December 2011Biomarkers of Inflammation and Hemostasis Associated with Left Ventricular Mass: The Multiethnic Study of Atherosclerosis (MESA).
Arnett DK, McClelland RL, Bank A, Bluemke DA, Cushman M, Szalai AJ, Jain N, Gomes AS, Heckbert SR, Hundley WG, Lima JA.
Biomarkers of inflammation and hemostasis have been associated with left ventricular (LV) mass. We studied relationships of C-reactive protein (CRP), interleukin-6 (IL6), D-dimer, soluble intercellular adhesion molecule-1 (sICAM-1), plasminogen activator inhibitor 1 (PAI-1), soluble thrombomodulin (sTM), soluble tumor necrosis factor type 1 receptor (sTNFR1), von Willebrand factor (vWF), soluble E-selectin (sE-selectin), factor VIII, fibrinogen, matrix metalloproteinase 3 (MMP3), and matrix metalloproteinase 9 (MMP9) with LV mass in an asymptomatic population. Multi-Ethnic Study of Atherosclerosis participants underwent magnetic resonance imaging to characterize LV mass; biomarkers were measured using standardized protocols (N = 763 to 4979). Adjusted models were used to associate each biomarker with LV mass while correcting for potential confounding.
December 2011Treatment with Imatinib Results in Reduced IL-4-Producing T Cells, but Increased CD4+ T Cells in the Broncho-Alveolar Lavage of Patients with Systemic Sclerosis.
Divekar AA, Khanna D, Abtin F, Maranian P, Saggar R, Saggar R, Furst DE, Singh RR.
T cells, particularly those producing IL-4, are implicated in inflammation-mediated fibrosis. In our phase I/IIa open-label pilot study in 15 patients with scleroderma-interstitial lung disease (SSc-ILD), high-dose imatinib treatment showed modest improvement in lung function and skin score, but with several adverse events. Here, we investigated T cell phenotype and cytokine production in bronchoalveolar lavage (BAL) from patients enrolled in this trial. We found that IL-4+ T cells showed a stronger correlation with ground glass opacity (GGO) than fibrosis scores on lung high-resolution computer tomography scans. Frequencies of IL-4+ T cells also discriminated patients with high (≥ 20) versus low (< 20) GGO scores. Functional annotation clustering of proteins that correlated with T cells identified two major clusters that belonged to immune/ inflammatory and wounding response. Repeat analyses after 1 year of treatment in 10 BAL samples, one each from the right middle and lower lobes of lung from 5 patients, showed that post-imatinib, IL-4+ T cells were profoundly reduced but CD4+ T cells increased, except in one patient who showed worsening of SSc-ILD. Post-imatinib increase in CD4+ T cells correlated with soluble ICAM-3 and PECAM-1 levels in BAL, which associated with the lack of worsening in SSc-ILD. Thus, imatinib might confer its therapeutic effect in fibrosis via re-directing T cell responses from type 2 to other, non-type 2 cytokine producing CD4+ T cells.
December 2011Novel Spinal Cord Imaging
Ellingson BM, Holly LT.
Conventional cervical spine imaging techniques such as standard T1- and T2-weighted MR imaging and CT myelography provide limited sensitivity to the microstructure of the spinal cord. Although not routinely used in clinical practice, diffusion tensor (DT) imaging has shown significant sensitivity to structural changes in the human spinal cord and holds promise as an important biomarker for assessing structural damage as well as predicting functional deficits. For example, DT imaging has been used to detect changes in the spinal cord in cases of multiple sclerosis, acute spinal cord injury, and chronic spinal cord injury, suggesting it may be a valuable clinical biomarker for spinal cord health. Additionally, studies have shown that measurements of diffusivity taken in the transverse plane (radially), perpendicular to the orientation of the spinal cord, reflect the degree of myelination. Furthermore, there is evidence to suggest that measurements taken in the longitudinal orientation (axially), parallel to the spinal cord, may reflect the functional integrity of the axon tracts.
December 2011Endpoints for Hemodialysis Access Procedures: Correlation Between Fistulography and Intraaccess Blood Flow Measurements.
Goyal A, Orth RC, Parekh RS, Wolfson T, Gamst A, Kuo MD.
The success of percutaneous interventions on stenotic hemo- dialysis prosthetic grafts and autogenous fistulas is assessed by comparing vessel diameter before and after treatment. These changes do not correlate with gold standard access blood flow (ABF) measurements obtained during hemodialysis. The Angio- Flow (AngioDynamics, Inc, Queensbury, New York) calculates real-time blood flow through access circuits and may provide more physiologically relevant data in the interventional suite. This study compares angiographic vessel diameter and access circuit flow rates obtained with the AngioFlow Meter before and after percutaneous interventions on stenotic hemodialysis prosthetic grafts and autogenous fistulas ABF measurements obtained during hemodialysis. Angiographic images and AngioFlow measurements for 76 procedures in 35 patients undergoing hemodialysis with arteriovenous grafts or fistulas were analyzed retrospectively. Correlations between ABF, fistulography, and AngioFlow measurements before and after treatment were computed. Regression analyses of AngioFlow measurements and measurements after ABF were performed to account for confounding factors. Time to failure of treatment was modeled in first-time patients stratified by AngioFlow values obtained after treatment. Only patients with ABF measurements obtained within 5 weeks of intervention were included.
December 2011Quantitative Texture-Based Assessment of One-Year Changes in Fibrotic Reticular Patterns on HRCT in Scleroderma Lung Disease Treated with Oral Cyclophosphamide.
Kim HJ, Brown MS, Elashoff R, Li G, Gjertson DW, Lynch DA, Strollo DC, Kleerup E, Chong D, Shah SK, Ahmad S, Abtin F, Tashkin DP, Goldin JG.
The Scleroderma Lung Study showed the efficacy of cyclophosphamide in modestly improving the forced vital capacity (FVC) compared with placebo over 1 year. Using changes in texture-based scores that quantify lung fibrosis as the percentage involvement of reticulation patterns, the effective- ness of cyclophosphamide was re-assessed by examining its impact on quantitative lung fibrosis (QLF). Axial HRCT images were acquired (1-mm slice thickness, 10-mm increments) in the prone position at inspiration. A validated model for quantifying interstitial disease patterns was applied to images from 83 subjects at baseline and 12 months. Scores were calculated for six zones (upper, mid, lower of the right/left lung) and the whole lung. Average changes were compared. Correlations were performed between QLF and physiological and clinical scores.
December 2011Evidence for Sequenced Molecular Evolution of IDH1 Mutant Glioblastoma From a Distinct Cell of Origin
Lai A, Kharbanda S, Pope WB, Tran A, Solis OE, Peale F, Forrest WF, Pujara K, Carrillo JA, Pandita A, Ellingson BM, Bowers CW, Soriano RH, Schmidt NO, Mohan S, Yong WH, Seshagiri S, Modrusan Z, Jiang Z, Aldape KD, Mischel PS, Liau LM, Escovedo CJ, Chen W, Nghiemphu PL, James CD, Prados MD, Westphal M, Lamszus K, Cloughesy T, Phillips HS.
Mutation in isocitrate dehydrogenase 1 (IDH1) at R132 (IDH1R132MUT) is frequent in low-grade diffuse gliomas and, within glioblastoma (GBM), has been proposed as a marker for GBMs that arise by transformation from lower-grade gliomas, regardless of clinical history. To determine how GBMs arising with IDH1R132MUT differ from other GBMs, we undertook a comprehensive comparison of patients presenting clinically with primary GBM as a function of IDH1R132 mutation status. In all, 618 treatment-naive primary GBMs and 235 lower-grade diffuse gliomas were sequenced for IDH1R132 and analyzed for demographic, radiographic, anatomic, histologic, genomic, epigenetic, and transcriptional characteristics.
December 2011Clear Cell Renal Cell Carcinoma: Multiphasic Multidetector CT Imaging Features Help Predict Genetic Karyotypes
Sauk SC, Hsu MS, Margolis DJ, Lu DS, Rao NP, Belldegrun AS, Pantuck AJ, Raman SS.
The purpose of this study is to determine whether imaging characteristics at multiphasic multidetector computed tomography (CT) correlate with common karyotypic abnormalities in patients with clear cell renal cell carcinomas (ccRCCs). Institutional review board approval was obtained, and informed consent was waived for this HIPAA-compliant retrospective study. From January 2000 through September 2007, the prenephrectomy multiphasic (corticomedullary, nephrographic, and excretory phases), multidetector helical CT images of 58 histologically proved and karyotyped ccRCCs were reviewed by two readers with experience in abdominal imaging. Imaging features assessed included degree of attenuation, contour, and presence of calcifications and neovascularity. These features were independently correlated with specific karyotypic abnormalities on the resected specimens. Degree of attenuation data were analyzed with logistic regression for significance (P < .05), and morphologic characteristics were analyzed with odds ratios for assessing their diagnostic power.
November 2011A One-Year, Phase I/IIa, Open-Label Pilot Trial of Imatinib Mesylate in the Treatment of Systemic Sclerosis-Associated Active Interstitial Lung Disease.
Khanna D, Saggar R, Mayes MD, Abtin F, Clements PJ, Maranian P, Assassi S, Saggar R, Singh RR, Furst DE.
Transforming growth factor β (TGFβ) and platelet-derived growth factor (PDGF) may play a critical role in systemic sclerosis (SSc)-related interstitial lung disease (ILD), and imatinib is a potent inhibitor of TGFβ and PDGF production. In this 1-year, phase I/IIa open-label pilot study of imatinib in patients with SSc-related active ILD, our primary aim was to assess the safety of imatinib; we also explored its efficacy. We recruited 20 SSc patients with a forced vital capacity (FVC) of <85% predicted, dyspnea on exertion, and presence of a ground-glass appearance on high-resolution computed tomography. Patients received oral therapy with imatinib (up to 600 mg/day) for a period of 1 year. Adverse events were recorded, pulmonary function was tested, and the modified Rodnan skin thickness score (MRSS) was assessed every 3 months. The course of changes in lung function, the Health Assessment Questionnaire (HAQ) disability index (DI), and the MRSS were modeled over the period of study to explore treatment efficacy.
November 2011The Presence of Two Local Myocardial Sheet Populations Confirmed by Diffusion Tensor MRI and Histological Validation.
Kung GL, Nguyen TC, Itoh A, Skare S, Ingels NB Jr, Miller DC, Ennis DB.
The purpose of the study is to establish the correspondence between the two histologically observable and diffusion tensor MRI (DTMRI) measurements of myolaminae orientation for the first time and show that single myolaminar orientations observed in local histology may result from histological artifact. DTMRI was performed on six sheep left ventricles (LV), then corresponding direct histological transmural measurements were made within the anterobasal and lateral-equatorial LV. Secondary and tertiary eigenvectors of the diffusion tensor were compared with each of the two locally observable sheet orientations from histology. Diffusion tensor invariants were calculated to compare differences in microstructural diffusive properties between histological locations with one observable sheet population and two observable sheet populations.
November 2011Estimated Radiation Dose Associated With Low-Dose Chest CT of Average-Size Participants in the National Lung Screening Trial.
Larke FJ, Kruger RL, Cagnon CH, Flynn MJ, McNitt-Gray MM, Wu X, Judy PF, Cody DD.
The objective of our study was to determine the distribution of effective dose associated with a single low-dose CT chest examination of average-size participants in the National Lung Screening Trial. Organ doses were also investigated. Thirty-three sites nationwide provided volume CT dose index (CTDIvol) data annually for the 97 MDCT scanners used to image 26,724 participants during the trial. The dose data were representative of the imaging protocols used by the sites for average-size participants. Effective doses were estimated first using the product of the dose-length product (CTDIvol 35-cm scan length) and a published conversion factor, k. The commercial software product CT-Expo was then used to estimate organ doses to males and females from the average CTDIvol. Applying tissue-weighting factors from both publication 60 and the more recent publication 103 of the International Commission on Radiological Protection (ICRP) allowed comparisons of effective doses to males and to females.
November 2011The National Lung Screening Trial's Endpoint Verification Process: Determining the Cause of Death.
Marcus PM, Gareen IF, Miller AB, Rosenbaum J, Keating K, Aberle DR, Berg CD.
Randomized controlled trials (RCTs) evaluating cancer screening modalities usually employ cause-specific mortality as their primary endpoint. Because death certificate cause of death can be inaccurate, RCTs frequently use review committees to assign an underlying cause of death. We describe the National Lung Screening Trial's (NLST's) death review approach, the Endpoint Verification Process (EVP), which strives to minimize errors in assignment of cause of death due to lung cancer. Deaths selected for review include those with a notation of lung cancer on the death certificate and those occurring among participants ever diagnosed with lung cancer. Other criteria that trigger death review include, but are not limited to, death within 6months of a screen suspicious for lung cancer and death within 60days of certain diagnostic evaluation procedures associated with a screen suspicious for lung cancer or a lung cancer diagnosis. EVP requires concordance on whether death was due to lung cancer. Deaths are first reviewed by the EVP chair. If concordance is not achieved, the death is next reviewed by an Endpoint Verification Team (EVT) member. If concordance between the chair- and member-assigned cause of death is not achieved, the death is next reviewed by a group of at least three EVT members. Cause of death is assigned at the step in which concordance was achieved, or if necessary, at the team review.
November 2011Benign Bone Tumors
Motamedi K, Seeger LL.
A solid knowledge of underlying histopathology of benign bone tumors aids in differential diagnoses of these tumors. Important factors in diagnosis of a bone tumor include patient age and gender; the bone involved; the location of the tumor along, within, or on the bone; lesion margin; matrix proliferation; and periosteal reaction. This article provides a review of the origin of the tumor matrix and its influence on the imaging properties of these tumors.
November 2011Effect of Time to Reperfusion on Clinical Outcome of Anterior Circulation Strokes Treated With Thrombectomy: Pooled Analysis of the MERCI and Multi MERCI Trials.
Nogueira RG, Smith WS, Sung G, Duckwiler G, Walker G, Roberts R, Saver JL, Liebeskind DS; on Behalf of the MERCI and Multi MERCI Writing Committee.
Previous studies have demonstrated a strong correlation between treatment time and outcomes after intravenous recombinant tissue-type plasminogen activator. However, the temporal profile of ischemia may vary according to the level of occlusion, and it is likely that more proximal occlusions have a more variable temporal course than their distal counterparts. We sought to establish how time influences outcomes in anterior circulation proximal arterial occlusions. All patients from the MERCI/Multi MERCI trials with intracranial internal carotid artery and/or middle cerebral artery (M1-M2 segments) occlusions who were successfully revascularized were included in univariate / multivariate analyses to define the predictors of independent functional outcomes (modified Rankin Scale score 2) and mortality at 90 days. The effect of time to reperfusion on outcomes was calculated after adjustment for age, baseline National Institutes of Health Stroke Scale, and glucose levels.
Oct 2011Graded Functional Diffusion Map-Defined Characteristics of Apparent Diffusion Coefficients Predict Overall Survival in Recurrent Glioblastoma Treated with Bevacizumab.
Ellingson BM, Cloughesy TF, Lai A, Mischel PS, Nghiemphu PL, Lalezari S, Schmainda KM, Pope WB.
Diffusion imaging has shown promise as a predictive and prognostic biomarker in glioma. We assessed the ability of graded functional diffusion maps (fDMs) and apparent diffusion coefficient (ADC) characteristics to predict overall survival (OS) in recurrent glioblastoma multiforme (GBM) patients treated with bevacizumab. Seventy-seven patients with recurrent GBMs were retrospectively examined. MRI scans were obtained before and approximately 6 weeks after treatment with bevacizumab. Graded fDMs were created by registering datasets to each patient's pretreatment scan and then performing voxel-wise subtraction between post- and pretreatment ADC maps. Voxels were categorized according to the degree of change in ADC within pretreatment fluid-attenuated inversion recovery (FLAIR) and contrast-enhancing regions of interest (ROIs). We found that the volume of tissue showing decreased ADC within both FLAIR and contrast-enhancing regions stratified OS (log-rank, P < .05). fDMs applied to contrast-enhancing ROIs more accurately predicted OS compared with fDMs applied to FLAIR ROIs. Graded fDMs (showing voxels with decreased ADC between 0.25 and 0.4 μm2/ms) were more predictive of OS than traditional (single threshold) fDMs, and the predictive ability of graded fDMs could be enhanced even further by adding the ADC characteristics from the fDM-classified voxels to the analysis (log-rank, P < .001). These results demonstrate that spatially resolved diffusion-based tumor metrics are a powerful imaging biomarker of survival in patients with recurrent GBM treated with bevacizumab.
Oct 2011Cell Invasion, Motility, and Proliferation Level Estimate (CIMPLE) Maps Derived from Serial Diffusion MR Images in Recurrent Glioblastoma Treated with Bevacizumab.
Ellingson BM, Cloughesy TF, Lai A, Nghiemphu PL, Pope WB.
Microscopic invasion of tumor cells and undetected tumor proliferation is the primary reason for a dismal prognosis in glioblastoma patients. Identification and quantification of spatially localized brain regions undergoing high rates of cell migration and proliferation is critical for improving patient survival; however, there are currently no non-invasive imaging biomarkers for estimating proliferation and migration rates of human gliomas in vivo. To accomplish this, we developed CIMPLE (cell invasion, motility, and proliferation level estimates) image maps using serial diffusion MRI scans and a solution to a glioma growth model equation. CIMPLE represent a novel method of quantifying the level of aggressive malignant behavior. In the current pilot study, we demonstrate the utility of CIMPLE maps to predict progression free survival (PFS) and overall survival (OS) in 26 recurrent glioblastoma patients treated with bevacizumab from our Neuro-Oncology database. Voxel-wise estimates of cell proliferation rate predicted spatial regions of contrast enhancement in 35% of patients. A linear correlation was found between the mean proliferation rate and progression-free survival (PFS; P < 0.0001) as well as overall survival (OS; P = 0.0093). Similarly, the mean proliferation rate was able to stratify patients with early and late PFS as well as OS.
October 2011Pineocytoma with Diffuse Dissemination to the Leptomeninges.
Gomez C, Wu J, Pope W, Vinters H, Desalles A, Selch M.
Pineal parenchymal tumors are rare. Of the three types of pineal parenchymal tumors, pineocytomas are the least aggressive and are not known to diffusely disseminate. In this paper, we report the successful treatment of a case of pineocytoma with diffuse leptomeningeal relapse following initial stereotactic radiotherapy. A 39-year-old female presented with headaches, balance impairment, urinary incontinence, and blunted affect. A pineal mass was discovered on magnetic resonance imaging (MRI). A diagnosis of pineocytoma was established with an endoscopic pineal gland biopsy, and the patient received stereotactic radiotherapy. Ten years later, she developed diffuse leptomeningeal dissemination. The patient was then successfully treated with craniospinal radiation therapy. Leptomeningeal spread may develop as late as 10 years after initial presentation of pineocytoma. Our case demonstrates the importance of long-term follow-up of patients with pineal parenchymal tumors following radiation therapy, and the efficacy of craniospinal radiation in the treatment of leptomeningeal dissemination.
October 2011Clinical Course of Lung Physiology in Patients with Scleroderma and Interstitial Lung Disease: Analysis of the Scleroderma Lung Study Placebo Group.
Khanna D, Tseng CH, Farmani N, Steen V, Furst DE, Clements PJ, Roth MD, Goldin J, Elashoff R, Seibold JR, Saggar R, Tashkin DP.
Patients with systemic sclerosisassociated interstitial lung disease (SSc-ILD) are thought to have the greatest decline in lung function (forced vital capacity [FVC] % predicted) in the early years after disease onset. The aim of this study was to assess the natural history of the decline in FVC % predicted in patients receiving placebo in the Scleroderma Lung Study and to evaluate possible factors for cohort enrichment in future therapeutic trials. Patients randomized to receive placebo (n = 79) were divided into 3 groups based on the duration of SSc (02 years, 24 years, and >4 years). Descriptive statistics and a mixed-effects model were used to analyze the rate of decline in the FVC % predicted over a 1-year period. Additional analyses stratified according to the severity of fibrosis on high-resolution computed tomography (HRCT) were performed, and interactions between disease severity and disease duration were explored.
October 2011Next Generation Radiologic-Pathologic Correlation in Oncology: Rad-Path 2.0
Kuo MD, Yamamoto S.
The bedrock of radiology has been radiologic-pathologic (Rad-Path) correlation: the correlation of imaging to ex vivo gross and histopathologic findings of disease. This classical view is being challenged by our increasing understanding of the molecular basis of disease, particularly in oncology. The traditional lines in diagnostic sciences have blurred with the development of new in vitro diagnostic molecular assays and molecular imaging methods as well as the growing evidence that conventional diagnostic imaging has potential use in understanding genomic properties of disease. The purpose of this article is to make the case for a fundamental shift to the next generation of Rad-Path correlation (Rad-Path 2.0).
October 2011Position Statement by the Society of Interventional Radiology: Maintenance of Privileges for Image-Guided Interventions.
Murphy TP, Kuo MD, Benenati JF, Dixon RG, Goodwin SC, Hicks M, Miller DL, Sidhu MK, Silberzweig JE, Vedantham S, Cardella JF.
This credentialing document pertains to maintenance of noncoronary percutaneous interventional procedures privileges in the hospital setting. Safe and efficacious delivery of these services requires p...
October 2011Low Dose CE-MRA.
Nael K, Moriarty JM, Finn JP.
Over the last decade, three-dimensional contrast-enhanced magnetic resonance angiography (CE-MRA) has emerged as a widely accepted and powerful technique for diagnostic assessment of almost all vascular territories. Its non-invasive nature and lack of ionizing radiation, its potential to cover a large field of view and the safety of gadolinium-based contrast agents make CE-MRA an appealing alternative to digital subtraction angiography (DSA) or computed tomography angiography (CTA). However, recent reports linking high dose gadolinium-based contrast agents to the development of nephrogenic systemic fibrosis have raised concerns over the safety of CE-MRA. As a result, many investigators have focused attention on gadolinium dose reduction strategies . This article reviews existing state-of-the-art 3D CE-MRA strategies to reduce contrast dose and summarizes current applications and clinical experience to date. It also highlights evolving techniques, which the authors feel are likely to enhance the future impact of CE-MRA.
October 2011Wall Shear Stress Distribution Inside Growing Cerebral Aneurysm
Tanoue T, Tateshima S, Villablanca JP, Viñuela F, Tanishita K.
Hemodynamic stimulation has been suggested to affect the growth of cerebral aneurysms. The present study examined the effects of intra-aneurysmal hemodynamics on aneurysm growth. Velocity profiles were measured for 2 cases of AcomA aneurysms. Realistically shaped models of these aneurysms were constructed, based on CT angiograms. Flow fields and WSS in the models were measured by using particle image velocimetry and LDV. In 1 case, hemodynamic changes were observed in 4 stages of growth over a 27-month period, whereas no development was observed in the other case.
September 2011Variant Carotid Origin of Left Anterior Inferior Cerebellar Artery Mimicking Infarct on Angiography.
Bykowski J, Jahan R, Pakbaz RS.
A case is presented of a rare anterior inferior cerebellar artery variant, originating from the internal carotid artery. This mimicked a cerebellar infarct on vertebral angiography of a patient who presented with dysmetria and gait imbalance. It is important for the neuroradiologist and neurointerventionist to be aware of common and unusual cerebellar arterial anatomic variants to avoid incorrect diagnoses, as well as understand possible implications for surgery and interventional therapies.
September 2011Risk of Nephrogenic Systemic Fibrosis in Liver Transplantation Patients.
Chow DS, Bahrami S, Raman SS, Rotchel S, Sayre JW, Busuttil RW, Lu DS.
The purpose of our study was to evaluate the exposure of our institution's liver transplantation population to gadolinium-based contrast agents and assess the rate of nephrogenic systemic fibrosis (NSF) within this unique group. Institutional review board approval was obtained for a retrospective review of medical records of patients who had undergone liver transplantation at our institution between 1997 and 2008. Informed consent was not required. Demographic information, history of gadolinium-based contrast agent exposure, stage of chronic kidney disease (CKD), and evidence of NSF were recorded.
September 2011Our Specialty's Heritage.
Hirsch J, Tarr R, Duckwiler G, Prestigiacomo CJ.
Interventional neuroradiology, endovascular surgical neuro- radiology or, its present preferred name, neurointerventional surgery, has a rich, albeit a somewhat brief history. The field's colorful past and its relative youth are made obvious by the very name of the field itself, for it has been, and continues to be, called..
September 2011Lung Cancer Screening with Low-Dose Helical CT: Results from the National Lung Screening Trial (NLST).
Kramer BS, Berg CD, Aberle DR, Prorok PC.
After long debate about the worth of screening for lung cancer, and even about the merits of doing a randomized trial to address the issue, initial results from the first large-scale randomized controlled trial ever to show a reduction in lung cancer mortality associated with screening were announced to the public last November 4.1 The story behind this historical first is informative, and the editor of the Journal of Medical Screening played a role in that story. But more of that later.
September 2011Abandoned Pacemaker Leads Are a Potential Risk for Patients Undergoing MRI
Langman DA, Finn JP, Ennis DB.
For patients with implanted cardiac pacemakers, magnetic resonance imaging (MRI) has been contraindicated since 1983 when concerns about harmful MRI-pacemaker interactions were first described.1 The number of patients with pacemakers and implantable cardiac defibrillators (ICD) continues to grow rapidly, and because of safety concerns, these patients are denied potentially crucial diagnostic imaging tests. This research will help in the development of objective guidelines on the risks of scanning patients with abandoned pacemaker leads.
September 2011High Plasma Leptin Levels Confer Increased Risk of Atherosclerosis in Women with Systemic Lupus Erythematosus, and are Associated with Inflammatory Oxidised Lipids.
McMahon M, Skaggs BJ, Sahakian L, Grossman J, Fitzgerald J, Ragavendra N, Charles-Schoeman C, Chernishof M, Gorn A, Witztum JL, Wong WK, Weisman M, Wallace DJ, La Cava A, Hahn BH.
The objective of this study is to examine the association between these adipokines and subclinical atherosclerosis in SLE, and also with other known inflammatory biomarkers of atherosclerosis. Carotid ultrasonography was performed in 250 women with SLE and 122 controls. Plasma leptin and adiponectin levels were measured. Lipoprotein a (Lp(a)), oxidised phospholipids on apoB100 (OxPL/apoB100), paraoxonase, apoA-1 and inflammatory high-density lipoprotein (HDL) function were also assessed.
September 2011Predicting Treatment Outcomes and Responder Subsets in Scleroderma-Related Interstitial Lung Disease.
Roth MD, Tseng CH, Clements PJ, Furst DE, Tashkin DP, Goldin JG, Khanna D, Kleerup EC, Li N, Elashoff D, Elashoff RM; Scleroderma Lung Study Research Group.
The objective of this study is to identify baseline characteristics of patients with scleroderma-related interstitial lung disease (SSc-ILD) that could serve as predictors of the most favorable response to 12-month treatment with oral cyclophosphamide (CYC). Regression analyses were retrospectively applied to the Scleroderma Lung Study data in order to identify baseline characteristics that correlated with the absolute change in forced vital capacity (FVC) (% predicted values) and the placebo-adjusted change in % predicted FVC over time (the CYC treatment effect).
September 2011Detection and Grading of Esophageal Varices on Liver CT: Comparison of Standard and Thin-Section Multiplanar Reconstructions in Diagnostic Accuracy.
Yu NC, Margolis D, Hsu M, Raman SS, Lu DS.
The objective of our study was to evaluate the performance of liver CT in the diagnosis of esophageal varices in patients with cirrhosis and to determine whether thin-section multiplanar reconstructions (MPRs) improve accuracy. We identified 109 patients with cirrhosis who underwent endoscopy within 10 weeks after dual-phase liver MDCT supplemented with thin-section axial and coronal portal venous phase reconstructions. Two blinded radiologists independently evaluated each CT examination for the presence and sizes of varices using standard 5-mm axial versus 1- to 3-mm multiplanar images in separate sessions. Sensitivity, specificity, and predictive value calculations and receiver operating characteristic analysis were performed using endoscopy as the reference standard. Interobserver variability and correlation of CT size to variceal grade were assessed.
August 20113D Quantitative Evaluation of Atherosclerotic Plaque Based on Rotational Angiography.
Chien A, Sayre J, Dong B, Ye J, Viñuela F.
Atherosclerosis is a systemic disease that has been shown to cause various cardiovascular diseases and stroke. However, technologies to evaluate the volume of atherosclerotic plaque are limited. We present a method for determination of 3D plaque volume based on RA. 3DRA images obtained from patients were used to evaluate the plaque. Six patients who were diagnosed with atherosclerotic lesions were included. The PR model developed for 3DRA was applied to analyze the geometry of the vessel and calculate the plaque volume. To validate the present method, we tested computer-generated phantoms with different degrees of stenosis.
August 2011High Order Diffusion Tensor Imaging in Human Glioblastoma
Ellingson BM, Cloughesy TF, Lai A, Nghiemphu PL, Liau LM, Pope WB.
Diffusion tensor imaging has been used to characterize tumor heterogeneity and invasion in human glioblastoma. Recently, higher order diffusion tensors have been proposed as solutions to errors associated with diffusion tensor imaging estimates of complex microstructures. The purpose of the current study was to examine higher order diffusion characteristics in human glioblastoma prior to surgical resection using the fourth-order diffusion tensor model. Twenty-five patients with newly diagnosed glioblastoma participated in the study. Diffusion-weighted images were collected in 21 directions. The second-order (traditional) and fourth-order diffusion tensors were calculated and compared in regions of contrast enhancement, T2 signal abnormality, and normal-appearing white matter.
August 2011The Cardiac Atlas Projectan Imaging Database for Computational Modeling and Statistical Atlases of the Heart
Fonseca CG, Backhaus M, Bluemke DA, Britten RD, Chung JD, Cowan BR, Dinov ID, Finn JP, Hunter PJ, Kadish AH, Lee DC, Lima JA, Medrano-Gracia P, Shivkumar K, Suinesiaputra A, Tao W, Young AA.
Integrative mathematical and statistical models of cardiac anatomy and physiology can play a vital role in understanding cardiac disease phenotype and planning therapeutic strategies. However, the accuracy and predictive power of such models is dependent upon the breadth and depth of noninvasive imaging datasets. The Cardiac Atlas Project (CAP) has established a large-scale database of cardiac imaging examinations and associated clinical data in order to develop a shareable, web-accessible, structural and functional atlas of the normal and pathological heart for clinical, research and educational purposes. A goal of CAP is to facilitate collaborative statistical analysis of regional heart shape and wall motion and characterize cardiac function among and within population groups.
August 2011Comparison of Plasmin With Recombinant Tissue-Type Plasminogen Activator in Lysis of Cerebral Thromboemboli Retrieved From Patients With Acute Ischemic Stroke
Marder VJ, Blinc A, Gruber T, Tratar G, Sabovic M, Starkman S, Jahan R, Duckwiler G, Viñuela F, Tateshima S, Liebeskind D, Ovbiagele B, Ali L, Kim D, Gonzalez N, Vespa PM, Saver JL.
Plasmin is a direct-acting thrombolytic with a better safety profile than recombinant tissue-type plasminogen activator (rtPA) in animal models. With the application of retrieval devices for managing acute ischemic stroke, extracted thromboemboli are available for ex vivo examination. We ask whether such thrombi are amenable to plasmin thrombolysis and whether such activity is different with rtPA. Thromboembolic fragments (total 29) were retrieved from the intracranial carotid artery system of 15 patients with acute ischemic stroke and randomly assigned to ex vivo thrombolysis with plasmin or rtPA. After an initial 2-hour exposure, residual material was exposed to the other agent for an additional 2 hours. Thrombolysis was quantified by change in thrombus area and released d-dimer.
August 2011Prophylactic Embolization of the Cystic Artery Before Radioembolization: Feasibility, Safety, and Outcomes
McWilliams JP, Kee ST, Loh CT, Lee EW, Liu DM.
The purpose of this study is to evaluate the safety and efficacy of two different methods of proximal cystic artery embolization in patients undergoing yttrium-90 radioembolization. Forty-six patients had cystic artery embolization performed immediately before yttrium-90 radioembolization, either by using Gelfoam pledgets (n = 35) or coils (n = 11). Clinical symptomatology during the admission and angiographic findings at 1-month follow-up were retrospectively reviewed. Rates of collateralization or recanalization of the cystic artery were compared, as well as the frequency of postprocedural abdominal pain and need for cholecystectomy.
August 2011Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening
National Lung Screening Trial Research Team, Aberle DR, Adams AM, Berg CD, Black WC, Clapp JD, Fagerstrom RM, Gareen IF, Gatsonis C, Marcus PM, Sicks JD.
The National Lung Screening Trial (NLST) was conducted to determine whether screening with low-dose CT could reduce mortality from lung cancer. From August 2002 through April 2004, we enrolled 53,454 persons at high risk for lung cancer at 33 U.S. medical centers. Participants were randomly assigned to undergo three annual screenings with either low-dose CT (26,722 participants) or single-view posteroanterior chest radiography (26,732). Data were collected on cases of lung cancer and deaths from lung cancer that occurred through December 31, 2009...
August 2011Revisiting CT-Guided Percutaneous Core Needle Biopsy of Musculoskeletal Lesions: Contributors to Biopsy Success.
Omura MC, Motamedi K, Uybico S, Nelson SD, Seeger LL.
The purpose of this article is to investigate potential technical, imaging, and histopathologic contributors to the success of CT biopsy. 444 consecutive CT biopsies of musculoskeletal lesions performed from 2005 to 2008 were retrospectively classified as diagnostic or nondiagnostic and as accurate or inaccurate. A biopsy was considered as diagnostic if it provided a definitive pathologic diagnosis or was clinically useful; as accurate if it was concordant with the ultimate diagnosis with respect to identification of malignancy, grade, and histopathologic features; and as successful if it was both diagnostic and accurate. Biopsy success rate, diagnostic yield, and accuracy were assessed according to lesion location, use of sedation, biopsy equipment type, bone lesion matrix type, and lesion histologic type (i.e., bone or soft-tissue origin, malignant or benign neoplasm, and lowor intermediate-to-high-grade neoplasm).
August 2011Initial Results on Development and Application of Statistical Atlas of Femoral Cartilage in Osteoarthritis to Determine Sex Differences in Structure: Data from the Osteoarthritis Initiative
Tameem HZ, Ardekani S, Seeger L, Thompson P, Sinha US.
The purpose of this study is to create an average atlas of knee femoral cartilage morphology, to apply the atlas for quantitative assessment of osteoarthritis (OA), and to study localized sex differences. High-resolution 3D magnetic resonance imaging (MRI) data of the knee cartilage collected at 3 T as part of the Osteoarthritis Initiative (OAI) were used. An atlas was created based on images from 30 male Caucasian high-risk subjects with no symptomatic OA at baseline. A female cohort of age- and disease-matched Caucasian subjects was also selected from the OAI database. The Jacobian determinant was calculated from the deformation vector fields that nonlinearly registered each subject to the atlas. Statistical analysis based on the general linear model was used to test for regions of significant differences in the Jacobian values between the two cohorts.
July 2011Breast Imaging Training and Attitudes: Update Survey of Senior Radiology Residents
Bassett LW, Bent C, Sayre JW, Marzan R, Verma A, Porter C.
The purpose of this study was to investigate the training and attitudes of senior residents regarding breast imaging. In 2008 a follow-up survey was completed by a chief or senior resident at 201 radiology training programs in North America. Questions included organization of breast imaging rotation, resident responsibilities, clinical practice protocols at the institution, resident impressions regarding breast imaging, and resident interest in performing breast imaging after residency. Results were compared with those of a survey completed in 2000.
July 2011Use of BI-RADS 3-Probably Benign Category in the American College of Radiology Imaging Network Digital Mammographic Imaging Screening Trial
Baum JK, Hanna LG, Acharyya S, Mahoney MC, Conant EF, Bassett LW, Pisano ED.
The purpose of this study was to determine (a) how often the Breast Imaging Reporting and Data System (BI-RADS) category 3 was used in the American College of Radiology Imaging Network (ACRIN) Digital Mammographic Imaging Screening Trial (DMIST), either at the time of screening mammography or after work-up, (b) how often subjects actually returned for the recommended follow-up examination, and (c) the rate and stages of any malignancies subsequently found in subjects for whom short-term interval follow-up was recommended. A total of 47599 DMIST-eligible and evaluable subjects, all of whom consented to undergo both digital and screen-film mammography, were included in this analysis. Cases referred for short-term interval follow-up based on digital, screen-film, or both imaging examinations were determined. Compliance with the recommendations and the final outcome (malignancy diagnosis at biopsy or no malignancy confirmed through follow-up) of each evaluable case were determined.
July 2011Mammographic Signs of Systemic Disease
Cao MM, Hoyt AC, Bassett LW.
Although mammography is primarily used for the detection of breast cancer, it can occasionally reveal breast abnormalities related to extramammary disease. Knowledge of the imaging characteristics of various systemic diseases affecting the breast will aid the radiologist in differentiating systemic disease from suspect breast lesions, thereby helping ensure appropriate follow-up. Furthermore, recognition of systemic diseases such as Cowden syndrome that are associated with an increased risk of breast cancer will allow the radiologist to recommend appropriate surveillance.
July 2011Lung Cancer Chemoprevention with Celecoxib in Former Smokers
Mao JT, Roth MD, Fishbein MC, Aberle DR, Zhang ZF, Rao JY, Tashkin DP, Goodglick L, Holmes EC, Cameron RB, Dubinett SM, Elashoff R, Szabo E, Elashoff D.
Ample studies suggest that the cyclooxygenase-2 (COX-2) / prostaglandin E2 (PGE2) pathway plays a pivotal role in carcinogenesis and that COX-2 inhibition may help prevent lung cancer. Therefore, we conducted a randomized, double-blind, placebo-controlled trial of the COX-2selective inhibitor celecoxib (400 mg bid for 6 months) in former-smokers (age 45, 30 pack-years of smoking, 1 year of sustained abstinence from smoking). We assessed the impact of celecoxib on cellular and molecular events associated with lung cancer pathogenesis; the primary endpoint was bronchial Ki-67 labeling index (Ki-67 LI) after 6 months of treatment. Of 137 randomized subjects, 101 completed both baseline and 6-month bronchoscopies and were evaluable for the primary endpoint analysis.
July 2011Role of Endorectal Magnetic Resonance Spectroscopic Imaging in Two Different Gleason Scores in Prostate Cancer
Nagarajan R, Margolis D, McClure T, Raman S, Thomas MA.
The major goal of the work was to record three-dimensional magnetic resonance spectroscopic imaging (MRSI) and to compare metabolite ratios between different Gleason scores (GS). Materials and Methods: MRSI localized by endorectal coil-acquired point-resolved spectroscopy was performed in 14 men with prostate cancer of GS 6 (n = 7) and 7 (n = 7) using a 1.5-tesla MRI scanner.
July 2011Characterization of Myocardial Scars: Electrophysiological Imaging Correlates in a Porcine Infarct Model
Nakahara S, Vaseghi M, Ramirez RJ, Fonseca CG, Lai CK, Finn JP, Mahajan A, Boyle NG, Shivkumar K.
The purpose of this study was to verify the anatomic location and heterogeneity of scars as obtained by electroanatomic mapping with contrast-enhanced MRI (CeMRI) and histo- pathology, and to characterize the distribution of late potentials in a chronic porcine infarct model. In vivo 3-dimensional cardiac CeMRI was performed in 5 infarcted porcine hearts. High-density electroanatomic mapping was used to generate epicardial and endocardial voltage maps. Scar surface area and position on CeMRI were then correlated with voltage maps. Locations of late potentials were subsequently identified. These were classified according to their duration and fractionation. All hearts underwent histopathological examination after mapping.
July 2011Leukoaraiosis and Collaterals in Acute Ischemic Stroke
Sanossian N, Ovbiagele B, Saver JL, Alger JR, Starkman S, Kim D, Ohanian AG, Buck BH, Ali LK, Duckwiler GR, Jahan R, Viñuela F, Liebeskind DS.
We examined the correlation of angiographic collaterals in acute stroke with the presence, extent, and distribution of white matter changes, so-called Leukoaraiosis, in an effort to determine if Leukoaraiosis indicates chronic cerebral hypo- perfusion and/or is associated with the development of cerebral collateral circulation. Consecutive acute strokes due to large-vessel occlusion on angiography had preprocedure CT or MRI white matter changes graded utilizing the Fazekas scale incorporating deep and periventricular components. Angiographic collaterals evaluated with a 5-point scale were correlated with leukoaraiosis.
June 2011Gender and Iron Genes May Modify Associations Between Brain Iron and Memory in Healthy Aging.
Bartzokis G, Lu PH, Tingus K, Peters DG, Amar CP, Tishler TA, Finn JP, Villablanca P, Altshuler LL, Mintz J, Neely E, Connor JR.
Brain iron increases with age and is abnormally elevated early in the disease process in several neurodegenerative disorders that impact memory including Alzheimer's disease (AD). Higher brain iron levels are associated with male gender and presence of highly prevalent allelic variants in genes encoding for iron metabolism proteins (hemochromatosis H63D (HFE H63D) and transferrin C2 (TfC2)). In this study, we examined whether in healthy older individuals memory performance is associated with increased brain iron, and whether gender and gene variant carrier (IRON+) vs noncarrier (IRON) status (for HFE H63D/TfC2) modify the associations.
June 2011Indications for Cardiac Catheterization and Intervention in Pediatric Cardiac Disease: a Scientific Statement from the American Heart Association.
Feltes TF, Bacha E, Beekman RH 3rd, Cheatham JP, Feinstein JA, Gomes AS, Hijazi ZM, Ing FF, de Moor M, Morrow WR, Mullins CE, Taubert KA, Zahn EM; on behalf of the American Heart Association Congenital Cardiac Defects Committee of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, and Council on Cardiovascular Radiology and Intervention.
The objective of the present writing group, which included representatives of the AHA and endorsements from the Society for Cardiovascular Angiography and Interventions and the American Academy of Pediatrics, was not only to provide the reader with an inventory of diagnostic catheterization and interventional treatment options but also to critically review the literature and formulate relative recommendations that are based on key opinion leader expertise and level of evidence. The writing group was charged with the task of performing an assessment of the evidence and giving a classification of recommendations and a level of evidence to each recommendation.
June 2011The Reliability and Validity of Three Non-Radiological Measures of Thoracic Kyphosis and Their Relations to the Standing Radiological Cobb Angle.
Greendale GA, Nili NS, Huang MH, Seeger L, Karlamangla AS.
The objective of this study is to describe the reliability of three non-radiological kyphosis measures (Debrunner kyphosis angle, flexicurve kyphosis index, and flexicurve kyphosis angle) and their validity compared to the Cobb angle and to approximate a Cobb angle from non-radiological kyphosis measures. We analyzed data from 113 participants aged 60 years with kyphosis angle 40. Cobb angle was measured on a standing lateral thoracolumbar radiograph using bounds at T4 and T12. Non-radiological measures of kyphosis were made three times by a single rater and a 4th time by a blinded second rater.
June 2011Computational Hemodynamics Framework for the Analysis of Cerebral Aneurysms.
Mut F, Lhner R, Chien A, Tateshima S, Viñuela F, Putman C, Cebral J.
This paper describes a computational framework to study and characterize the hemodynamic environment of cerebral aneurysms in order to relate it to clinical events, such as growth or rupture. In particular, a number of hemodynamic quantities are proposed to describe the most salient features of these hemodynamic environments.
June 2011Clinical Application of a 3D Ultrasound-Guided Prostate Biopsy System
Natarajan S, Marks LS, Margolis DJ, Huang J, Macairan ML, Lieu P, Fenster A.
Prostate biopsy (Bx) has for 3 decades been performed in a systematic, but blind fashion using 2D ultrasound (US). Herein is described the initial clinical evaluation of a 3D Bx tracking and targeting device (Artemis; Eigen, Grass Valley, CA). Our main objective was to test accuracy of the new 3D method in men undergoing first and follow-up Bx to rule out prostate cancer (CaP). Patients in the study were men ages 35-87 years (66.1 ± 9.9), scheduled for Bx to rule out CaP, who entered into an IRB-approved protocol. A total of 218 subjects underwent conventional trans-rectal US (TRUS); the tracking system was then attached to the US probe; the prostate was scanned and a 3D reconstruction was created. All Bx sites were visualized in 3D and tracked electronically. In 11 men, a pilot study was conducted to test ability of the device to return a Bx to an original site. In 47 men, multi-parametric 3 Tesla MRI, incorporating T2-weighted images, dynamic contrast enhancement, and diffusion-weighted imaging, was performed in advance of the TRUS, allowing the stored MRI images to be fused with real-time US during biopsy. Lesions on MRI were delineated by a radiologist, assigned a grade of CaP suspicion, and fused into TRUS for biopsy targeting.
June 2011Advances in MRI Assessment of Gliomas and Response to Anti-VEGF Therapy
Pope WB, Young JR, Ellingson BM.
Bevacizumab is thought to normalize tumor vasculature and restore the blood-brain barrier, decreasing enhancement and peritumoral edema. Conventional measurements of tumor response rely upon dimensions of enhancing tumor. After bevacizumab treatment, glioblastomas are more prone to progress as nonenhancing tumor. The RANO (Response Assessment in Neuro-Oncology) criteria for glioma response use fluid-attenuated inversion recovery (FLAIR)/T2 hyperintensity as a surrogate for nonenhancing tumor; however, nonenhancing tumor can be difficult to differentiate from other causes of FLAIR/T2 hyperintensity (eg, radiation-induced gliosis). Due to these difficulties, recent efforts have been directed toward identifying new biomarkers that either predict treatment response or accurately measure response of both enhancing and nonenhancing tumor shortly after treatment initiation. This will allow for earlier treatment decisions, saving patients from the adverse effects of ineffective therapies while allowing them to try alternative therapies sooner. An active area of research is the use of physiologic imaging, which can potentially detect treatment effects before changes in tumor size are evident. The goals of this article are to review current criteria for glioma response and to discuss new MRI techniques that may provide potential biomarkers of treatment effect.
June 2011Pro-Inflammatory Cytokines are Raised in Extrahepatic Portal Venous Obstruction, with Minimal Hepatic Encephalopathy
Srivastava A, Yadav SK, Yachha SK, Thomas MA, Saraswat VA, Gupta RK.
Minimal hepatic encephalopathy (MHE) and hyperammonemia are seen in patients with extrahepatic portal venous obstruction (EHPVO). Inflammation has been shown to play an important role in the pathogenesis of hepatic encephalopathy in cirrhotics. This study assessed serum pro-inflammatory cytokines and their correlation with hyperammonemia, H-magnetic resonance (MR) spectroscopy-derived brain glutamine, and diffusion tensor imaging (DTI)-derived metrics in patients with EPHVO, with and without MHE. Neuropsychological tests, DTI, 1H-MR spec- troscopy, and estimation of blood ammonia, pro-inflammatory cytokines (tumor necrosis factor-[TNF-], and interleukin-6 [IL-6]) were done in 20 patients with EHPVO and eight healthy controls.
May 2011Evaluation of Expanded Polytetrafluoroethylene-Covered Stents for the Treatment of Venous Outflow Stenosis in Hemodialysis Access Grafts
Chan MG, Miller FJ, Valji K, Kuo MD.
The purpose of this study is to investigate the use of an expanded polytetrafluoroethylenecoated nitinol stent-graft in patients with failing hemodialysis access circuits and compare grafts with and without a heparin-coated surface. A single-institution retrospective review of 16 patients (average age, 55 years; seven men) treated for hemodialysis access circuit stenoses was performed. Patients had a prosthetic arteriovenous (AV) graft (n = 10) or autogenous AV fistula (n = 6), all with clinically relevant access stenoses that were refractory to angioplasty alone; 10 patients also had access circuit thrombosis at the time of treatment. Stents were placed in the basilic (n = 4), brachial (n = 7), cephalic (n = 4), and femoral (n = 1) veins. Study endpoints included primary treatment area patency, primary circuit patency, primary assisted circuit patency, and secondary circuit patency, followed to a maximum of 6 months.
May 2011The New Staging System for Lung Cancer: Imaging and Clinical Implications.
Greaves SM, Brown K, Garon EB, Garon BL.
Accurate staging of lung cancer is necessary to describe and communicate disease extent, predict prognosis, determine therapy, and evaluate the results of clinical trials. The Union Internationale Contre le Cancer and the American Joint Committee on Cancer published the seventh edition of tumor, node, and metastasis in lung cancer in 2009. Changes to the sixth edition have been based on the analysis of a large database of patients with lung cancer by the International Staging Committee of the International Association for the Study of Lung Cancer. This study reviews the new seventh edition of the tumor, node, and metastasis lung cancer staging system and discusses the radiologic and therapeutic implications.
May 2011ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompetent Patients.
Kirsch J, Ramirez J, Mohammed TL, Amorosa JK, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Macmahon H, Ravenel JG, Saleh AG, Shah RD.
This study reviews the literature on the indications and usefulness of radiologic studies for the evaluation of acute respiratory illness in the immunocompetent patient. The following recommendations are the result of evidence-based consensus by the American College of Radiology Appropriateness Criteria Expert Panel on Thoracic Radiology. Chest radiographs are usually appropriate in (1) patients with positive physical examination or risk factors for pneumonia, (2) for the assessment of complicated pneumonia, or (3) in cases of emerging infections and biological warfare agents such as severe acute respiratory syndrome, H1N1, and anthrax. Computed tomography, although having a more limited role, is usually appropriate (1) in the assessment of complicated pneumonia and (2) in patients with suspected severe acute respiratory syndrome, H1N1, or anthrax and a normal radiograph.
May 2011Radiology Health Services Research: from Imperative to Legislative Mandate
Lee CI, Forman HP
In the era of health care reform, our value-added to patient care, its corresponding level of reimbursement, and the stature of radiology as a specialty will likely be grounded in the scientific evaluation methods of health services research. We need to create more opportunities for training, provide resources and incentives for the brightest candidates to enter this field, and cultivate enriching environments for health services research in all academic radiology departments.
May 2011CT and MRI Early Vessel Signs Reflect Clot Composition in Acute Stroke
Liebeskind DS, Sanossian N, Yong WH, Starkman S, Tsang MP, Moya AL, Zheng DD, Abolian AM, Kim D, Ali LK, Shah SH, Towfighi A, Ovbiagele B, Kidwell CS, Tateshima S, Jahan R, Duckwiler GR, Viñuela F, Salamon N, Villablanca JP, Vinters HV, Marder VJ, Saver JL.
The purpose of this study was to provide the first correlative study of the hyperdense middle cerebral artery sign (HMCAS) and gradient-echo MRI blooming artifact (BA) with pathology of retrieved thrombi in acute ischemic stroke.
May 2011Response Assessment in Neuro-Oncology Criteria: Implementation Challenges in Multicenter Neuro-Oncology Trials
Pope WB, Hessel C.
The RANO criteria and guidelines are a needed advance over the formerly widely adopted Macdonald criteria. This is particularly evident in antiangiogenic therapy for glioblastoma. Some ambiguities in the response criteria pose challenges to applying them consistently and rigorously, particularly in multicenter trials with both investigator and independent review facility assessment of response. Given the rapid changes in treatment strategies, the guidelines are clearly a work in progress, probably requiring more frequent updates in the future. In this editorial, we sought to highlight some challenging areas of response assessment and suggest some added details and modifications that could be incorporated into future guidelines with the hope of improving the standardization of their application.
May 2011Apparent Diffusion Coefficient Histogram Analysis Stratifies Progression-Free Survival in Newly Diagnosed Bevacizumab-Treated Glioblastoma
Pope WB, Lai A, Mehta R, Kim HJ, Qiao J, Young JR, Xue X, Goldin J, Brown MS, Nghiemphu PL, Tran A, Cloughesy TF.
Our aim was to determine if ADC histogram analysis can stratify progression-free and overall survival in patients with newly diagnosed GBM treated "up-front" (ie, before tumor recurrence) with bevacizumab. Up-front bevacizumab-treated and control patients (n = 59 and 62, respectively) with newly diagnosed GBM were analyzed by using an ADC histogram approach based on enhancing tumor. Progression-free and overall survival was determined by using Cox proportional HRs and the Kaplan-Meier method with logrank and Wilcoxon tests.
May 2011Intra-Lymph Node Prime-Boost Vaccination against Melan A and Tyrosinase for the Treatment of Metastatic Melanoma: Results of a Phase 1 Clinical Trial
Ribas A, Weber JS, Chmielowski B, Comin-Anduix B, Lu D, Douek M, Ragavendra N, Raman S, Seja E, Rosario D, Miles S, Diamond DC, Qiu Z, Obrocea M, Bot A.
The goal of this study was to test the safety and activity of a therapeutic vaccine, MKC1106-MT, in patients with metastatic melanoma. MKC1106-MT comprises a plasmid (pMEL-TYR) and two peptides (E-MEL and E-TYR), corresponding to Melan A and tyrosinase, administered by intralymph node injection in a prime-boost sequence. All 18 patients were HLA-A*0201 positive and received a fixed priming dose of plasmid and a low or a high peptide dose. Enumeration of antigen-specific T cells was done prior to and throughout the treatment. Patients who did not exhibit disease progression remained on study and could receive up to eight cycles of treatment.
April 2011Computed Tomography Characteristics of Hepatic and Splenic Abscesses Associated with Melioidosis: A 7-year Study.
Apisarnthanarak P, Thairatananon A, Muangsomboon K, Lu DS, Mundy LM, Apisarnthanarak A.
This study aimed to characterise the CT findings associated with hepatic and splenic melioid abscesses. Patients with CT evidence of hepatic and/or splenic abscesses were retrospectively evaluated for clinical evidence of melioidosis over a 7-year period. After blinded review of the CT characteristics of intra-abdominal abscesses (IAA), we conducted a stratified analysis of patients with and without melioid IAA.
April 2011Influence of Annual Interpretive Volume on Screening Mammography Performance in the United States.
Buist DS, Anderson ML, Haneuse SJ, Sickles EA, Smith RA, Carney PA, Taplin SH, Rosenberg RD, Geller BM, Onega TL, Monsees BS, Bassett LW, Yankaskas BC, Elmore JG, Kerlikowske K, Miglioretti DL.
The purpose of this study is to examine whether U.S. radiologists interpretive volume affects their screening mammography performance. Annual interpretive volume measures were collected for 120 radiologists in the Breast Cancer Surveillance Consortium (BCSC) who interpreted 783965 screening mammograms from 2002 to 2006. Volume measures in 1 year were examined by using multivariate logistic regression relative to screening sensitivity, false-positive rates, and cancer detection rate the next year.
April 2011Impact and Costs of Targeted Recruitment of Minorities to the National Lung Screening Trial.
Duda C, Mahon I, Chen MH, Snyder B, Barr R, Chiles C, Falk R, Fishman EK, Gemmel D, Goldin JG, Brown K, Munden RF, Vydareny K, Aberle DR.
To promote results in the National Lung Screening Trial (NLST) that are generalizable across the entire US population, a subset of NLST sites developed dedicated strategies for minority recruitment. The objectives of this article were to determine the effects of targeted strategies on accruing underrepresented minorities, the participant characteristics as a result of the targeted strategies, and the estimated costs of targeted enrollment.
April 2011Optimizing Radiation Use during Fluoroscopic Procedures: Proceedings from a Multidisciplinary Consensus Panel
Duncan JR, Balter S, Becker GJ, Brady J, Brink JA, Bulas D, Chatfield MB, Choi S, Connolly BL, Dixon RG, Gray JE, Kee ST, Miller DL, Robinson DW, Sands MJ, Schauer DA, Steele JR, Street M, Thornton RH, Wise RA.
Diagnostic and interventional fluoroscopic procedures have dramatically improved patient care. They have helped minimize the need for more invasive surgical procedures and consequently reduced the mor...
April 2011Quantitative Volumetric Analysis of Conventional MRI Response in Recurrent Glioblastoma Treated with Bevacizumab.
Ellingson BM, Cloughesy TF, Lai A, Nghiemphu PL, Mischel PS, Pope WB.
The objective of the study was to quantify the change in contrast-enhancing and fluid-attenuated inversion recovery (FLAIR) signal volume before and after treatment with bevacizumab and to determine whether these early changes were predictive of progression-free survival (PFS) or overall survival (OS). Additionally, we aimed to test whether the ratio of FLAIR volume to contrast-enhancing volume, termed the relative nonenhancing tumor ratio (rNTR), was a significant predictor of PFS and/or OS. In the current study, we retrospectively examined volumetric changes on conventional MRI scans in 84 patients with recurrent glioblastoma multiforme. MRIs were obtained before (mean, 11 days) and after (mean, 42 days) treatment with bevacizumab.
April 2011Spatially Quantifying Microscopic Tumor Invasion and Proliferation Using a Voxel-Wise Solution to a Glioma Growth Model and Serial Diffusion MRI.
Ellingson BM, Laviolette PS, Rand SD, Malkin MG, Connelly JM, Mueller WM, Prost RW, Schmainda KM.
The purpose of this study was to develop a voxel-wise analytical solution to a glioma growth model using serial diffusion MRI. These cell invasion, motility, and proliferation level estimates (CIMPLE maps) provide quantitative estimates of microscopic tumor growth dynamics. After an analytical solution was found, noise simulations were performed to predict the effects that perturbations in apparent diffusion coefficient values and the time between apparent diffusion coefficient map acquisitions would have on the accuracy of CIMPLE maps. CIMPLE maps were then created for 53 patients with gliomas with WHO grades of IIIV. MR spectroscopy estimates of the choline-to-N-acetyl- aspartate ratio were compared to cell proliferation estimates in CIMPLE maps using Pearson's correlation analysis. Median differences in cell proliferation and diffusion rates between WHO grades were compared.
April 2011Regional Left Ventricular Myocardial Dysfunction as a Predictor of Incident Cardiovascular Events MESA (Multi-Ethnic Study of Atherosclerosis)
Yan RT, Bluemke D, Gomes A, Burke G, Shea S, Liu K, Bahrami H, Sinha S, Wu C, Fernandes V, McClelland R, Lima JA.
We sought to examine the prognostic value of subclinical left ventricular (LV) regional myocardial dysfunction (RMD) measured by magnetic resonance imaging (MRI) among asymptomatic individuals. We used MRI to evaluate baseline regional LV myocardial function and prospectively followed a multiethnic (African American, Caucasian, Chinese, and Hispanic) population- based sample of 4,510 men and women without cardiovascular disease for a mean of 4.6 years. Regional myocardial dysfunction was defined as the presence of impaired systolic wall thickening (<10th percentile of segment-specific population distribution) in 2 contiguous LV segments within any given coronary artery territory.
March 2011Can the Reparability of Meniscal Tears be Predicted with Magnetic Resonance Imaging?
Bernthal NM, Seeger LL, Motamedi K, Stavrakis AI, Kremen TJ, McAllister DR, Motamedi AR.
BACKGROUND: Historically, magnetic resonance imaging (MRI) has been very useful in diagnosing meniscal tears but not as valuable in predicting whether a meniscal tear is reparable. Given that several recent studies suggested that MRI can be used to predict tear reparability, the topic has resurfaced as a controversy in the orthopaedic and radiology literatures. HYPOTHESIS: Experienced musculoskeletal radiologists can use MRI to predict the reparability of meniscal tears with good to excellent accuracy using the same arthroscopic criteria used by surgeons intraoperatively. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Fifty-eight patients with meniscal tears treated with repair were matched by age and sex with 61 patients with tears treated with meniscectomy. Two senior musculoskeletal radiologists independently and blindly reviewed preoperative MRI of these 119 meniscal tears. Using established arthroscopic criteria, the radiologists were asked to grade each tear 0 to 4, with 1 point for each of the following: a tear larger than 10 mm, within 3 mm of the meniscosynovial junction, greater than 50% thickness, and with an intact inner meniscal fragment. Only a tear with a score of 4 would be predicted to be reparable.
March 2011Limitations of Minimally Acceptable Interpretive Performance Criteria for Screening Mammography.
Doyle GP, Onysko J, Pogany L, Major D, Caines J, Shumak R, Wadden N, Carney PA, Sickles EA, Monsees BS, Bassett LW, Miglioretti DL.
The May 2010 Radiology article by Dr Carney and colleagues (1) piqued our interest. The authors set cut points to identify underperforming radiologists who might benefit from additional training. These include sensitivity less than 75%, specificity less than 88% or greater than 95%, recall rate (RR) less than 5% or greater than 12%, positive predictive value (PPV) less than 3% or greater than 8%, and cancer detection rate (CDR) less than 2.5 per 1000 interpretations.
March 2011Volumetric Analysis of Functional Diffusion Maps is a Predictive Imaging Biomarker for Cytotoxic and Anti-Angiogenic Treatments in Malignant Gliomas.
Ellingson BM, Malkin MG, Rand SD, Laviolette PS, Connelly JM, Mueller WM, Schmainda KM.
Anti-angiogenic agents targeting brain tumor neovasculature may increase progression-free survival in patients with recurrent malignant gliomas. However, when these patients do recur it is not always apparent as an increase in enhancing tumor volume on MRI, which has been the standard of practice for following patients with brain tumors. Therefore alternative methods are needed to evaluate patients treated with these novel therapies. Furthermore, a method that can also provide useful information for the evaluation of conventional therapies would provide an important advantage for general applicability. Diffusion-weighted magnetic resonance imaging (DWI) has the potential to serve as a valuable biomarker for these purposes. In the current study, we explore the prognostic ability of functional diffusion maps (fDMs), which examine voxel-wise changes in the apparent diffusion coefficient (ADC) over time, applied to regions of fluid-attenuated inversion recovery (FLAIR) abnormalities in patients with malignant glioma, treated with either anti-angiogenic or cytotoxic therapies. Results indicate that the rate of change in fDMs is an early predictor of tumor progression, time to progression and overall survival for both treatments, suggesting the application of fDMs in FLAIR abnormal regions may be a significant advance in brain tumor biomarker technology.
March 2011Scenario Planning.
Enzmann DR, Beauchamp NJ Jr, Norbash A.
In facing future developments in health care, scenario planning offers a complementary approach to traditional strategic planning. Whereas traditional strategic planning typically consists of predicting the future at a single point on a chosen time horizon and mapping the preferred plans to address such a future, scenario planning creates stories about multiple likely potential futures on a given time horizon and maps the preferred plans to address the multiple described potential futures. Each scenario is purposefully different and specifically not a consensus worst-case, average, or best-case forecast; nor is scenario planning a process in probabilistic prediction. Scenario planning focuses on high-impact, uncertain driving forces that in the authors' example affect the field of radiology. Uncertainty is the key concept as these forces are mapped onto axes of uncertainty, the poles of which have opposed effects on radiology. One chosen axis was "market focus," with poles of centralized health care (government control) vs a decentralized private market. Another axis was "radiology's business model," with one pole being a unified, single specialty vs a splintered, disaggregated subspecialty. The third axis was "technology and science," with one pole representing technology enabling to radiology vs technology threatening to radiology. Selected poles of these axes were then combined to create 3 scenarios. One scenario, termed "entrepreneurialism," consisted of a decentralized private market, a disaggregated business model, and threatening technology and science. A second scenario, termed "socialized medicine," had a centralized market focus, a unified specialty business model, and enabling technology and science. A third scenario, termed "freefall," had a centralized market focus, a disaggregated business model, and threatening technology and science. These scenarios provide a range of futures that ultimately allow the identification of defined "signposts" that can suggest which basic features among the "possible futures" are playing out. Scenario planning provides for the implementation of appropriate constructed strategic responses. Scenarios allow for a pre-prepared game plan available for ready use as the future unfolds. They allow a deliberative response rather than a hastily constructed, urgent response.
March 20113D Visualization of Subdural Electrode Shift as Measured at Craniotomy Reopening.
Laviolette PS, Rand SD, Ellingson BM, Raghavan M, Lew SM, Schmainda KM, Mueller W.
PURPOSE: Subdural electrodes are implanted for recording intracranial EEG (iEEG) in cases of medically refractory epilepsy as a means to locate cortical regions of seizure onset amenable to surgical resection. Without the aid of imaging-derived 3D electrode models for surgical planning, surgeons have relied on electrodes remaining stationary from the time between placement and follow-up resection. This study quantifies electrode shift with respect to the cortical surface occurring between electrode placement and subsequent reopening. METHODS: CT and structural MRI data were gathered following electrode placement on 10 patients undergoing surgical epilepsy treatment. MRI data were used to create patient specific post-grid 3D reconstructions of cortex, while CT data were co-registered to the MRI and thresholded to reveal electrodes only. At the time of resective surgery, the craniotomy was reopened and electrode positions were determined using intraoperative navigational equipment. Changes in position were then calculated between CT coordinates and intraoperative electrode coordinates.
March 2011Three-Dimensional Visualization of Subdural Electrodes for Presurgical Planning.
LaViolette PS, Rand SD, Raghavan M, Ellingson BM, Schmainda KM, Mueller W.
BACKGROUND: Accurate localization and visualization of subdural electrodes implanted for intracranial electroencephalography in cases of medically refractory epilepsy remains a challenging clinical problem. OBJECTIVE: We introduce a technique for creating accurate 3-dimensional (3D) brain models with electrode overlays, ideal for resective surgical planning. METHODS: Our procedure uses postimplantation magnetic resonance imaging (MRI) and computed tomographic (CT) imaging to create 3D models of compression-affected brain combined with intensity-thresholded CT-derived electrode models using freely available software. Footprints, or "shadows," beneath electrodes are also described for better visualization of sulcus-straddling electrodes. Electrode models were compared with intraoperative photography for validation.
March 2011Partial Recanalization of Concomitant Internal Carotid-Middle Cerebral Arterial Occlusions Promotes Distal Recanalization of Residual Thrombus within 24 H.
Loh Y, Liebeskind DS, Shi ZS, Jahan R, Gonzalez NR, Tateshima S, Vespa PM, Starkman S, Saver JL, Viñuela F, Duckwiler GR.
OBJECTIVES: Acute, simultaneous, concomitant internal carotid artery (ICA) and middle cerebral arteries (MCA) occlusions almost invariably lead to significant neurological disability if left untreated. Endovascular therapy is frequently the method of treatment in such situations but there remains a chance of incomplete recanalization. Successful recanalization of the proximal aspect of the occlusion may allow for endogenous thrombolysis and facilitate further endogenous recanalization of any residual MCA occlusion. METHODS: Consecutive patients with acute ischemic stroke undergoing endovascular therapy for tandem extracranial ICA-MCA or contiguous intracranial ICA-MCA occlusions were retrospectively analyzed. Rates of facilitated endogenous recanalization at 24 h (FER(24)) were compared by imaging within the immediate post-intervention 5-24 h period in those with proximal recanalization and in those without.
March 2011Endovascular Management of Anterior Cranial Fossa Dural Arteriovenous Malformations. A Technical Report and Anatomical Discussion.
Mack WJ, Gonzalez NR, Jahan R, Viñuela F.
Dural arteriovenous fistulas (dAVFs) of the anterior cranial fossa have traditionally been treated by open surgical disconnection. Safe navigation through the ophthalmic artery or fragile cortical veins has historically provided a barrier to effective endovascular occlusion of these lesions. Using current microcatheter technology and embolic materials, safe positioning within the distal ophthalmic artery, beyond the origin of the central retinal artery, is achievable. We describe two cases in which anterior cranial fossa dAVFs were treated by exclusively endovascular strategies, and highlight the pertinent technical and anatomic considerations. We discuss the clinical symptoms resulting from the differing venous drainage patterns.
March 2011Effectiveness-Based Guidelines for the Prevention of Cardiovascular Disease in Women--2011 Update: a Guideline from the American Heart Association.
Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, Newby LK, Piña IL, Roger VL, Shaw LJ, Zhao D, Beckie TM, Bushnell C, D'Armiento J, Kris-Etherton PM, Fang J, Ganiats TG, Gomes AS, Gracia CR, Haan CK, Jackson EA, Judelson DR, Kelepouris E, Lavie CJ, Moore A, Nussmeier NA, Ofili E, Oparil S, Ouyang P, Pinn VW, Sherif K, Smith SC Jr, Sopko G, Chandra-Strobos N, Urbina EM, Vaccarino V, Wenger NK.
Substantial progress has been made in the awareness, treatment, and prevention of cardiovascular disease (CVD) in women since the first women-specific clinical recommendations for the prevention of CVD were published by the American Heart Association (AHA) in 1999.1 The myth that heart disease is a “man's disease” has been debunked; the rate of public awareness of CVD as the leading cause of death among US women has increased from 30% in 1997 to 54% in 2009.2 The age-adjusted death rate resulting from coronary heart disease (CHD) in females, which accounts for about half of all CVD deaths in women, was 95.7 per 100 000 females in 2007, a third of what it was in 1980.3,4 Approximately 50% of this decline in CHD deaths has been attributed to reducing major risk factors and the other half to treatment of CHD including secondary preventive therapies.4 Major randomized controlled clinical trials such as the Women's Health Initiative have changed the practice of CVD prevention in women over the past decade.5 The investment in combating this major public health issue for women has been significant, as have the scientific and medical achievements.
March 2011Bilateral Vascular Supply in Juvenile Nasopharyngeal Angiofibromas.
Wu AW, Mowry SE, Viñuela F, Abemayor E, Wang MB.
OBJECTIVES: Juvenile nasopharyngeal angiofibroma (JNA) is a rare, benign tumor of the nasopharynx, exclusively affecting males in their teens and twenties. Historically, it has been thought that JNAs primarily receive their blood supply from the ipsilateral external carotid system. We demonstrate in our case series and literature review that bilateral vascular supply in these tumors is, in fact, very common. STUDY DESIGN: Case series and literature review. METHODS: We present four consecutive cases of JNA in a three-year period from a major tertiary care center. A literature review on the topic of vascular supply in JNA was performed.
February 2011The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI): a Completed Reference Database of Lung Nodules on CT Scans.
Armato SG 3rd, McLennan G, Hawkins D, Bidaut L, McNitt-Gray MF, Meyer CR, Reeves AP, Zhao B, Aberle DR, Henschke CI, Hoffman EA, Kazerooni EA, MacMahon H, Van Beeke EJ, Yankelevitz D, Biancardi AM, Bland PH, Brown MS, Engelmann RM, Laderach GE, Max D, Pais RC, Qing DP, Roberts RY, Smith AR, Starkey A, Batrah P, Caligiuri P, Farooqi A, Gladish GW, Jude CM, Munden RF, Petkovska I, Quint LE, Schwartz LH, Sundaram B, Dodd LE, Fenimore C, Gur D, Petrick N, Freymann J, Kirby J, Hughes B, Casteele AV, Gupte S, Sallamm M, Heath MD, Kuhn MH, Dharaiya E, Burns R, Fryd DS, Salganicoff M, Anand V, Shreter U, Vastagh S, Croft BY, Clarke LP.
PURPOSE: The development of computer-aided diagnostic (CAD) methods for lung nodule detection, classification, and quantitative assessment can be facilitated through a well-characterized repository of computed tomography (CT) scans. The Lung Image Database Consortium (LIDC) and Image Database Resource Initiative (IDRI) completed such a database, establishing a publicly available reference for the medical imaging research community. Initiated by the National Cancer Institute (NCI), further advanced by the Foundation for the National Institutes of Health (FNIH), and accompanied by the Food and Drug Administration (FDA) through active participation, this public-private partnership demonstrates the success of a consortium founded on a consensus-based process. METHODS: Seven academic centers and eight medical imaging companies collaborated to identify, address, and resolve challenging organizational, technical, and clinical issues to provide a solid foundation for a robust database. The LIDC/IDRI Database contains 1018 cases, each of which includes images from a clinical thoracic CT scan and an associated XML file that records the results of a two-phase image annotation process performed by four experienced thoracic radiologists. In the initial blinded-read phase, each radiologist independently reviewed each CT scan and marked lesions belonging to one of three categories ("nodule > or =3 mm," "nodule <3 mm," and "non-nodule > or =3 mm"). In the subsequent unblinded-read phase, each radiologist independently reviewed their own marks along with the anonymized marks of the three other radiologists to render a final opinion. The goal of this process was to identify as completely as possible all lung nodules in each CT scan without requiring forced consensus.
February 2011Pacemaker Lead Tip Heating in Abandoned and Pacemaker-attached Leads at 1.5 Tesla MRI.
Langman DA, Goldberg IB, Finn JP, Ennis DB.
PURPOSE: To assess the risk of RF-induced heating in pacemaker-attached and abandoned leads using in vitro temperature measurements at 1.5 Tesla as a function of lead length. MATERIALS AND METHODS: Five custom lead lengths, 20-60 cm, were exposed to a uniform magnitude and phase radiofrequency electric field to examine the effect of lead length on pacemaker lead tip heating for pacemaker-attached and abandoned pacemaker leads.
February 2011ACR Appropriateness Criteria® Screening for Pulmonary Metastases.
Mohammed TL, Chowdhry A, Reddy GP, Amorosa JK, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Kirsch J, Macmahon H, Parker JA, Ravenel JG, Saleh AG, Shah RD.
Screening for pulmonary metastatic disease is an important step for staging a patient with a known or recently discovered malignancy. Here we present our recommendations for screening for metastatic disease based on recommendations from the literature and experiences of pulmonary radiologists. In short, chest computed tomographic (CT) screening is the most appropriate tool for evaluation of pulmonary metastasis in the majority of cases. Chest computed tomographic screening is also recommended for follow-up and to determine response to therapy. Other modalities such as chest radiography, magnetic resonance imaging, and scintigraphy will also be discussed. Please note that this study is a summary of the complete version of this topic, which is available on the ACR website at www.acr.org. Practitioners are encouraged to refer to the complete version.
February 2011Patterns of Progression in Patients with Recurrent Glioblastoma Treated with Bevacizumab.
Pope WB, Xia Q, Paton VE, Das A, Hambleton J, Kim HJ, Huo J, Brown MS, Goldin J, Cloughesy T.
OBJECTIVE: We evaluated patterns of tumor progression in patients with recurrent glioblastoma who were treated with bevacizumab (BEV) alone or in combination with irinotecan (CPT-11) while participating in the BRAIN study. METHODS: An independent neuroradiologist reviewed MRI scans at baseline and progression in patients who received BEV (n = 85) or BEV+CPT-11 (n = 82) while on BRAIN. Tumor patterns were scored as local, distant, diffuse, or multifocal. Median progression-free survival (PFS) and overall survival (OS) were estimated using Kaplan-Meier methods. Hazard ratios for PFS and OS were estimated using a Cox regression model.
February 2011International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society International Multidisciplinary Classification of Lung Adenocarcinoma.
Travis WD, Brambilla E, Noguchi M, Nicholson AG, Geisinger KR, Yatabe Y, Beer DG, Powell CA, Riely GJ, Van Schil PE, Garg K, Austin JH, Asamura H, Rusch VW, Hirsch FR, Scagliotti G, Mitsudomi T, Huber RM, Ishikawa Y, Jett J, Sanchez-Cespedes M, Sculier JP, Takahashi T, Tsuboi M, Vansteenkiste J, Wistuba I, Yang PC, Aberle D, Brambilla C, Flieder D, Franklin W, Gazdar A, Gould M, Hasleton P, Henderson D, Johnson B, Johnson D, Kerr K, Kuriyama K, Lee JS, Miller VA, Petersen I, Roggli V, Rosell R, Saijo N, Thunnissen E, Tsao M, Yankelewitz D.
INTRODUCTION: Adenocarcinoma is the most common histologic type of lung cancer. To address advances in oncology, molecular biology, pathology, radiology, and surgery of lung adenocarcinoma, an international multidisciplinary classification was sponsored by the International Association for the Study of Lung Cancer, American Thoracic Society, and European Respiratory Society. This new adenocarcinoma classification is needed to provide uniform terminology and diagnostic criteria, especially for bronchioloalveolar carcinoma (BAC), the overall approach to small nonresection cancer specimens, and for multidisciplinary strategic management of tissue for molecular and immunohistochemical studies. METHODS: An international core panel of experts representing all three societies was formed with oncologists/pulmonologists, pathologists, radiologists, molecular biologists, and thoracic surgeons. A systematic review was performed under the guidance of the American Thoracic Society Documents Development and Implementation Committee. The search strategy identified 11,368 citations of which 312 articles met specified eligibility criteria and were retrieved for full text review. A series of meetings were held to discuss the development of the new classification, to develop the recommendations, and to write the current document. Recommendations for key questions were graded by strength and quality of the evidence according to the Grades of Recommendation, Assessment, Development, and Evaluation approach.
February 2011CT and MRI Improve Detection of Hepatocellular Carcinoma, Compared With Ultrasound Alone, in Patients With Cirrhosis.
Yu NC, Chaudhari V, Raman SS, Lassman C, Tong MJ, Busuttil RW, Lu DS.
BACKGROUND & AIMS: In patients with cirrhosis, hepatocellular carcinoma (HCC) is detected by ultrasound (US), computed tomography (CT), or magnetic resonance imaging (MRI); US is recommended for screening and surveillance. We performed a retrospective analysis of the abilities of these cross-sectional imaging modalities to detect HCC. METHODS: We analyzed data from 638 consecutive adult patients with cirrhosis who received liver transplants within 6 months of imaging at a tertiary care institution. Imaging reports and serum alpha-fetoprotein levels were compared with results from pathology analysis of explants as the reference standard. Sensitivities of US, CT, and MRI were calculated overall and in defined size categories. False-positive imaging results and patient-based specificities were evaluated.
January 2011The Clinicopathologic Spectrum of Focal Cortical Dysplasias: A Consensus Classification Proposed by an Ad Hoc Task Force of the ILAE Diagnostic Methods Commission(1).
Blümcke I, Thom M, Aronica E, Armstrong DD, Vinters HV, Palmini A, Jacques TS, Avanzini G, Barkovich AJ, Battaglia G, Becker A, Cepeda C, Cendes F, Colombo N, Crino P, Cross JH, Delalande O, Dubeau F, Duncan J, Guerrini R, Kahane P, Mathern G, Najm I, Ozkara C, Raybaud C, Represa A, Roper SN, Salamon N, Schulze-Bonhage A, Tassi L, Vezzani A, Spreafico R.
PURPOSE: Focal cortical dysplasias (FCD) are localized regions of malformed cerebral cortex and are very frequently associated with epilepsy in both children and adults. A broad spectrum of histopathology has been included in the diagnosis of FCD. An ILAE task force proposes an international consensus classification system to better characterize specific clinicopathological FCD entities. METHODS: Thirty-two Task Force members have reevaluated available data on electroclinical presentation, imaging, neuropathological examination of surgical specimens as well as postsurgical outcome.
January 2011Evaluation of Treatment Response After Nonoperative Therapy for Early-Stage Non-Small Cell Lung Carcinoma.
Eradat J, Abtin F, Gutierrez A, Suh R.
Nonsurgical management of early primary lung cancer has grown tremendously in recent years, and today, available options extend far beyond that of conventional radiation therapy (CRT) to include minimally invasive image-guided delivery of thermal energies, specifically radiofrequency ablation, microwave ablation, and cryoablation, and more conformal stereotactic body radiation therapy. Because the tumor is never resected with these nonoperative interventions, histopathological evaluation of tumor margins for the presence of residual tumor is impossible, and as such, tumor response after each of these therapies is largely based on imaging. To date, computerized tomography and computerized tomography-positron emission tomography remain the most readily available modalities for assessment of therapeutic efficacy, and to this end as detailed within this article, strict imaging survey and familiarity with the expected imaging characteristics of the treated tumor will aid in recognition of unexpected findings, specifically those of incomplete therapy and/or tumor recurrence.
January 2011Phase II Study of Bevacizumab Plus Temozolomide During and After Radiation Therapy for Patients with Newly Diagnosed Glioblastoma Multiforme.
Lai A, Tran A, Nghiemphu PL, Pope WB, Solis OE, Selch M, Filka E, Yong WH, Mischel PS, Liau LM, Phuphanich S, Black K, Peak S, Green RM, Spier CE, Kolevska T, Polikoff J, Fehrenbacher L, Elashoff R, Cloughesy T.
PURPOSE: This open-label, prospective, multicenter single-arm phase II study combined bevacizumab (BV) with radiation therapy (RT) and temozolomide (TMZ) for the treatment of newly diagnosed glioblastoma (GBM). The objectives were to determine the efficacy of this treatment combination and the associated toxicity. PATIENTS AND METHODS: Seventy patients with newly diagnosed GBM were enrolled between August 2006 and November 2008. Patients received standard RT starting within 3 to 6 weeks after surgery with concurrent administration of daily TMZ and biweekly BV. After completion of RT, patients resumed TMZ for 5 days every 4 weeks and continued biweekly BV. MGMT promoter methylation was assessed on patient tumor tissue. A University of California, Los Angeles/Kaiser Permanente Los Angeles (KPLA) control cohort of newly diagnosed patients treated with first-line RT and TMZ who had mostly received BV at recurrence was derived for comparison.
January 2011Preoperative Magnetic Resonance Angiography Detection of Septocutaneous Perforators in Fibula Free Flap Transfer.
Miller ME, Moriarty JM, Blackwell KE, Finn JP, Yiee JH, Nabili V.
OBJECTIVE: To investigate whether preoperative magnetic resonance angiography (MRA) is predictive of surgical findings in fibula free flap surgery for head and neck reconstruction. METHODS: Retrospective review (April 2004 until September 2009) of 123 patients who underwent preoperative MRA as part of surgical planning for fibula free flap tissue transfer for head and neck reconstruction. Each MRA was reviewed by a board-certified radiologist masked to the intraoperative findings and to the number of septocutaneous perforators documented. Operative notes were reviewed and the number of septocutaneous perforators found during the operation was recorded. A κ interrater agreement statistic was calculated to compare these values.
January 2011The National Lung Screening Trial: Overview and Study Design.
National Lung Screening Trial Research Team, Aberle DR, Berg CD, Black WC, Church TR, Fagerstrom RM, Galen B, Gareen IF, Gatsonis C, Goldin J, Gohagan JK, Hillman B, Jaffe C, Kramer BS, Lynch D, Marcus PM, Schnall M, Sullivan DC, Sullivan D, Zylak CJ.
The National Lung Screening Trial (NLST) is a randomized multicenter study comparing low-dose helical computed tomography (CT) with chest radiography in the screening of older current and former heavy smokers for early detection of lung cancer, which is the leading cause of cancer-related death in the United States. Five-year survival rates approach 70% with surgical resection of stage IA disease; however, more than 75% of individuals have incurable locally advanced or metastatic disease, the latter having a 5-year survival of less than 5%. It is plausible that treatment should be more effective and the likelihood of death decreased if asymptomatic lung cancer is detected through screening early enough in its preclinical phase. For these reasons, there is intense interest and intuitive appeal in lung cancer screening with low-dose CT. The use of survival as the determinant of screening effectiveness is, however, confounded by the well-described biases of lead time, length, and overdiagnosis. Despite previous attempts, no test has been shown to reduce lung cancer mortality, an endpoint that circumvents screening biases and provides a definitive measure of benefit when assessed in a randomized controlled trial that enables comparison of mortality rates between screened individuals and a control group that does not undergo the screening intervention of interest. The NLST is such a trial. The rationale for and design of the NLST are presented.