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Research Publications


January 2016

MRI Suggests Increased Tonicity of the Levator Ani in Women with Interstitial Cystitis/bladder Pain Syndrome.

Ackerman AL, Lee UJ, Jellison FC, Tan N, Patel M, Raman SS, Rodriguez LV.

INTRODUCTION AND HYPOTHESIS: In interstitial cystitis/bladder pain syndrome (IC/BPS), pelvic floor dysfunction may contribute significantly to pelvic pain. To determine if pelvic floor hypertonicity manifests alterations on magnetic resonance imaging (MRI) in patients with IC/BPS, we retrospectively compared pelvic measurements between patients and controls. METHODS: Fifteen women with IC/BPS and 15 age-matched controls underwent pelvic MRI. Two blinded radiologists measured the pelvic musculature, including the H- and M lines, vaginal length, urethral length and cross-sectional area, levator width and length, and posterior puborectalis angle. MRI measures and clinical factors, such as age, parity, and duration of symptoms, were compared using a paired, two-tailed t test.


January 2016

Ischemic Core and Hypoperfusion Volumes Predict Infarct Size in SWIFT PRIME.

Albers GW, Goyal M, Jahan R, Bonafe A, Diener HC, Levy EI, Pereira VM, Cognard C, Cohen DJ, Hacke W, Jansen O, Jovin TG, Mattle HP, Nogueira RG, Siddiqui AH, Yavagal DR, Baxter BW, Devlin TG, Lopes DK, Reddy VK, de Rochemont Rdu M, Singer OC, Bammer R, Saver JL.

OBJECTIVE: Within the context of a prospective randomized trial (SWIFT PRIME), we assessed whether early imaging of stroke patients, primarily with computed tomography (CT) perfusion, can estimate the size of the irreversibly injured ischemic core and the volume of critically hypoperfused tissue. We also evaluated the accuracy of ischemic core and hypoperfusion volumes for predicting infarct volume in patients with the target mismatch profile. METHODS: Baseline ischemic core and hypoperfusion volumes were assessed prior to randomized treatment with intravenous (IV) tissue plasminogen activator (tPA) alone versus IV tPA + endovascular therapy (Solitaire stent-retriever) using RAPID automated postprocessing software. Reperfusion was assessed with angiographic Thrombolysis in Cerebral Infarction scores at the end of the procedure (endovascular group) and Tmax > 6-second volumes at 27 hours (both groups). Infarct volume was assessed at 27 hours on noncontrast CT or magnetic resonance imaging (MRI).


January 2016

RadPath:: A Web-based System for Integrating and Correlating Radiology and Pathology Findings During Cancer Diagnosis.

Arnold CW, Wallace WD, Chen S, Oh A, Abtin F, Genshaft S, Binder S, Aberle D, Enzmann D.

RATIONALE AND OBJECTIVES: The current paradigm of cancer diagnosis involves uncoordinated communication of findings from radiology and pathology to downstream physicians. Discordance between these findings can require additional time from downstream users to resolve, or given incorrect resolution, may adversely impact treatment decisions. To mitigate this problem, we developed a web-based system, called RadPath, for correlating and integrating radiology and pathology reporting. MATERIALS AND METHODS: RadPath includes interfaces to our institution's clinical information systems, which are used to retrieve reports, images, and test results that are structured into an interactive compendium for a diagnostic patient case. The system includes an editing interface for physicians, allowing for the inclusion of additional clinical data, as well as the ability to retrospectively correlate and contextualize imaging findings following pathology diagnosis.


January 2016

Synopsis of the PI-RADS v2 Guidelines for Multiparametric Prostate Magnetic Resonance Imaging and Recommendations for Use.

Barentsz JO, Weinreb JC, Verma S, Thoeny HC, Tempany CM, Shtern F, Padhani AR, Margolis D, Macura KJ, Haider MA, Cornud F, Choyke PL.

Rapid technical advances have enabled multiparametric magnetic resonance imaging (mpMRI) combined with magnetic resonance (MR)-targeted biopsy to become valuable tools for early detection of clinically significant prostate cancer (PCa) while reducing overdiagnosis of indolent PCa. There has been concern, however, that the widespread implementation and acceptance of mpMRI could be impaired by a lack of standardisation of image acquisition, interpretation and reporting guidance, and inter- and intraobserver variability that could result in poor clinical test performance in daily practise.


January 2016

Contrast Enhancement Patterns after Irreversible Electroporation: Experimental Study of CT Perfusion Correlated to Histopathology in Normal Porcine Liver.

Chung DJ, Sung K, Osuagwu FC, Wu HH, Lassman C, Lu DS.

PURPOSE: To analyze ablated tissue zones after irreversible electroporation (IRE) of porcine liver using computed tomography (CT) perfusion imaging with histopathologic correlation. MATERIALS AND METHODS: Under ultrasound and CT guidance, 10 IRE ablations were performed percutaneously in three Yorkshire pigs using a single bipolar electrode. CT perfusion imaging was performed in all pigs immediately after ablation and on day 2. Pathologic sections were prepared for correlation with histopathology (hematoxylin-eosin and terminal deoxynucleotidyl transferase dUTP nick end labeling stains, 5-mm-thick slices). The short diameter of different enhancing zones on CT was correlated with the gross specimen.


January 2016

Impact of Glucose on Outcomes in Patients Treated With Mechanical Thrombectomy: A Post Hoc Analysis of the Solitaire Flow Restoration With the Intention for Thrombectomy Study.

Kim JT, Jahan R, Saver JL; SWIFT Investigators.

BACKGROUND AND PURPOSE: Sparse data are available regarding the association between hyperglycemia and outcomes in acute ischemic stroke patients receiving mechanical thrombectomy (MT). We investigated whether hyperglycemia affected the outcomes of subjects treated with MT in the Solitaire Flow Restoration With the Intention for Thrombectomy (SWIFT) multicenter randomized trial, overall and according to reperfusion status after MT. METHODS: We analyzed the relationships between the presenting glucose level as a continuous variable and presenting hyperglycemia (>140 mg/dL glucose) as a binary variable and several outcomes of interest. Subjects were stratified according to the completeness of reperfusion (Thrombolysis In Myocardial Ischemia scale 3 versus 0-2) after MT. Excellent outcome at 3 months was defined as a modified Rankin scale score of 0-1.


January 2016

Pain and Interoception Imaging Network (PAIN): A Multimodal, Multisite, Brain-imaging Repository for Chronic Somatic and Visceral Pain Disorders.

Labus JS, Naliboff B, Kilpatrick L, Liu C, Ashe-McNalley C, Dos Santos IR, Alaverdyan M, Woodworth D, Gupta A, Ellingson BM, Tillisch K, Mayer EA.

The Pain and Interoception Imaging Network (PAIN) repository (painrepository.org) is a newly created NIH (NIDA/NCCAM) funded neuroimaging data repository that aims to accelerate scientific discovery regarding brain mechanisms in pain and to provide more rapid benefits to pain patients through the harmonization of efforts and data sharing. The PAIN Repository consists of two components, an Archived Repository and a Standardized Repository. Similar to other 'open' imaging repositories, neuroimaging researchers can deposit any dataset of chronic pain patients and healthy controls into the Archived Repository. Scans in the Archived Repository can be very diverse in terms of scanning procedures and clinical metadata, complicating the merging of datasets for analyses. The Standardized Repository overcomes these limitations through the use of standardized scanning protocols along with a standardized set of clinical metadata, allowing an unprecedented ability to perform pooled analyses. The Archived Repository currently includes 741 scans and is rapidly growing. The Standardized Repository currently includes 433 scans. Pain conditions currently represented in the PAIN repository include: irritable bowel syndrome, vulvodynia, migraine, chronic back pain, and inflammatory bowel disease. Both the PAIN Archived and Standardized Repositories promise to be important resources in the field of chronic pain research. The enhanced ability of the Standardized Repository to combine imaging, clinical and other biological datasets from multiple sites in particular make it a unique resource for significant scientific discoveries.


January 2016

Cost Analysis of Vestibular Schwannoma Screening with Contrast-enhanced Magnetic Resonance Imaging in Patients with Asymmetrical Hearing Loss.

Pan P, Huang J, Morioka C, Hathout G, El-Saden SM.

BACKGROUND: Vestibular schwannomas are a rare cause of asymmetrical hearing loss, and routine screening with magnetic resonance imaging can be costly. This paper reports results on vestibular schwannoma screening at our institution and compares the cost of screening to a utility of hearing benefit. METHOD: All screening examinations with magnetic resonance imaging performed for asymmetrical hearing loss between 2006 and 2011 were retrospectively reviewed. The cost per new vestibular schwannoma diagnosis was calculated. The cost per patient for those who benefitted from intervention was estimated based on rates of hearing preservation reported in the literature.


January 2016

Collateral Flow as Causative of Good Outcomes in Endovascular Stroke Therapy.

Sheth SA, Sanossian N, Hao Q, Starkman S, Ali LK, Kim D, Gonzalez NR, Tateshima S, Jahan R, Duckwiler GR, Saver JL, Vinuela F, Liebeskind DS; UCLA Collateral Investigators.

BACKGROUND: Endovascular reperfusion techniques are a promising intervention for acute ischemic stroke (AIS). Prior studies have identified markers of initial injury (arrival NIH stroke scale (NIHSS) or infarct volume) as predictive of outcome after these procedures. We sought to define the role of collateral flow at the time of presentation in determining the extent of initial ischemic injury and its influence on final outcome. METHODS: Demographic, clinical, laboratory, and radiographic data were prospectively collected on a consecutive cohort of patients who received endovascular therapy for acute cerebral ischemia at a single tertiary referral center from September 2004 to August 2010.


January 2016

Magnetic Resonance Imaging of Iron Oxide-Labeled Human Embryonic Stem Cell-Derived Cardiac Progenitors.

Skelton RJ, Khoja S, Almeida S, Rapacchi S, Han F, Engel J, Zhao P, Hu P, Stanley EG, Elefanty AG, Kwon M, Elliott DA, Ardehali R.

Given the limited regenerative capacity of the heart, cellular therapy with stem cell-derived cardiac cells could be a potential treatment for patients with heart disease. However, reliable imaging techniques to longitudinally assess engraftment of the transplanted cells are scant. To address this issue, we used ferumoxytol as a labeling agent of human embryonic stem cell-derived cardiac progenitor cells (hESC-CPCs) to facilitate tracking by magnetic resonance imaging (MRI) in a large animal model. Differentiating hESCs were exposed to ferumoxytol at different time points and varying concentrations. We determined that treatment with ferumoxytol at 300 μg/ml on day 0 of cardiac differentiation offered adequate cell viability and signal intensity for MRI detection without compromising further differentiation into definitive cardiac lineages. Labeled hESC-CPCs were transplanted by open surgical methods into the left ventricular free wall of uninjured pig hearts and imaged both ex vivo and in vivo. Comprehensive T2*-weighted images were obtained immediately after transplantation and 40 days later before termination. The localization and dispersion of labeled cells could be effectively imaged and tracked at days 0 and 40 by MRI. Thus, under the described conditions, ferumoxytol can be used as a long-term, differentiation-neutral cell-labeling agent to track transplanted hESC-CPCs in vivo using MRI.


January 2016

Image-Guided Biopsy in the Era of Personalized Cancer Care: Proceedings from the Society of Interventional Radiology Research Consensus Panel.

Tam AL, Lim HJ, Wistuba II, Tamrazi A, Kuo MD, Ziv E, Wong S, Shih AJ, Webster RJ 3rd, Fischer GS, Nagrath S, Davis SE, White SB, Ahrar K.

Image-guided percutaneous biopsy is a common procedure in oncology that is integral in confirming the diagnosis of cancer, staging the disease, and determining tumor histology. However, in the era of personalized medicine, in which advances in knowledge of specific cellular pathways and characterization of tissue at molecular and genetic levels has resulted in an increase in targeted therapies, the role of the image-guided percutaneous biopsy is evolving. Biopsy samples are required for more than just histologic diagnosis, as biomarker status now guides standard-of-care therapy in a growing number of solid tumors including melanoma, breast, colon, and lung cancers. In addition, biopsies are no longer being performed only at the time of initial diagnosis, but are being performed at multiple time points to detect progression, predict prognosis, and guide next-line therapy. Image-guided biopsies are also playing an increasing role in oncologic clinical trials, as the US Food and Drug Administration (FDA) has mandated that targeted therapies be accompanied by a companion diagnostic test for appropriate patient selection. The research biopsy is so critical to clinical trial design that many stakeholders share the sentiment that the absence of high-quality biologic specimens is one of the most significant roadblocks to developing and validating biomarkers for their intended use. Finally, prioritizing the actualization of personalized cancer care in the United States was brought to the forefront by President Obama in his 2015 State of the Union address, in which he announced the Precision Medicine Initiative, which should "bring us closer to curing diseases like cancer."


January 2016

Hypopharyngeal Venous Malformation Presenting with Foreign Body Sensation and Dysphagia.

Vahabzadeh-Hagh AM, Sepahdari AR, Fitter J, Abemayor E.

OBJECTIVE: Review the importance of imaging selection and clinicoanatomic correlation for a vascular malformations presenting with unique symptomatology. METHODS: Case study and literature review.


January 2016

PI-RADS Prostate Imaging - Reporting and Data System: 2015, Version 2.

Weinreb JC, Barentsz JO, Choyke PL, Cornud F, Haider MA, Macura KJ, Margolis D, Schnall MD, Shtern F, Tempany CM, Thoeny HC, Verma S.

The Prostate Imaging - Reporting and Data System Version 2 (PI-RADS™ v2) is the product of an international collaboration of the American College of Radiology (ACR), European Society of Uroradiology (ESUR), and AdMetech Foundation. It is designed to promote global standardization and diminish variation in the acquisition, interpretation, and reporting of prostate multiparametric magnetic resonance imaging (mpMRI) examination, and it is based on the best available evidence and expert consensus opinion. It establishes minimum acceptable technical parameters for prostate mpMRI, simplifies and standardizes terminology and content of reports, and provides assessment categories that summarize levels of suspicion or risk of clinically significant prostate cancer that can be used to assist selection of patients for biopsies and management. It is intended to be used in routine clinical practice and also to facilitate data collection and outcome monitoring for research.


January 2016

High-Resolution 3-T Endorectal Prostate MRI: A Multireader Study of Radiologist Preference and Perceived Interpretive Quality of 2D and 3D T2-Weighted Fast Spin-Echo MR Images.

Westphalen AC, Noworolski SM, Harisinghani M, Jhaveri KS, Raman SS, Rosenkrantz AB, Wang ZJ, Zagoria RJ, Kurhanewicz J.

OBJECTIVE: The goal of this study was to compare the perceived quality of 3-T axial T2-weighted high-resolution 2D and high-resolution 3D fast spin-echo (FSE) endorectal MR images of the prostate. MATERIALS AND METHODS: Six radiologists independently reviewed paired 3-T axial T2-weighted high-resolution 2D and 3D FSE endorectal MR images of the prostates of 85 men in two sessions. In the first session (n = 85), each reader selected his or her preferred images; in the second session (n = 28), they determined their confidence in tumor identification and compared the depiction of the prostatic anatomy, tumor conspicuity, and subjective intrinsic image quality of images. A meta-analysis using a random-effects model, logistic regression, and the paired Wilcoxon rank-sum test were used for statistical analyses.


January 2016

Accelerated Five-dimensional Echo Planar J-resolved Spectroscopic Imaging: Implementation and Pilot Validation in Human Brain.

Wilson NE, Iqbal Z, Burns BL, Keller M, Thomas MA.

PURPOSE: To implement an accelerated five-dimensional (5D) echo-planar J-resolved spectroscopic imaging sequence combining 3 spatial and 2 spectral encoding dimensions and to apply the sequence in human brain. METHODS: An echo planar readout was used to acquire a single spatial and a single spectral dimension during one readout. Nonuniform sampling was applied to the two phase-encoded spatial directions and the indirect spectral dimension. Nonlinear reconstruction was used to minimize the ℓ1-norm or the total variation and included a spectral mask to enhance sparsity. Retrospective reconstructions at multiple undersamplings were performed in phantom. Ten healthy volunteers were scanned with 8x undersampling and compared to a fully sampled single slice scan.


January 2016

Hypopharyngeal Venous Malformation Presenting with Foreign Body Sensation and Dysphagia.

Vahabzadeh-Hagh AM, Sepahdari AR, Fitter J, Abemayor E.

PURPOSE: To implement an accelerated five-dimensional (5D) echo-planar J-resolved spectroscopic imaging sequence combining 3 spatial and 2 spectral encoding dimensions and to apply the sequence in human brain. METHODS: An echo planar readout was used to acquire a single spatial and a single spectral dimension during one readout. Nonuniform sampling was applied to the two phase-encoded spatial directions and the indirect spectral dimension. Nonlinear reconstruction was used to minimize the ℓ1-norm or the total variation and included a spectral mask to enhance sparsity. Retrospective reconstructions at multiple undersamplings were performed in phantom. Ten healthy volunteers were scanned with 8x undersampling and compared to a fully sampled single slice scan.


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