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Affiliation(s)
- Andreas M Rauschecker
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - Tyler J Gleason
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - Pierre Nedelec
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - Michael Tran Duong
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - David A Weiss
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - Evan Calabrese
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - John B Colby
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - Leo P Sugrue
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - Jeffrey D Rudie
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
| | - Christopher P Hess
- Department of Radiology & Biomedical Imaging, University of California, San Francisco, 513 Parnassus Ave, Room S-261, Box 0628, San Francisco, CA 94143-0628 (A.M.R., T.J.G., P.N., D.A.W., E.C., J.B.C., L.P.S., J.D.R., C.P.H.); and Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (M.T.D., D.W.)
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23
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Glastonbury CM, Bucknor M, Wall SD, Hess CP. Hiring Through the Lens of Diversity: Strategies to Create Diverse Departments. Acad Radiol 2021; 28:1775-1778. [PMID: 32863152 DOI: 10.1016/j.acra.2020.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/24/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
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24
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Hinkley LBN, Larson PS, Henderson Sabes J, Mizuiri D, Demopoulos C, Adams ME, Neylan TC, Hess CP, Nagarajan SS, Cheung SW. Striatal networks for tinnitus treatment targeting. Hum Brain Mapp 2021; 43:633-646. [PMID: 34609038 PMCID: PMC8720198 DOI: 10.1002/hbm.25676] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 12/30/2022] Open
Abstract
Neuromodulation treatment effect size for bothersome tinnitus may be larger and more predictable by adopting a target selection approach guided by personalized striatal networks or functional connectivity maps. Several corticostriatal mechanisms are likely to play a role in tinnitus, including the dorsal/ventral striatum and the putamen. We examined whether significant tinnitus treatment response by deep brain stimulation (DBS) of the caudate nucleus may be related to striatal network increased functional connectivity with tinnitus networks that involve the auditory cortex or ventral cerebellum. The first study was a cross-sectional 2-by-2 factorial design (tinnitus, no tinnitus; hearing loss, normal hearing, n = 68) to define cohort level abnormal functional connectivity maps using high-field 7.0 T resting-state fMRI. The second study was a pilot case-control series (n = 2) to examine whether tinnitus modulation response to caudate tail subdivision stimulation would be contingent on individual level striatal connectivity map relationships with tinnitus networks. Resting-state fMRI identified five caudate subdivisions with abnormal cohort level functional connectivity maps. Of those, two connectivity maps exhibited increased connectivity with tinnitus networks-dorsal caudate head with Heschl's gyrus and caudate tail with the ventral cerebellum. DBS of the caudate tail in the case-series responder resulted in dramatic reductions in tinnitus severity and loudness, in contrast to the nonresponder who showed no tinnitus modulation. The individual level connectivity map of the responder was in alignment with the cohort expectation connectivity map, where the caudate tail exhibited increased connectivity with tinnitus networks, whereas the nonresponder individual level connectivity map did not.
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Affiliation(s)
- Leighton B N Hinkley
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Jennifer Henderson Sabes
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Danielle Mizuiri
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Carly Demopoulos
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Meredith E Adams
- Department of Otolaryngology - Head and Neck Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Thomas C Neylan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Srikantan S Nagarajan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA.,Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California, USA
| | - Steven W Cheung
- Department of Otolaryngology - Head and Neck Surgery, University of California, San Francisco, California, USA
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25
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Dayan I, Roth HR, Zhong A, Harouni A, Gentili A, Abidin AZ, Liu A, Costa AB, Wood BJ, Tsai CS, Wang CH, Hsu CN, Lee CK, Ruan P, Xu D, Wu D, Huang E, Kitamura FC, Lacey G, de Antônio Corradi GC, Nino G, Shin HH, Obinata H, Ren H, Crane JC, Tetreault J, Guan J, Garrett JW, Kaggie JD, Park JG, Dreyer K, Juluru K, Kersten K, Rockenbach MABC, Linguraru MG, Haider MA, AbdelMaseeh M, Rieke N, Damasceno PF, E Silva PMC, Wang P, Xu S, Kawano S, Sriswasdi S, Park SY, Grist TM, Buch V, Jantarabenjakul W, Wang W, Tak WY, Li X, Lin X, Kwon YJ, Quraini A, Feng A, Priest AN, Turkbey B, Glicksberg B, Bizzo B, Kim BS, Tor-Díez C, Lee CC, Hsu CJ, Lin C, Lai CL, Hess CP, Compas C, Bhatia D, Oermann EK, Leibovitz E, Sasaki H, Mori H, Yang I, Sohn JH, Murthy KNK, Fu LC, de Mendonça MRF, Fralick M, Kang MK, Adil M, Gangai N, Vateekul P, Elnajjar P, Hickman S, Majumdar S, McLeod SL, Reed S, Gräf S, Harmon S, Kodama T, Puthanakit T, Mazzulli T, de Lavor VL, Rakvongthai Y, Lee YR, Wen Y, Gilbert FJ, Flores MG, Li Q. Federated learning for predicting clinical outcomes in patients with COVID-19. Nat Med 2021; 27:1735-1743. [PMID: 34526699 PMCID: PMC9157510 DOI: 10.1038/s41591-021-01506-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Abstract
Federated learning (FL) is a method used for training artificial intelligence models with data from multiple sources while maintaining data anonymity, thus removing many barriers to data sharing. Here we used data from 20 institutes across the globe to train a FL model, called EXAM (electronic medical record (EMR) chest X-ray AI model), that predicts the future oxygen requirements of symptomatic patients with COVID-19 using inputs of vital signs, laboratory data and chest X-rays. EXAM achieved an average area under the curve (AUC) >0.92 for predicting outcomes at 24 and 72 h from the time of initial presentation to the emergency room, and it provided 16% improvement in average AUC measured across all participating sites and an average increase in generalizability of 38% when compared with models trained at a single site using that site's data. For prediction of mechanical ventilation treatment or death at 24 h at the largest independent test site, EXAM achieved a sensitivity of 0.950 and specificity of 0.882. In this study, FL facilitated rapid data science collaboration without data exchange and generated a model that generalized across heterogeneous, unharmonized datasets for prediction of clinical outcomes in patients with COVID-19, setting the stage for the broader use of FL in healthcare.
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Affiliation(s)
- Ittai Dayan
- MGH Radiology and Harvard Medical School, Boston, MA, USA
| | | | - Aoxiao Zhong
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- School of Engineering and Applied Sciences, Harvard University, Boston, MA, USA
| | | | | | | | | | | | - Bradford J Wood
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hung Wang
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Nan Hsu
- Center for Research in Biological Systems, University of California, San Diego, CA, USA
| | - C K Lee
- NVIDIA, Santa Clara, CA, USA
| | | | | | - Dufan Wu
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | | | | | | | - Gustavo Nino
- Division of Pediatric Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Hao-Hsin Shin
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Hui Ren
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason C Crane
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | | | - John W Garrett
- Departments of Radiology and Medical Physics, The University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Joshua D Kaggie
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | - Jung Gil Park
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | - Keith Dreyer
- MGH Radiology and Harvard Medical School, Boston, MA, USA
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Krishna Juluru
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
- Departments of Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Masoom A Haider
- Joint Dept. of Medical Imaging, Sinai Health System, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada
| | | | | | - Pablo F Damasceno
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Pochuan Wang
- MeDA Lab Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Sheng Xu
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Sira Sriswasdi
- Research Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center for Artificial Intelligence in Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Soo Young Park
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Thomas M Grist
- Departments of Radiology, Medical Physics, and Biomedical Engineering, The University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Varun Buch
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Watsamon Jantarabenjakul
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Weichung Wang
- MeDA Lab Institute of Applied Mathematical Sciences, National Taiwan University, Taipei, Taiwan
- Department of Computer Science and Information Engineering, National Taiwan University, Taipei, Taiwan
| | - Won Young Tak
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Xiang Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Xihong Lin
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Young Joon Kwon
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | - Andrew N Priest
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, Cambridge University Hospital, Cambridge, UK
| | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Benjamin Glicksberg
- Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai and Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bernardo Bizzo
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | - Byung Seok Kim
- Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, South Korea
| | - Carlos Tor-Díez
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA
| | - Chia-Cheng Lee
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chia-Jung Hsu
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chin Lin
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chiu-Ling Lai
- Medical Review and Pharmaceutical Benefits Division, National Health Insurance Administration, Taipei, Taiwan
| | - Christopher P Hess
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | | | - Eric K Oermann
- Department of Neurosurgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Evan Leibovitz
- Center for Clinical Data Science, Massachusetts General Brigham, Boston, MA, USA
| | | | - Hitoshi Mori
- Self-Defense Forces Central Hospital, Tokyo, Japan
| | | | - Jae Ho Sohn
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | | | - Li-Chen Fu
- MOST/NTU All Vista Healthcare Center, Center for Artificial Intelligence and Advanced Robotics, National Taiwan University, Taipei, Taiwan
| | | | - Mike Fralick
- Division of General Internal Medicine and Geriatrics (Fralick), Sinai Health System, Toronto, Ontario, Canada
| | - Min Kyu Kang
- Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, South Korea
| | | | - Natalie Gangai
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peerapon Vateekul
- Department of Computer Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand
| | | | - Sarah Hickman
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | - Sharmila Majumdar
- Center for Intelligent Imaging, Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA, USA
| | - Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute, Sinai Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheridan Reed
- Radiology & Imaging Sciences/Clinical Center, National Institutes of Health, Bethesda, MD, USA
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Stefan Gräf
- Department of Medicine and NIHR BioResource for Translational Research, NIHR Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Stephanie Harmon
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Clinical Research Directorate, Frederick National Laboratory for Cancer, National Cancer Institute, Frederick, MD, USA
| | | | - Thanyawee Puthanakit
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Thai Red Cross Emerging Infectious Diseases Clinical Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Tony Mazzulli
- Department of Microbiology, Sinai Health/University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | | | - Yothin Rakvongthai
- Chulalongkorn University Biomedical Imaging Group and Division of Nuclear Medicine, Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yu Rim Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | | | - Fiona J Gilbert
- Department of Radiology, NIHR Cambridge Biomedical Resource Centre, University of Cambridge, Cambridge, UK
| | | | - Quanzheng Li
- Center for Advanced Medical Computing and Analysis, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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26
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Gao S, Nelson J, Weinsheimer S, Winkler EA, Rutledge C, Abla AA, Gupta N, Shieh JT, Cooke DL, Hetts SW, Tihan T, Hess CP, Ko N, Walcott BP, McCulloch CE, Lawton MT, Su H, Pawlikowska L, Kim H. Somatic mosaicism in the MAPK pathway in sporadic brain arteriovenous malformation and association with phenotype. J Neurosurg 2021; 136:148-155. [PMID: 34214981 DOI: 10.3171/2020.11.jns202031] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/16/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Sporadic brain arteriovenous malformation (BAVM) is a tangled vascular lesion characterized by direct artery-to-vein connections that can cause life-threatening intracerebral hemorrhage (ICH). Recently, somatic mutations in KRAS have been reported in sporadic BAVM, and mutations in other mitogen-activated protein kinase (MAPK) signaling pathway genes have been identified in other vascular malformations. The objectives of this study were to systematically evaluate somatic mutations in MAPK pathway genes in patients with sporadic BAVM lesions and to evaluate the association of somatic mutations with phenotypes of sporadic BAVM severity. METHODS The authors performed whole-exome sequencing on paired lesion and blood DNA samples from 14 patients with sporadic BAVM, and 295 genes in the MAPK signaling pathway were evaluated to identify genes with somatic mutations in multiple patients with BAVM. Digital droplet polymerase chain reaction was used to validate KRAS G12V and G12D mutations and to assay an additional 56 BAVM samples. RESULTS The authors identified a total of 24 candidate BAVM-associated somatic variants in 11 MAPK pathway genes. The previously identified KRAS G12V and G12D mutations were the only recurrent mutations. Overall, somatic KRAS G12V was present in 14.5% of BAVM lesions and G12D was present in 31.9%. The authors did not detect a significant association between the presence or allelic burden of KRAS mutation and three BAVM phenotypes: lesion size (maximum diameter), age at diagnosis, and age at ICH. CONCLUSIONS The authors confirmed the high prevalence of somatic KRAS mutations in sporadic BAVM lesions and identified several candidate somatic variants in other MAPK pathway genes. These somatic variants may contribute to understanding of the etiology of sporadic BAVM and the clinical characteristics of patients with this condition.
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Affiliation(s)
- Sen Gao
- Departments of1Anesthesia and Perioperative Care.,2Center for Cerebrovascular Research, and
| | - Jeffrey Nelson
- Departments of1Anesthesia and Perioperative Care.,2Center for Cerebrovascular Research, and
| | - Shantel Weinsheimer
- Departments of1Anesthesia and Perioperative Care.,2Center for Cerebrovascular Research, and.,4Institute for Human Genetics, University of California, San Francisco, California
| | | | | | | | | | - Joseph T Shieh
- 4Institute for Human Genetics, University of California, San Francisco, California.,11Pediatrics, and
| | | | | | | | | | | | - Brian P Walcott
- 3Neurological Surgery.,8NorthShore University Health System, Evanston, Illinois; and
| | | | - Michael T Lawton
- 10Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| | - Hua Su
- Departments of1Anesthesia and Perioperative Care.,2Center for Cerebrovascular Research, and
| | - Ludmila Pawlikowska
- Departments of1Anesthesia and Perioperative Care.,2Center for Cerebrovascular Research, and.,4Institute for Human Genetics, University of California, San Francisco, California
| | - Helen Kim
- Departments of1Anesthesia and Perioperative Care.,2Center for Cerebrovascular Research, and.,4Institute for Human Genetics, University of California, San Francisco, California
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Porter KK, Arleo EK, Spalluto LB, McGinty G, Hess CP. A lactation credit model to support breastfeeding in radiology: The new gold standard to support "liquid gold". Clin Imaging 2021; 80:16-18. [PMID: 34218079 DOI: 10.1016/j.clinimag.2021.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 06/11/2021] [Accepted: 06/24/2021] [Indexed: 11/25/2022]
Abstract
Breastfeeding has medical and economic benefits and providing an environment supportive of breastfeeding should be a priority in radiology to promote diversity, equity and inclusion. Most breastfeeding radiologists do not meet their breastfeeding goals and inadequate time for pumping is the most commonly cited barrier. The UCSF lactation credit model sets the standard for breastfeeding support in medicine by providing protected time without productivity penalties and it should be adapted and implemented across radiology practices to more fully support breastfeeding radiologists and radiation oncologists.
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Affiliation(s)
- Kristin K Porter
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America.
| | - Elizabeth Kagan Arleo
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America
| | - Lucy B Spalluto
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America
| | - Geraldine McGinty
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America
| | - Christopher P Hess
- University of Alabama at Birmingham, Department of Radiology, 619 19th Street South, Birmingham, AL 35249, United States of America
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Rudie JD, Weiss DA, Colby JB, Rauschecker AM, Laguna B, Braunstein S, Sugrue LP, Hess CP, Villanueva-Meyer JE. Three-dimensional U-Net Convolutional Neural Network for Detection and Segmentation of Intracranial Metastases. Radiol Artif Intell 2021; 3:e200204. [PMID: 34136817 PMCID: PMC8204134 DOI: 10.1148/ryai.2021200204] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 02/05/2021] [Accepted: 02/19/2021] [Indexed: 05/05/2023]
Abstract
PURPOSE To develop and validate a neural network for automated detection and segmentation of intracranial metastases on brain MRI studies obtained for stereotactic radiosurgery treatment planning. MATERIALS AND METHODS In this retrospective study, 413 patients (average age, 61 years ± 12 [standard deviation]; 238 women) with a total of 5202 intracranial metastases (median volume, 0.05 cm3; interquartile range, 0.02-0.18 cm3) undergoing stereotactic radiosurgery at one institution were included (January 2017 to February 2020). A total of 563 MRI examinations were performed among the patients, and studies were split into training (n = 413), validation (n = 50), and test (n = 100) datasets. A three-dimensional (3D) U-Net convolutional network was trained and validated on 413 T1 postcontrast or subtraction scans, and several loss functions were evaluated. After model validation, 100 discrete test patients, who underwent imaging after the training and validation patients, were used for final model evaluation. Performance for detection and segmentation of metastases was evaluated using Dice scores, false discovery rates, and false-negative rates, and a comparison with neuroradiologist interrater reliability was performed. RESULTS The median Dice score for segmenting enhancing metastases in the test set was 0.75 (interquartile range, 0.63-0.84). There were strong correlations between manually segmented and predicted metastasis volumes (r = 0.98, P < .001) and between the number of manually segmented and predicted metastases (R = 0.95, P < .001). Higher Dice scores were strongly correlated with larger metastasis volumes on a logarithmically transformed scale (r = 0.71). Sensitivity across the whole test sample was 70.0% overall and 96.4% for metastases larger than 6 mm. There was an average of 0.46 false-positive results per scan, with the positive predictive value being 91.5%. In comparison, the median Dice score between two neuroradiologists was 0.85 (interquartile range, 0.80-0.89), with sensitivity across the test sample being 87.9% overall and 98.4% for metastases larger than 6 mm. CONCLUSION A 3D U-Net-based convolutional neural network was able to segment brain metastases with high accuracy and perform detection at the level of human interrater reliability for metastases larger than 6 mm.Keywords: Adults, Brain/Brain Stem, CNS, Feature detection, MR-Imaging, Neural Networks, Neuro-Oncology, Quantification, Segmentation© RSNA, 2021.
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29
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Riley ED, Chow FC, Josephson SA, Dilworth SE, Lynch KL, Wade AN, Braun C, Hess CP. Cocaine Use and White Matter Hyperintensities in Homeless and Unstably Housed Women. J Stroke Cerebrovasc Dis 2021; 30:105675. [PMID: 33677311 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105675] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cocaine use has been linked to stroke in several studies. However, few studies have considered the influence of cocaine use on stroke mechanisms such as small vessel disease (SVD). We conducted a study to assess associations between the toxicology-confirmed use of multiple drugs, including cocaine, and a marker of SVD, white matter hyperintensities (WMH). MATERIALS AND METHODS We conducted a nested case-control study (n = 30) within a larger cohort study (N = 245) of homeless and unstably housed women recruited from San Francisco community venues. Participants completed six monthly study visits consisting of an interview, blood draw, vital sign assessment and baseline brain MRI. We examined associations between toxicology-confirmed use of multiple substances, including cocaine, methamphetamine, heroin, alcohol and tobacco, and WMH identified on MRI. RESULTS Mean study participant age was 53 years, 70% of participants were ethnic minority women and 86% had a history of cocaine use. Brain MRIs indicated the presence of WMH (i.e., Fazekas score>0) in 54% (18/30) of imaged participants. The odds of WMH were significantly higher in women who were toxicology-positive for cocaine (Odd Ratio=7.58, p=0.01), but not in women who were toxicology-positive for other drugs or had several other cerebrovascular risk factors. CONCLUSIONS Over half of homeless and unstably housed women showed evidence of WMH. Cocaine use is highly prevalent and a significant correlate of WMH in this population, while several traditional CVD risk factors are not. Including cocaine use in cerebrovascular risk calculators may improve stroke risk prediction in high-risk populations and warrants further investigation.
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Affiliation(s)
- Elise D Riley
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Felicia C Chow
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA; University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
| | - S Andrew Josephson
- University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
| | - Samantha E Dilworth
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Kara L Lynch
- University of California, San Francisco, Department of Laboratory Medicine, San Francisco, CA, USA.
| | - Amanda N Wade
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Carl Braun
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Christopher P Hess
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA.
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Mamlouk MD, Vossough A, Caschera L, Maheshwari M, Hess CP. Arterial Spin-Labeling Perfusion for PHACE Syndrome. AJNR Am J Neuroradiol 2021; 42:173-177. [PMID: 33214180 DOI: 10.3174/ajnr.a6871] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/19/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE Arterial stroke is a rare-but-reported complication in patients with posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities (PHACE) syndrome. Currently, stroke risk is inferred by the severity of arterial anomalies identified on MRA, though no evidenced-based data exist. The purpose of our study was to determine whether arterial spin-labeling MR imaging perfusion can detect alterations in CBF in patients with PHACE syndrome. MATERIALS AND METHODS Records were reviewed from 3 institutions for all patients with PHACE syndrome who underwent arterial spin-labeling from 2000 to 2019. CBF was qualitatively investigated with arterial spin-labeling to determine whether there was decreased or normal perfusion. Arterial anomalies were characterized on MRA imaging, and parenchymal brain findings were evaluated on conventional MR imaging sequences. RESULTS Forty-one patients with PHACE syndrome had arterial spin-labeling imaging. There were 30 females and 11 males (age range, 7 days to 15 years). Of the 41 patients, 10 (24%) had decreased CBF signal corresponding to a major arterial territory. Ten of 10 patients had decreased CBF signal in the anterior circulation, 2/10 had decreased anterior and posterior circulation CBF signal, 2/10 had decreased bilateral anterior circulation CBF signal, and 1/10 had globally decreased CBF signal. Forty of 41 (97.5%) patients had at least 1 arteriopathy, and in those with decreased CBF signal, the arteriopathy corresponded to the CBF signal alteration in 10/10 patients. CONCLUSIONS Arterial spin-labeling can potentially characterize hemodynamic changes in patients with PHACE syndrome.
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Affiliation(s)
- M D Mamlouk
- From the Department of Radiology (M.D.M.), The Permanente Medical Group, Kaiser Permanente Medical Center, Santa Clara, Santa Clara, California
- Department of Radiology and Biomedical Imaging (M.D.M., C.P.H.), University of California, San Francisco, San Francisco, California
| | - A Vossough
- Department of Radiology (A.V., L.C.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - L Caschera
- Department of Radiology (A.V., L.C.), Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Department of Radiology (L.C.), La Fondazione Institute for Research, Hospitalization and Health Care Ca' Granda Ospedale Maggiore di Milano Policlinico, Milan, Italy
| | - M Maheshwari
- Department of Radiology (M.M.), Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - C P Hess
- Department of Radiology and Biomedical Imaging (M.D.M., C.P.H.), University of California, San Francisco, San Francisco, California
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31
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Mummaneni PV, Burke JF, Chan AK, Sosa JA, Lobo EP, Mummaneni VP, Antrum S, Berven SH, Conte MS, Doernberg SB, Goldberg AN, Hess CP, Hetts SW, Josephson SA, Kohi MP, Ma CB, Mahadevan VS, Molinaro AM, Murr AH, Narayana S, Roberts JP, Stoller ML, Theodosopoulos PV, Vail TP, Wienholz S, Gropper MA, Green A, Berger MS. Consensus-based perioperative protocols during the COVID-19 pandemic. J Neurosurg Spine 2020; 34:13-21. [PMID: 33007752 DOI: 10.3171/2020.6.spine20777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic, quaternary-care facilities continue to provide care for patients in need of urgent and emergent invasive procedures. Perioperative protocols are needed to streamline care for these patients notwithstanding capacity and resource constraints. METHODS A multidisciplinary panel was assembled at the University of California, San Francisco, with 26 leaders across 10 academic departments, including 7 department chairpersons, the chief medical officer, the chief operating officer, infection control officers, nursing leaders, and resident house staff champions. An epidemiologist, an ethicist, and a statistician were also consulted. A modified two-round, blinded Delphi method based on 18 agree/disagree statements was used to build consensus. Significant disagreement for each statement was tested using a one-sided exact binomial test against an expected outcome of 95% consensus using a significance threshold of p < 0.05. Final triage protocols were developed with unblinded group-level discussion. RESULTS Overall, 15 of 18 statements achieved consensus in the first round of the Delphi method; the 3 statements with significant disagreement (p < 0.01) were modified and iteratively resubmitted to the expert panel to achieve consensus. Consensus-based protocols were developed using unblinded multidisciplinary panel discussions. The final algorithms 1) quantified outbreak level, 2) triaged patients based on acuity, 3) provided a checklist for urgent/emergent invasive procedures, and 4) created a novel scoring system for the allocation of personal protective equipment. In particular, the authors modified the American College of Surgeons three-tiered triage system to incorporate more urgent cases, as are often encountered in neurosurgery and spine surgery. CONCLUSIONS Urgent and emergent invasive procedures need to be performed during the COVID-19 pandemic. The consensus-based protocols in this study may assist healthcare providers to optimize perioperative care during the pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Steven W Hetts
- 9Radiology and Biomedical Imaging
- 10Interventional Neuroradiology
| | | | - Maureen P Kohi
- 9Radiology and Biomedical Imaging
- 12Vascular and Interventional Radiology, and
| | | | | | | | | | | | | | | | | | | | - Sandra Wienholz
- 16Perioperative Care, University of California, San Francisco, California
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32
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Morrison MA, Mueller S, Felton E, Jakary A, Stoller S, Avadiappan S, Yuan J, Molinaro AM, Braunstein S, Banerjee A, Hess CP, Lupo JM. Rate of radiation-induced microbleed formation on 7T MRI relates to cognitive impairment in young patients treated with radiation therapy for a brain tumor. Radiother Oncol 2020; 154:145-153. [PMID: 32966846 DOI: 10.1016/j.radonc.2020.09.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/04/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Radiation therapy (RT) is essential to the management of many brain tumors, but has been known to lead to cognitive decline and vascular injury in the form of cerebral microbleeds (CMBs). PURPOSE In a subset of children, adolescents, and young adults recruited from a larger trial investigating arteriopathy and stroke risk after RT, we evaluated the prevalence of CMBs after RT, examined risk factors for CMBs and cognitive impairment, and related their longitudinal development to cognitive performance changes. METHODS Twenty-five patients (mean 17 years, range: 10-25 years) underwent 7-Tesla MRI and cognitive assessment. Nineteen patients were treated with whole-brain or focal RT 1-month to 20-years prior, while 6 non-irradiated patients with posterior-fossa tumors served as controls. CMBs were detected on 7T susceptibility-weighted imaging (SWI) using semi-automated software, a first use in this population. RESULTS CMB detection sensitivity with 7T SWI was higher than previously reported at lower field strengths, with one or more CMBs detected in 100% of patients treated with RT at least 1-year prior. CMBs were localized to dose-targeted brain volumes with risk factors including whole-brain RT (p = 0.05), a higher RT dose (p = 0.01), increasing time since RT (p = 0.03), and younger age during RT (p = 0.01). Apart from RT dose, these factors were associated with impaired memory performance. Follow-up data in a subset of patients revealed a proportional increase in CMB count with worsening verbal memory performance (r = -0.85, p = 0.03). CONCLUSIONS Treatment with RT during youth is associated with the chronic development of CMBs that evolve with memory impairment over time.
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Affiliation(s)
- Melanie A Morrison
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Sabine Mueller
- Department of Neurology, University of California San Francisco, USA
| | - Erin Felton
- Department of Neurology, University of California San Francisco, USA
| | - Angela Jakary
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Schuyler Stoller
- Department of Neurology, University of California San Francisco, USA
| | - Sivakami Avadiappan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Justin Yuan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA
| | - Annette M Molinaro
- Department of Neurological Surgery, University of California San Francisco, USA; Department of Epidemiology & Biostatistics, University of California San Francisco, USA
| | - Steve Braunstein
- Department of Radiation Oncology, University of California San Francisco, USA
| | - Anu Banerjee
- Department of Neurology, University of California San Francisco, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA; Department of Neurology, University of California San Francisco, USA
| | - Janine M Lupo
- Department of Radiology and Biomedical Imaging, University of California San Francisco, USA.
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Tymofiyeva O, Zhou VX, Lee CM, Xu D, Hess CP, Yang TT. MRI Insights Into Adolescent Neurocircuitry-A Vision for the Future. Front Hum Neurosci 2020; 14:237. [PMID: 32733218 PMCID: PMC7359264 DOI: 10.3389/fnhum.2020.00237] [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: 12/12/2019] [Accepted: 05/29/2020] [Indexed: 11/13/2022] Open
Abstract
Adolescence is the time of onset of many psychiatric disorders. Half of pediatric patients present with comorbid psychiatric disorders that complicate both their medical and psychiatric care. Currently, diagnosis and treatment decisions are based on symptoms. The field urgently needs brain-based diagnosis and personalized care. Neuroimaging can shed light on how aberrations in brain circuits might underlie psychiatric disorders and their development in adolescents. In this perspective article, we summarize recent MRI literature that provides insights into development of psychiatric disorders in adolescents. We specifically focus on studies of brain structural and functional connectivity. Ninety-six included studies demonstrate the potential of MRI to assess psychiatrically relevant constructs, diagnose psychiatric disorders, predict their development or predict response to treatment. Limitations of the included studies are discussed, and recommendations for future research are offered. We also present a vision for the role that neuroimaging may play in pediatrics and primary care in the future: a routine neuropsychological and neuropsychiatric imaging (NPPI) protocol for adolescent patients, which would include a 30-min brain scan, a quality control and safety read of the scan, followed by computer-based calculation of the structural and functional brain network metrics that can be compared to the normative data by the pediatrician. We also perform a cost-benefit analysis to support this vision and provide a roadmap of the steps required for this vision to be implemented.
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Affiliation(s)
- Olga Tymofiyeva
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Vivian X Zhou
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Chuan-Mei Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States.,Clinical Excellence Research Center, Stanford University, Stanford, CA, United States
| | - Duan Xu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Tony T Yang
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
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34
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Lui YW, Chang PD, Zaharchuk G, Barboriak DP, Flanders AE, Wintermark M, Hess CP, Filippi CG. Artificial Intelligence in Neuroradiology: Current Status and Future Directions. AJNR Am J Neuroradiol 2020; 41:E52-E59. [PMID: 32732276 PMCID: PMC7658873 DOI: 10.3174/ajnr.a6681] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fueled by new techniques, computational tools, and broader availability of imaging data, artificial intelligence has the potential to transform the practice of neuroradiology. The recent exponential increase in publications related to artificial intelligence and the central focus on artificial intelligence at recent professional and scientific radiology meetings underscores the importance. There is growing momentum behind leveraging artificial intelligence techniques to improve workflow and diagnosis and treatment and to enhance the value of quantitative imaging techniques. This article explores the reasons why neuroradiologists should care about the investments in new artificial intelligence applications, highlights current activities and the roles neuroradiologists are playing, and renders a few predictions regarding the near future of artificial intelligence in neuroradiology.
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Affiliation(s)
- Y W Lui
- From the Department of Radiology (Y.W.L.), New York University Langone Medical Center, New York, New York
| | - P D Chang
- Department of Radiology (P.D.C.), University of California Irvine Health Medical Center, Orange, California
| | - G Zaharchuk
- Department of Neuroradiology (G.Z., M.W.), Stanford University, Stanford, California
| | - D P Barboriak
- Department of Radiology (D.P.B.), Duke University Medical Center, Durham, North Carolina
| | - A E Flanders
- Department of Radiology (A.E.F.), Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - M Wintermark
- Department of Neuroradiology (G.Z., M.W.), Stanford University, Stanford, California
| | - C P Hess
- Department of Radiology and Biomedical Imaging (C.P.H.), University of California, San Francisco, San Francisco, California
| | - C G Filippi
- Department of Radiology (C.G.F.), Northwell Health, New York, New York.
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35
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Norbash AM, Moore AV, Recht MP, Brink JA, Hess CP, Won JJ, Jain S, Sun X, Brown M, Enzmann D. Early-Stage Radiology Volume Effects and Considerations with the Coronavirus Disease 2019 (COVID-19) Pandemic: Adaptations, Risks, and Lessons Learned. J Am Coll Radiol 2020; 17:1086-1095. [PMID: 32717183 PMCID: PMC7346772 DOI: 10.1016/j.jacr.2020.07.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 12/23/2022]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic resulted in significant loss of radiologic volume as a result of shelter-at-home mandates and delay of non-time-sensitive imaging studies to preserve capacity for the pandemic. We analyze the volume-related impact of the COVID-19 pandemic on six academic medical systems (AMSs), three in high COVID-19 surge (high-surge) and three in low COVID-19 surge (low-surge) regions, and a large national private practice coalition. We sought to assess adaptations, risks of actions, and lessons learned. Methods Percent change of 2020 volume per week was compared with the corresponding 2019 volume calculated for each of the 14 imaging modalities and overall total, outpatient, emergency, and inpatient studies in high-surge AMSs and low-surge AMSs and the practice coalition. Results Steep examination volume drops occurred during week 11, with slow recovery starting week 17. The lowest total AMS volume drop was 40% compared with the same period the previous year, and the largest was 70%. The greatest decreases were seen with screening mammography and dual-energy x-ray absorptiometry scans, and the smallest decreases were seen with PET/CT, x-ray, and interventional radiology. Inpatient volume was least impacted compared with outpatient or emergency imaging. Conclusion Large percentage drops in volume were seen from weeks 11 through 17, were seen with screening studies, and were larger for the high-surge AMSs than for the low-surge AMSs. The lowest drops in volume were seen with modalities in which delays in imaging had greater perceived adverse consequences.
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Affiliation(s)
- Alexander M Norbash
- Chair, Department of Radiology, University of California, San Diego, California.
| | - Arl Van Moore
- Chair, Chief Executive Officer, Strategic Radiology, LLC, Palmetto, Florida
| | - Michael P Recht
- Chair, Department of Radiology, New York University, Grossman School of Medicine, New York, New York
| | - James A Brink
- Chair, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher P Hess
- Chair, Department of Radiology, University of California, San Francisco, California
| | - Jay J Won
- University of California, Los Angeles, California
| | - Sonia Jain
- University of California, San Diego, California
| | | | - Manuel Brown
- Chair, Department of Radiology, Henry Ford Health System, Detroit, Michigan
| | - Dieter Enzmann
- Chair, Department of Radiology, University of California, Los Angeles, California
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36
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Gelfand JM, Greenfield AL, Barkovich M, Mendelsohn BA, Van Haren K, Hess CP, Mannis GN. Allogeneic HSCT for adult-onset leukoencephalopathy with spheroids and pigmented glia. Brain 2020; 143:503-511. [PMID: 31840744 DOI: 10.1093/brain/awz390] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 05/31/2019] [Revised: 10/18/2019] [Accepted: 10/29/2019] [Indexed: 02/06/2023] Open
Abstract
Adult-onset leukoencephalopathy with spheroids and pigmented glia (ALSP) is an autosomal dominant leukoencephalopathy caused by mutations in colony stimulating factor 1 receptor (CSF1R). Here we report clinical and imaging outcomes following allogeneic haematopoietic stem cell transplantation (HSCT) in two patients with ALSP at the University of California, San Francisco between January 2016 and December 2017. Patient 1 proceeded to transplantation at age 53 with a haplo-identical sibling donor. Patient 2, whose sister and mother had died of the disease, proceeded to transplantation at age 49 with a 12/12 human leukocyte antigen-matched unrelated donor. Both patients received reduced intensity conditioning regimens. At 28 and 26 months post-HSCT, respectively, both patients were alive, without evidence of graft-versus-host disease, with major infection at 1 year in one and new-onset seizures in the other. In both cases, neurological worsening continued post-HSCT; however, the progression in cognitive deficits, overall functional status and gait impairment gradually stabilized. There was continued progression of parkinsonism in both patients. On brain MRI, within 1 year there was stabilization of T2/FLAIR abnormalities, and after 2 years there was complete resolution of abnormal multifocal reduced diffusion. In summary, after >2 years of follow-up, allogeneic HSCT in ALSP led to interval resolution of diffusion MRI abnormalities, stabilization of T2/FLAIR MRI abnormalities, and partial clinical stabilization, supportive of treatment response. Allogeneic HSCT may be beneficial in ALSP by providing a supply of bone marrow-derived brain-engrafting myeloid cells with donor wild-type CSF1R to repopulate the microglial niche.
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Affiliation(s)
- Jeffrey M Gelfand
- Department of Neurology, Division of Neuroimmunology and Glial Biology, University of California, San Francisco, CA, USA
| | - Ariele L Greenfield
- Department of Neurology, Division of Neuroimmunology and Glial Biology, University of California, San Francisco, CA, USA
| | - Matthew Barkovich
- Department of Radiology, Division of Neuroradiology, University of California, San Francisco, CA, USA
| | - Bryce A Mendelsohn
- Division of Genetics, Department of Pediatrics, University of California, San Francisco, CA, USA
| | - Keith Van Haren
- Department of Neurology, Stanford University, Palo Alto, CA, USA
| | - Christopher P Hess
- Department of Neurology, Division of Neuroimmunology and Glial Biology, University of California, San Francisco, CA, USA.,Department of Radiology, Division of Neuroradiology, University of California, San Francisco, CA, USA
| | - Gabriel N Mannis
- Hematology and Blood and Marrow Transplantation, University of California, San Francisco, CA, USA
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Avadiappan S, Payabvash S, Morrison MA, Jakary A, Hess CP, Lupo JM. A Fully Automated Method for Segmenting Arteries and Quantifying Vessel Radii on Magnetic Resonance Angiography Images of Varying Projection Thickness. Front Neurosci 2020; 14:537. [PMID: 32612496 PMCID: PMC7308498 DOI: 10.3389/fnins.2020.00537] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Precise quantification of cerebral arteries can help with differentiation and prognostication of cerebrovascular disease. Existing image processing and segmentation algorithms for magnetic resonance angiography (MRA) are limited to the analysis of either 2D maximum intensity projection images or the entire 3D volume. The goal of this study was to develop a fully automated, hybrid 2D-3D method for robust segmentation of arteries and accurate quantification of vessel radii using MRA at varying projection thicknesses. METHODS A novel algorithm that employs an adaptive Frangi filter for segmentation of vessels followed by estimation of vessel radii is presented. The method was evaluated on MRA datasets and corresponding manual segmentations from three healthy subjects for various projection thicknesses. In addition, the vessel metrics were computed in four additional subjects. Three synthetically generated angiographic datasets resembling brain vasculature were also evaluated under different noise levels. Dice similarity coefficient, Jaccard Index, F-score, and concordance correlation coefficient were used to measure the segmentation accuracy of manual versus automatic segmentation. RESULTS Our new adaptive filter rendered accurate representations of vessels, maintained accurate vessel radii, and corresponded better to manual segmentation at different projection thicknesses than prior methods. Validation with synthetic datasets under low contrast and noisy conditions revealed accurate quantification of vessels without distortions. CONCLUSION We have demonstrated a method for automatic segmentation of vascular trees and the subsequent generation of a vessel radii map. This novel technique can be applied to analyze arterial structures in healthy and diseased populations and improve the characterization of vascular integrity.
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Affiliation(s)
- Sivakami Avadiappan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Seyedmehdi Payabvash
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Melanie A. Morrison
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Angela Jakary
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher P. Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Janine M. Lupo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
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Bluemke DA, Moy L, Bredella MA, Ertl-Wagner BB, Fowler KJ, Goh VJ, Halpern EF, Hess CP, Schiebler ML, Weiss CR. Assessing Radiology Research on Artificial Intelligence: A Brief Guide for Authors, Reviewers, and Readers-From the Radiology Editorial Board. Radiology 2020; 294:487-489. [PMID: 31891322 DOI: 10.1148/radiol.2019192515] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Affiliation(s)
- David A Bluemke
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Linda Moy
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Miriam A Bredella
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Birgit B Ertl-Wagner
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Kathryn J Fowler
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Vicky J Goh
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Elkan F Halpern
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Christopher P Hess
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Mark L Schiebler
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
| | - Clifford R Weiss
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B., M.L.S.); Department of Radiology, New York University, New York, NY (L.M.); Department of Musculoskeletal Radiology (M.A.B.) and Institute for Technology Assessment (E.F.H.), Massachusetts General Hospital, Boston, Mass; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Canada (B.B.E.W.); Department of Radiology, University of California-San Diego, San Diego, Calif (K.J.F.); Department of Cancer Imaging, Division of Imaging Sciences & Biomedical Engineering, Kings College London, London, England (V.J.G.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (C.P.H.); and Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Md (C.R.W.)
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Chen Y, Jakary A, Avadiappan S, Hess CP, Lupo JM. QSMGAN: Improved Quantitative Susceptibility Mapping using 3D Generative Adversarial Networks with increased receptive field. Neuroimage 2020; 207:116389. [PMID: 31760151 PMCID: PMC8081272 DOI: 10.1016/j.neuroimage.2019.116389] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 10/31/2019] [Accepted: 11/20/2019] [Indexed: 11/27/2022] Open
Abstract
Quantitative susceptibility mapping (QSM) is a powerful MRI technique that has shown great potential in quantifying tissue susceptibility in numerous neurological disorders. However, the intrinsic ill-posed dipole inversion problem greatly affects the accuracy of the susceptibility map. We propose QSMGAN: a 3D deep convolutional neural network approach based on a 3D U-Net architecture with increased receptive field of the input phase compared to the output and further refined the network using the WGAN with gradient penalty training strategy. Our method generates accurate QSM maps from single orientation phase maps efficiently and performs significantly better than traditional non-learning-based dipole inversion algorithms. The generalization capability was verified by applying the algorithm to an unseen pathology--brain tumor patients with radiation-induced cerebral microbleeds.
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Affiliation(s)
- Yicheng Chen
- From the UCSF/UC Berkeley Graduate Program in Bioengineering, University of California, San Francisco and Berkeley, CA, USA; From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Angela Jakary
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Sivakami Avadiappan
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Christopher P Hess
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Janine M Lupo
- From the UCSF/UC Berkeley Graduate Program in Bioengineering, University of California, San Francisco and Berkeley, CA, USA; From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA.
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Callen AL, Chow DS, Chen YA, Richelle HR, Pao J, Bardis M, Weinberg BD, Hess CP, Sugrue LP. Predictive Value of Noncontrast Head CT with Negative Findings in the Emergency Department Setting. AJNR Am J Neuroradiol 2020; 41:213-218. [PMID: 31974080 DOI: 10.3174/ajnr.a6408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 08/07/2017] [Accepted: 12/06/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND PURPOSE Noncontrast head CTs are routinely acquired for patients with neurologic symptoms in the emergency department setting. Anecdotally, noncontrast head CTs performed in patients with prior negative findings with the same clinical indication are of low diagnostic yield. We hypothesized that the rate of acute findings in noncontrast head CTs performed in patients with a preceding study with negative findings would be lower compared with patients being imaged for the first time. MATERIALS AND METHODS We retrospectively evaluated patients in the emergency department setting who underwent noncontrast head CTs at our institution during a 4-year period, recording whether the patient had undergone a prior noncontrast head CT, the clinical indication for the examination, and the examination outcome. Positive findings on examinations were defined as those that showed any intracranial abnormality that would necessitate a change in acute management, such as acute hemorrhage, hydrocephalus, herniation, or interval worsening of a prior finding. RESULTS During the study period, 8160 patients in the emergency department setting underwent a total of 9593 noncontrast head CTs; 88.2% (7198/8160) had a single examination, and 11.8% (962/8160) had at least 1 repeat examination. The baseline positive rate of the "nonrepeat" group was 4.3% (308/7198). The 911 patients in the "repeat" group with negative findings on a baseline/first CT had a total of 1359 repeat noncontrast head CTs during the study period. The rate of positive findings for these repeat examinations was 1.8% (25/1359), significantly lower than the 4.3% baseline rate (P < .001). Of the repeat examinations that had positive findings, 80% (20/25) had a study indication that was discordant with that of the prior examination, compared with only 44% (593/1334) of the repeat examinations that had negative findings (P < .001). CONCLUSIONS In a retrospective observational study based on approximately 10,000 examinations, we found that serial noncontrast head CT examinations in patients with prior negative findings with the same study indication are less likely to have positive findings compared with first-time examinations or examinations with a new indication. This finding suggests a negative predictive value of a prior noncontrast head CT examination with negative findings with the same clinical indication.
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Affiliation(s)
- A L Callen
- From the Neuroradiology Section (A.L.C., C.P.H., L.P.S.), Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - D S Chow
- Neuroradiology Section (D.S.C., H.R.R., J.P., M.B.), Department of Radiology, University of California, Irvine, Irvine, California
| | - Y A Chen
- Trillium Health Partners (Y.A.C.), University of Toronto, Toronto, Ontario, Canada
| | - H R Richelle
- Neuroradiology Section (D.S.C., H.R.R., J.P., M.B.), Department of Radiology, University of California, Irvine, Irvine, California
| | - J Pao
- Neuroradiology Section (D.S.C., H.R.R., J.P., M.B.), Department of Radiology, University of California, Irvine, Irvine, California
| | - M Bardis
- Neuroradiology Section (D.S.C., H.R.R., J.P., M.B.), Department of Radiology, University of California, Irvine, Irvine, California
| | - B D Weinberg
- Radiology and Imaging Sciences (B.D.W.), Emory University, Atlanta, Georgia
| | - C P Hess
- From the Neuroradiology Section (A.L.C., C.P.H., L.P.S.), Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - L P Sugrue
- From the Neuroradiology Section (A.L.C., C.P.H., L.P.S.), Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
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Kubik-Huch RA, Vilgrain V, Krestin GP, Reiser MF, Attenberger UI, Muellner AU, Hess CP, Hricak H. Women in radiology: gender diversity is not a metric-it is a tool for excellence. Eur Radiol 2019; 30:1644-1652. [PMID: 31802213 PMCID: PMC7033068 DOI: 10.1007/s00330-019-06493-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 09/23/2019] [Accepted: 10/02/2019] [Indexed: 10/31/2022]
Abstract
Women in Focus: Be Inspired was a unique programme held at the 2019 European Congress of Radiology that was structured to address a range of topics related to gender and healthcare, including leadership, mentoring and the generational progression of women in medicine. In most countries, women constitute substantially fewer than half of radiologists in academia or private practice despite frequently accounting for at least half of medical school enrolees. Furthermore, the proportion of women decreases at higher academic ranks and levels of leadership, a phenomenon which has been referred to as a "leaky pipeline". Gender diversity in the radiologic workplace, including in academic and leadership positions, is important for the present and future success of the field. It is a tool for excellence that helps to optimize patient care and research; moreover, it is essential to overcome the current shortage of radiologists. This article reviews the current state of gender diversity in academic and leadership positions in radiology internationally and explores a wide range of potential reasons for gender disparities, including the lack of role models and mentorship, unconscious bias and generational changes in attitudes about the desirability of leadership positions. Strategies for both individuals and institutions to proactively increase the representation of women in academic and leadership positions are suggested. KEY POINTS: • Gender-diverse teams perform better. Thus, gender diversity throughout the radiologic workplace, including in leadership positions, is important for the current and future success of the field. • Though women now make up roughly half of medical students, they remain underrepresented among radiology trainees, faculty and leaders. • Factors leading to the gender gap in academia and leadership positions in Radiology include a lack of role models and mentors, unconscious biases, other societal barriers and generational changes.
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Affiliation(s)
- Rahel A Kubik-Huch
- Department of Medical Services, Institute of Radiology, Kantonsspital Baden, CH-5404, Baden, Switzerland
| | - Valérie Vilgrain
- APHP, HUPNVS, Hôpital Beaujon, 100 bd General Leclerc, 92110, Clichy, France.,Université de Paris, Paris, France
| | - Gabriel P Krestin
- Department of Radiology and Nuclear Medicine at Erasmus MC, University Medical Center Rotterdam, Room Ne-515k, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maximilian F Reiser
- Department of Radiology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany
| | - Ulrike I Attenberger
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Ada U Muellner
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, c-278, New York, NY, 10065, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, Room M-392, UCSF, Box 0628, San Francisco, CA, 94143-0628, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, c-278, New York, NY, 10065, USA.
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Bucknor MD, Villanueva-Meyer JE, Kumar V, Talbott JF, Wall SD, Glastonbury CM, Dillon WP, Arenson RL, Wilson MW, Hess CP. Diversity and Inclusion Efforts in University of California, San Francisco Radiology: Reflections on 3 Years of Pipeline, Selection, and Education Initiatives. J Am Coll Radiol 2019; 16:1716-1719. [DOI: 10.1016/j.jacr.2019.06.012] [Citation(s) in RCA: 14] [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: 05/20/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 10/26/2022]
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Karch CM, Wen N, Fan CC, Yokoyama JS, Kouri N, Ross OA, Höglinger G, Müller U, Ferrari R, Hardy J, Schellenberg GD, Sleiman PM, Momeni P, Hess CP, Miller BL, Sharma M, Van Deerlin V, Smeland OB, Andreassen OA, Dale AM, Desikan RS. Selective Genetic Overlap Between Amyotrophic Lateral Sclerosis and Diseases of the Frontotemporal Dementia Spectrum. JAMA Neurol 2019; 75:860-875. [PMID: 29630712 DOI: 10.1001/jamaneurol.2018.0372] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder characterized by loss of upper and lower motor neurons. Although novel ALS genetic variants have been identified, the shared genetic risk between ALS and other neurodegenerative disorders remains poorly understood. Objectives To examine whether there are common genetic variants that determine the risk for ALS and other neurodegenerative diseases and to identify their functional pathways. Design, Setting, and Participants In this study conducted from December 1, 2016, to August 1, 2017, the genetic overlap between ALS, sporadic frontotemporal dementia (FTD), FTD with TDP-43 inclusions, Parkinson disease (PD), Alzheimer disease (AD), corticobasal degeneration (CBD), and progressive supranuclear palsy (PSP) were systematically investigated in 124 876 cases and controls. No participants were excluded from this study. Diagnoses were established using consensus criteria. Main Outcomes and Measures The primary outcomes were a list of novel loci and their functional pathways in ALS, FTD, PSP, and ALS mouse models. Results Among 124 876 cases and controls, genome-wide conjunction analyses of ALS, FTD, PD, AD, CBD, and PSP revealed significant genetic overlap between ALS and FTD at known ALS loci: rs13302855 and rs3849942 (nearest gene, C9orf72; P = .03 for rs13302855 and P = .005 for rs3849942) and rs4239633 (nearest gene, UNC13A; P = .03). Significant genetic overlap was also found between ALS and PSP at rs7224296, which tags the MAPT H1 haplotype (nearest gene, NSF; P = .045). Shared risk genes were enriched for pathways involving neuronal function and development. At a conditional FDR P < .05, 22 novel ALS polymorphisms were found, including rs538622 (nearest gene, ERGIC1; P = .03 for ALS and FTD), which modifies BNIP1 expression in human brains (35 of 137 females; mean age, 59 years; P = .001). BNIP1 expression was significantly reduced in spinal cord motor neurons from patients with ALS (4 controls: mean age, 60.5 years, mean [SE] value, 3984 [760.8] arbitrary units [AU]; 7 patients with ALS: mean age, 56 years, mean [SE] value, 1999 [274.1] AU; P = .02), in an ALS mouse model (mean [SE] value, 13.75 [0.09] AU for 2 SOD1 WT mice and 11.45 [0.03] AU for 2 SOD1 G93A mice; P = .002) and in brains of patients with PSP (80 controls: 39 females; mean age, 82 years, mean [SE] value, 6.8 [0.2] AU; 84 patients with PSP: 33 females, mean age 74 years, mean [SE] value, 6.8 [0.1] AU; β = -0.19; P = .009) or FTD (11 controls: 4 females; mean age, 67 years; mean [SE] value, 6.74 [0.05] AU; 17 patients with FTD: 10 females; mean age, 69 years; mean [SE] value, 6.53 [0.04] AU; P = .005). Conclusions and Relevance This study found novel genetic overlap between ALS and diseases of the FTD spectrum, that the MAPT H1 haplotype confers risk for ALS, and identified the mitophagy-associated, proapoptotic protein BNIP1 as an ALS risk gene. Together, these findings suggest that sporadic ALS may represent a selectively pleiotropic, polygenic disorder.
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Affiliation(s)
- Celeste M Karch
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Natalie Wen
- Department of Psychiatry, Washington University in St Louis, St Louis, Missouri
| | - Chun C Fan
- Department of Cognitive Sciences, University of California, San Diego, La Jolla
| | - Jennifer S Yokoyama
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Naomi Kouri
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Owen A Ross
- Department of Neuroscience, Mayo Clinic College of Medicine, Jacksonville, Florida
| | - Gunter Höglinger
- Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases, Munich, Germany.,Department of Neurology, Technical University of Munich, Munich Cluster for Systems Neurology SyNergy, Munich, Germany
| | - Ulrich Müller
- Institut for Humangenetik, Justus-Liebig-Universität, Giessen, Germany
| | - Raffaele Ferrari
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, United Kingdom
| | - John Hardy
- Department of Molecular Neuroscience, Institute of Neurology, University College London, London, United Kingdom
| | - Gerard D Schellenberg
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Patrick M Sleiman
- Center for Applied Genomics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Division of Human Genetics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Parastoo Momeni
- Laboratory of Neurogenetics, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock
| | - Christopher P Hess
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco
| | - Manu Sharma
- Department for Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,Institute for Clinical Epidemiology and Applied Biometry, University of Tübingen, Tübingen, Germany
| | - Vivianna Van Deerlin
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Olav B Smeland
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Neurosciences, University of California, San Diego, La Jolla
| | - Anders M Dale
- Department of Cognitive Sciences, University of California, San Diego, La Jolla.,Department of Neurosciences and Radiology, University of California, San Diego, La Jolla
| | - Rahul S Desikan
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco
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44
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Jabehdar Maralani P, Schieda N, Hecht EM, Litt H, Hindman N, Heyn C, Davenport MS, Zaharchuk G, Hess CP, Weinreb J. MRI safety and devices: An update and expert consensus. J Magn Reson Imaging 2019; 51:657-674. [PMID: 31566852 DOI: 10.1002/jmri.26909] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 12/22/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) is increasing globally, and MRI safety issues regarding medical devices, which are constantly being developed or upgraded, represent an ongoing challenge for MRI personnel. To assist the MRI community, a panel of 10 radiologists with expertise in MRI safety from nine high-volume academic centers formed, with the objective of providing clarity on some of the MRI safety issues for the 10 most frequently questioned devices. Ten device categories were identified. The panel reviewed the literature, including key MRI safety issues regarding screening and adverse event reports, in addition to the manufacturer's Instructions For Use. Using a Delphi-inspired method, 36 practical recommendations were generated with 100% consensus that can aid the clinical MRI community. Level of Evidence: 5 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:657-674.
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Affiliation(s)
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Canada
| | - Elizabeth M Hecht
- Department of Radiology, Columbia University, New York, New York, USA
| | - Harold Litt
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Hindman
- Department of Radiology, New York University, New York, New York, USA
| | - Chinthaka Heyn
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jeffrey Weinreb
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut, USA
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45
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Affiliation(s)
- Jason F. Talbott
- From the Department of Radiology and Biomedical Imaging (J.F.T., C.P.H.), Brain and Spinal Injury Center (J.F.T.), and Department of Neurology (C.P.H.), University of California, San Francisco, 505 Parnassus Ave, M392, San Francisco, CA 94143; and Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, Calif (J.F.T.)
| | - Christopher P. Hess
- From the Department of Radiology and Biomedical Imaging (J.F.T., C.P.H.), Brain and Spinal Injury Center (J.F.T.), and Department of Neurology (C.P.H.), University of California, San Francisco, 505 Parnassus Ave, M392, San Francisco, CA 94143; and Department of Radiology and Biomedical Imaging, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, Calif (J.F.T.)
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46
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Bonham LW, Steele NZR, Karch CM, Broce I, Geier EG, Wen NL, Momeni P, Hardy J, Miller ZA, Gorno-Tempini ML, Hess CP, Lewis P, Miller BL, Seeley WW, Manzoni C, Desikan RS, Baranzini SE, Ferrari R, Yokoyama JS. Genetic variation across RNA metabolism and cell death gene networks is implicated in the semantic variant of primary progressive aphasia. Sci Rep 2019; 9:10854. [PMID: 31350420 PMCID: PMC6659677 DOI: 10.1038/s41598-019-46415-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/19/2017] [Accepted: 06/28/2019] [Indexed: 12/28/2022] Open
Abstract
The semantic variant of primary progressive aphasia (svPPA) is a clinical syndrome characterized by neurodegeneration and progressive loss of semantic knowledge. Unlike many other forms of frontotemporal lobar degeneration (FTLD), svPPA has a highly consistent underlying pathology composed of TDP-43 (a regulator of RNA and DNA transcription metabolism). Previous genetic studies of svPPA are limited by small sample sizes and a paucity of common risk variants. Despite this, svPPA's relatively homogenous clinicopathologic phenotype makes it an ideal investigative model to examine genetic processes that may drive neurodegenerative disease. In this study, we used GWAS metadata, tissue samples from pathologically confirmed frontotemporal lobar degeneration, and in silico techniques to identify and characterize protein interaction networks associated with svPPA risk. We identified 64 svPPA risk genes that interact at the protein level. The protein pathways represented in this svPPA gene network are critical regulators of RNA metabolism and cell death, such as SMAD proteins and NOTCH1. Many of the genes in this network are involved in TDP-43 metabolism. Contrary to the conventional notion that svPPA is a clinical syndrome with few genetic risk factors, our analyses show that svPPA risk is complex and polygenic in nature. Risk for svPPA is likely driven by multiple common variants in genes interacting with TDP-43, along with cell death,x` working in combination to promote neurodegeneration.
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Affiliation(s)
- Luke W Bonham
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.,Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Natasha Z R Steele
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Celeste M Karch
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Iris Broce
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Ethan G Geier
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Natalie L Wen
- Department of Psychiatry, Washington University, St. Louis, MO, USA
| | - Parastoo Momeni
- Texas Tech University Health Science Center, Laboratory of Neurogenetics, Lubbock, TX, USA
| | - John Hardy
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Zachary A Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Maria Luisa Gorno-Tempini
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher P Hess
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Patrick Lewis
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK.,School of Pharmacy, University of Reading, Whiteknights, Reading, UK
| | - Bruce L Miller
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William W Seeley
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Claudia Manzoni
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK.,School of Pharmacy, University of Reading, Whiteknights, Reading, UK
| | - Rahul S Desikan
- Neuroradiology Section, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Sergio E Baranzini
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Raffaele Ferrari
- Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Jennifer S Yokoyama
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA.
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47
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Kallianos KG, Webb EM, Hess CP, Talbott J, Bucknor MD. Use of the Implicit Association Test to Improve Diversity in Radiology. J Am Coll Radiol 2019; 16:976-979. [DOI: 10.1016/j.jacr.2019.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/10/2019] [Accepted: 01/12/2019] [Indexed: 10/27/2022]
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48
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Wang ZJ, Ohliger MA, Larson PEZ, Gordon JW, Bok RA, Slater J, Villanueva-Meyer JE, Hess CP, Kurhanewicz J, Vigneron DB. Hyperpolarized 13C MRI: State of the Art and Future Directions. Radiology 2019; 291:273-284. [PMID: 30835184 DOI: 10.1148/radiol.2019182391] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Hyperpolarized (HP) carbon 13 (13C) MRI is an emerging molecular imaging method that allows rapid, noninvasive, and pathway-specific investigation of dynamic metabolic and physiologic processes that were previously inaccessible to imaging. This technique has enabled real-time in vivo investigations of metabolism that are central to a variety of diseases, including cancer, cardiovascular disease, and metabolic diseases of the liver and kidney. This review provides an overview of the methods of hyperpolarization and 13C probes investigated to date in preclinical models of disease. The article then discusses the progress that has been made in translating this technology for clinical investigation. In particular, the potential roles and emerging clinical applications of HP [1-13C]pyruvate MRI will be highlighted. The future directions to enable the adoption of this technology to advance the basic understanding of metabolism, to improve disease diagnosis, and to accelerate treatment assessment are also detailed.
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Affiliation(s)
- Zhen J Wang
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - Michael A Ohliger
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - Peder E Z Larson
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - Jeremy W Gordon
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - Robert A Bok
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - James Slater
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - Javier E Villanueva-Meyer
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - Christopher P Hess
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - John Kurhanewicz
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
| | - Daniel B Vigneron
- From the Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94143
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49
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Tan CH, Bonham LW, Fan CC, Mormino EC, Sugrue LP, Broce IJ, Hess CP, Yokoyama JS, Rabinovici GD, Miller BL, Yaffe K, Schellenberg GD, Kauppi K, Holland D, McEvoy LK, Kukull WA, Tosun D, Weiner MW, Sperling RA, Bennett DA, Hyman BT, Andreassen OA, Dale AM, Desikan RS. Polygenic hazard score, amyloid deposition and Alzheimer's neurodegeneration. Brain 2019; 142:460-470. [PMID: 30689776 PMCID: PMC6351776 DOI: 10.1093/brain/awy327] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 12/20/2022] Open
Abstract
Mounting evidence indicates that the polygenic basis of late-onset Alzheimer's disease can be harnessed to identify individuals at greatest risk for cognitive decline. We have previously developed and validated a polygenic hazard score comprising of 31 single nucleotide polymorphisms for predicting Alzheimer's disease dementia age of onset. In this study, we examined whether polygenic hazard scores are associated with: (i) regional tracer uptake using amyloid PET; (ii) regional volume loss using longitudinal MRI; (iii) post-mortem regional amyloid-β protein and tau associated neurofibrillary tangles; and (iv) four common non-Alzheimer's pathologies. Even after accounting for APOE, we found a strong association between polygenic hazard scores and amyloid PET standard uptake volume ratio with the largest effects within frontal cortical regions in 980 older individuals across the disease spectrum, and longitudinal MRI volume loss within the entorhinal cortex in 607 older individuals across the disease spectrum. We also found that higher polygenic hazard scores were associated with greater rates of cognitive and clinical decline in 632 non-demented older individuals, even after controlling for APOE status, frontal amyloid PET and entorhinal cortex volume. In addition, the combined model that included polygenic hazard scores, frontal amyloid PET and entorhinal cortex volume resulted in a better fit compared to a model with only imaging markers. Neuropathologically, we found that polygenic hazard scores were associated with regional post-mortem amyloid load and neuronal neurofibrillary tangles, even after accounting for APOE, validating our imaging findings. Lastly, polygenic hazard scores were associated with Lewy body and cerebrovascular pathology. Beyond APOE, we show that in living subjects, polygenic hazard scores were associated with amyloid deposition and neurodegeneration in susceptible brain regions. Polygenic hazard scores may also be useful for the identification of individuals at the highest risk for developing multi-aetiological dementia.
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Affiliation(s)
- Chin Hong Tan
- Division of Psychology, Nanyang Technological University, 48 Nanyang Avenue, Singapore
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, USA
| | - Luke W Bonham
- Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, USA
| | - Chun Chieh Fan
- Department of Cognitive Science, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Elizabeth C Mormino
- Department of Neurology and Neurological Sciences, Stanford University, 300 Pasteur Dr, Palo Alto, CA, USA
| | - Leo P Sugrue
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, USA
| | - Iris J Broce
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, USA
| | - Christopher P Hess
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, USA
| | - Jennifer S Yokoyama
- Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, USA
| | - Gil D Rabinovici
- Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, USA
| | - Bruce L Miller
- Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, USA
| | - Kristine Yaffe
- Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, USA
- Department of Psychiatry, University of California, San Francisco, 982 Mission St, San Francisco, CA, USA
| | - Gerard D Schellenberg
- Department of Pathology and Laboratory Medicine, University of Pennsylvania, 204 N Broad St, Philadelphia, PA, USA
| | - Karolina Kauppi
- Department of Radiology, University of California, San Diego, 8929 University Center, La Jolla, CA, USA
| | - Dominic Holland
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Linda K McEvoy
- Department of Radiology, University of California, San Diego, 8929 University Center, La Jolla, CA, USA
| | - Walter A Kukull
- National Alzheimer’s Coordinating Center, Department of Epidemiology, University of Washington, 1959 NE Pacific St, Seattle, WA, USA
| | - Duygu Tosun
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, USA
| | - Michael W Weiner
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, USA
| | - Reisa A Sperling
- Department of Neurology, Massachusetts General Hospital, 15 Parkman St, Boston, MA, USA
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, 1750 W Harrison St, Chicago, IL, USA
| | - Bradley T Hyman
- Department of Neurology, Massachusetts General Hospital, 15 Parkman St, Boston, MA, USA
| | - Ole A Andreassen
- NORMENT Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, Boks 1072 Blindern, Oslo, Norway
| | - Anders M Dale
- Department of Cognitive Science, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, USA
- Department of Radiology, University of California, San Diego, 8929 University Center, La Jolla, CA, USA
- Department of Neurosciences, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, USA
| | - Rahul S Desikan
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 500 Parnassus Avenue, San Francisco, CA, USA
- Department of Neurology, University of California, San Francisco, 400 Parnassus Ave, San Francisco, CA, USA
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50
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Kim H, Al-Shahi Salman R, Flemming KD, Flint AC, Hess CP, Hetts S, Krings T, Laakso A, Lanzino G, Lawton MT, McCulloch CE, Mohr JP, Morgan MK, Moy CS, Nakaji P, Pereira VM, Sgarabotto Ribeiro D, Stapf C, Stefani MA, Zaroff JG, Zhao Y. Abstract TP585: Long-Term Outcomes in Unruptured Brain Arteriovenous Malformation Patients: The Multicenter Arteriovenous Malformation Research Study (MARS). Stroke 2019. [DOI: 10.1161/str.50.suppl_1.tp585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Helen Kim
- Anesthesia, Epidemiology & Biostatistics, UCSF, San Francisco, CA
| | | | | | | | | | | | - Timo Krings
- Div of Neuroradiology, Univ of Toronto, Toronto, Canada
| | | | | | | | | | - Jay P Mohr
- Vascular Neurology, Columbia Univ Med Cntr, New York, NY
| | | | | | - Peter Nakaji
- Neurosurgery, Barrow Neurological Institute, Phoenix, AZ
| | | | | | | | - Marco A Stefani
- Universidade Federal do Rio Grande do Sul, Farroupilha, Brazil
| | | | - Yuanli Zhao
- Neurosurgery Cntr of Beijing Tiantan Hosp, Beijing, China
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