Research Publications

October 2025

Capiro N, Chalfant JS.

Solid organ transplantation volumes in the United States have been steadily increasing over the past decade. Rigorous evaluation of potential transplant recipients must be performed to ensure appropriate allocation of solid organs for transplant. Because active malignancy is a contraindication for most solid organ transplantations, appropriate cancer screening should be included as part of the pretransplant assessment for both potential transplant recipients and donors. This article provides a summary of the current state of solid organ transplant-related breast cancer screening in the United States.

October 2025

Capiro N, Khadka P, Sayre J, Sadigh G, Hoyt A.

BACKGROUND: After FDA clearance of digital breast tomosynthesis (DBT) in 2011, many insurers were slow to adopt full coverage without cost sharing. Our institution implemented a $45 out-of-pocket fee for DBT, refunded upon insurance payment. This fee was eliminated in January 2021 after most insurers began covering DBT. We evaluated the effect of out-of-pocket fee removal on DBT versus digital mammography use across patient groups. METHODS: We conducted a retrospective analysis of screening mammograms scheduled at a multisite academic institution between March 2018 and August 2022. A difference-in-difference analysis was performed for women with screening mammography both before and after fee removal to assess the effect of fee removal across patient groups.

October 2025

Joy A, Saucedo A, Wright MJ, Vallabhu P, Gupta N, Sayre J, Chien A, Emir U, Macey PM, Daar ES, Thomas MA.

Background: Despite effective antiretroviral therapy, HIV-associated neurocognitive disorders (HANDs) remain prevalent, highlighting the need for sensitive biomarkers of early brain alterations. Trace-weighted diffusion spectroscopic imaging offers a non-invasive means to assess microstructural changes in brain metabolites in a single shot by measuring apparent diffusion coefficients (ADCs) of total N-acetylaspartate (tNAA), total creatine (tCr), total choline (tCho), and water. Methods: In this study, we used trace-weighted single-shot diffusion-weighted radial echo-planar spectroscopic imaging (DW-RESPI) to investigate metabolite diffusion and relative concentrations in the brains of people living with HIV (PLWH). Using a 3T MRI scanner, we studied 16 PLWH and 15 healthy controls (HCs), and we collected two sets of data with low and high b-values from which metabolite ADCs were computed. Metabolite ratios were derived from the low b-value spectra. A brief neuropsychological assessment evaluated attention, executive function, and memory in a subset of subjects. Cognitive and affective performance was quantified using domain-specific deficit scores, as well as depression and anxiety assessments, offering a comprehensive evaluation of neurobehavioral function. In the male subgroup (N = 15) of PLWH, we calculated the correlations between ADC values and neuropsychological domain scores.

October 2025

Mao X, Chen Z, Hu Z, Lee HL, Kwan AC, Cokic I, Cao T, Han F, Xie Y, Li D, Christodoulou AG.

Purpose To evaluate a novel continuous-acquisition cardiac MRI method that integrates non-contrast-enhanced and contrast-enhanced imaging within a single 20-minute, free-breathing, non-electrocardiographically (ECG) gated scan. Materials and Methods A three-dimensional (3D) stack-of-stars T2-prepared fast low angle shot (FLASH) pulse sequence, combined with a 3D multitasking reconstruction and multiparametric mapping framework, was developed to jointly reconstruct coregistered precontrast and postcontrast images. A prospective study conducted from September 2021 to February 2022 involved 10 healthy human volunteers (mean age, 37 years ± 21 [SD]; eight male, two female) and four pigs with reperfusion injury. Quantitative and qualitative MRI measurements were verified in a digital phantom and in vivo. Statistical analysis included intraclass correlation coefficient, Bland-Altman analysis, and paired t tests to compare the proposed method against reference methods.

October 2025

Newman-Hung NJ, Khabaz K, Ding R, Pham D, Jackson NJ, Hsu W, Bernthal NM, Wessel LE.

Abstract Soft tissue sarcomas (STS) of the upper extremity (UE) are rare but can lead to devastating outcomes. The Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, Sarculator, and PERSARC predict local recurrence (LR), distant metastases (DM), and overall survival (OS) in extremity STS. We retrospectively reviewed 211 UE STS patients (2012-2022) at a single tertiary center, recording demographics, tumor factors, treatments, and outcomes. External validation employed concordance indices (C). The mean clinical follow-up was 4.9 years. Ninety-three patients (44%) presented after unplanned excision, and 168 patients (80%) underwent neoadjuvant or adjuvant therapy. LR occurred in 49 patients (23%), and DM in 47 patients (22%). Thirty-five patients (17%) expired at an average of 41.0 months post-presentation. C-indices for MSKCC nomograms were 0.28 (0.08, 0.52) and 0.30 (0.10, 0.54) for 3- and 5-year LR. C-indices for Sarculator were 0.64 (0.54, 0.73) and 0.63 (0.54, 0.72) for 5- and 10-year DM and 0.79 (0.67, 0.89) and 0.79 (0.67, 0.89) for 5- and 10-year OS. C-indices for PERSARC were 0.70 (0.59, 0.80) for 5-year LR and 0.81 (0.68, 0.91) for 5-year OS. Prognostic tools may underperform in UE STS due to small development cohorts and unique tumor characteristics.

October 2025

Nocera G, Sanvito F, Yao J, Oshima S, Bobholz SA, Teraishi A, Raymond C, Patel K, Everson RG, Liau LM, Connelly J, Castellano A, Mortini P, Salamon N, Cloughesy TF, LaViolette PS, Ellingson BM.

PURPOSE: In brain gliomas, non-invasive biomarkers reflecting tumor cellularity would be useful to guide supramarginal resections and to plan stereotactic biopsies. We aim to validate a previously-trained machine learning algorithm that generates cellularity prediction maps (CPM) from multiparametric MRI data to an independent, retrospective external cohort of gliomas undergoing image-guided biopsies, and to compare the performance of CPM and diffusion MRI apparent diffusion coefficient (ADC) in predicting cellularity. METHODS: A cohort of patients with treatment-naïve or recurrent gliomas were prospectively studied. All patients underwent pre-surgical MRI according to the standardized brain tumor imaging protocol. The surgical sampling site was planned based on image-guided biopsy targets and tissue was stained with hematoxylin-eosin for cell density count. The correlation between MRI-derived CPM values and histological cellularity, and between ADC and histological cellularity, was evaluated both assuming independent observations and accounting for non-independent observations.

October 2025

Norajitra T, Baumgartner MA, Cusumano LR, Ulloa JG, Rizzo CS, Haag F, Hertel A, Rathmann NA, Diehl SJ, Schoenberg SO, Maier-Hein KH, Rink JS.

BACKGROUND: Aortic dissection (AD) is a life-threatening condition. We developed an artificial intelligence (AI) algorithm capable of robust, accurate, and automated AD detection and sub-classification. Materials and methods: Based on 2010-2023 data from Mannheim University Medical Centre, heterogeneous internal training cases with confirmed AD (n = 70) were manually segmented and, together with non-AD cases (n = 87), used for training of a convolutional neural network (CNN; U-Net architecture) configured using the nnU-Net framework. Internal test dataset was composed of 106 cases. The external test was performed on a public dataset: 100 AD cases from ImageTBAD, Guangdong Provincial People's Hospital, China, and 38 non-AD cases from the AVT dataset (multiple sources). Model performance was evaluated by area under the receiver operating characteristic curve (AUROC), area under the precision-recall curve (AUPRC), sensitivity, specificity, precision, and F1-score, and by investigating performance on different subsets of cases. Confidence intervals were determined using DeLong's method and bootstrapping.

October 2025

Ramakrishnan A, Reilly D, Sayre J, Asachi P, Khabaz K, Quirk M, Plotnik A, Gomes A, Padia SA, McWilliams JP.

PURPOSE: Renal angiomyolipomas (AMLs) are benign renal neoplasms that may lead to spontaneous hemorrhage. Transcatheter arterial embolization (TAE) is a nephron-sparing treatment option, yet data on predictors of hemorrhage and re-intervention remain limited. This study evaluates clinical and radiologic outcomes of TAE and identifies predictors of hemorrhage and repeat embolization. MATERIALS AND METHODS: A retrospective review of 66 patients (69 AMLs) undergoing TAE between 2010 and 2024 was conducted. Clinical, radiological, and procedural variables were analyzed. Tumor size, vascularity, and aneurysmal features were assessed pre- and post-embolization. Logistic regression models identified predictors of hemorrhage and repeat TAE.

October 2025

Sanvito F, Yao J, Nocera G, Shao G, Wang Z, Cho NS, Teraishi A, Raymond C, Patel K, Pouratian N, Everson RG, Yang I, Salamon N, Kim W, Ellingson BM.

OBJECTIVE: To characterize MRI changes of brain metastases (BM) following laser interstitial thermal therapy (LITT), particularly in lesions exhibiting durable response or early progression. MATERIALS AND METHODS: Longitudinal scans from patients with LITT-treated BM were retrospectively analyzed. Treatment response was categorized as durable response, long-term disease control (i.e., stable at 1 year), stable disease < 1 year, or progression < 1 year. Volumetric and diffusion MRI changes after LITT were analyzed for each subregion (contrast-enhancing, central non-enhancing, whole lesion). Volumetric changes were modeled with bi-exponential fits in responding lesions and progressors.

September 2025

Clarke, JE, Cohen S, Acharya J.

Leber hereditary optic neuropathy (LHON) is a rare disorder that results in loss of central vision. Although the initial onset of LHON is most commonly seen in patients aged 15-35 years, it may occur at any age. The disorder is more common in men than women and is known to be caused by one of three mitochondrial DNA point mutations: 11778G>A, 3460G>A, or 14484T>C. Whereas the diagnosis of LHON is conventionally based on a patient's clinical presentation, family history, and the results of ophthalmologic examination and genetic testing, it can significantly benefit from early contribution of neuroimaging. We report a case of LHON in a 36-year-old woman with low visual acuity and progressive worsening of vision for 7 months, a family history of LHON, and abnormal central hyperintense signal within the optic nerves on T2-weighted fat-saturated magnetic resonance imaging of the orbits. Some etiopathogenetic and neuroimaging aspects of LHON as well as challenges in diagnosis and treatment of patients with the disorder are also discussed.

September 2025

Homer S, Homer R.

Stump appendicitis is an inflammation of appendiceal remnant after incomplete appendectomy. However, the inclusion of appendectomy in a patient's medical history often obfuscates a diagnosis of appendicitis, causing a delay in diagnosis and potentially leading to increased morbidity. Awareness of stump appendicitis can help radiologists distinguish this rare condition from more common entities. We report two cases of stump appendicitis that were correctly identified at the patients' time of presentation to the emergency department. In one case, the patient presented with recurrent stump appendicitis. In this case series, we discuss the radiographic features, clinical considerations, and treatment of stump appendicitis.

September 2025

Kaur K, Reese P, Chiang J, Jewett A.

This study found a strong link between interferon-gamma (IFN-γ) secretion from immune cells and changes in bone quality in pancreatic tumor-bearing humanized-BLT (hu-BLT) mice. Tumor presence in hu-BLT mice led to bone resorption and reduced IFN-γ production compared to healthy mice. Interestingly, oral supplementation with probiotic bacteria AJ2, either alone or combined with supercharged NK (sNK) cells, inhibited tumor growth and increased IFN-γ levels in tissue compartments and tumor sites. Enhanced IFN-γ secretion was observed in cell cultures from the pancreas, spleen, PBMCs, splenocyte-derived NK cells, and bone marrow of mice treated with sNK cells and AJ2 compared to untreated tumor-bearing mice. Higher IFN-γ levels were associated with improved bone integrity in hu-BLT mice. TRAP staining showed increased osteoclastic activity and bone resorption in untreated tumor mice, in contrast to those treated with sNK and AJ2. This research highlights the role of immune cell-derived IFN-γ in preventing tumor-induced bone loss and improving bone quality, suggesting that probiotics, alone or with immunotherapies, have potential as treatments for osteolytic cancers.

September 2025

Melehy A, Amara D, Gumate S, Ebaid S, Kaldas FM, Farmer DG, Bui AAT, Agopian VG.

Liver transplant (LT) centers may have variations in their approach to high-acuity (MELD ≥35) candidates for listing and transplantation. We investigated center-specific differences in waitlist outcomes, probability of LT, and post-LT survival in MELD ≥35 patients. Adult candidates of LT (MELD ≥35) were identified from the Scientific Registry of Transplant Recipients between January 1, 2010, and April 1, 2022. Waitlist mortality was modeled with the center as a random effect. Centers were grouped based on the random effect coefficient, with the highest tertile representing the highest risk group (comprises centers with the highest risk of waitlist mortality attributable to the center). Cumulative incidence of death/delisting, probability of LT, and 1-year post-LT survival were compared, with patients stratified by a listing MELD ≥35 or increase to MELD ≥35 after listing.

September 2025

Moriarty JM, Schiro BJ, Dohad SY, Tamaddon H, Davis HC, Shavelle DM, Chrysant GS, Iliadis EA, Dexter DJ 2nd, Ciampi Dopazo JJ, Holden A, West FM, Keeling B, Sharp ASP, Weinberg I.

BACKGROUND: Pulmonary embolism (PE) can be a life-threatening condition. Endovascular treatment is emerging as a promising treatment to restore hemodynamic stability and reverse right ventricular (RV) dysfunction in PE; however, more studies are needed to elucidate the effects on the right ventricle after endovascular treatment. This analysis reports the effects of computer assisted vacuum thrombectomy on RV function. METHODS: Eligible patients for the single-arm, prospective, international, multicenter STRIKE-PE (A Prospective, Multicenter Study of the Indigo Aspiration System Seeking to Evaluate the Long-Term Safety and Outcomes of Treating Pulmonary Embolism) cohort study are adults with acute PE with symptoms for ≤14 days and an RV/left ventricular ratio of ≥0.9 who are treated with computer assisted vacuum thrombectomy. Reported here are periprocedural and RV outcomes of the initial 300 patients of STRIKE-PE, to provide insights into effects on RV function after computer assisted vacuum thrombectomy.

September 2025

Nguyen D, Kim GHJ, Bedayat A.

INTRODUCTION: Large language models (LLMs) like ChatGPT are increasingly used in medicine due to their ability to synthesize information and support clinical decision-making. While prior research has evaluated ChatGPT's performance on medical board exams, limited data exist on radiology-specific exams especially considering prompt strategies and input modalities. This meta-analysis reviews ChatGPT's performance on radiology board-style questions, assessing accuracy across radiology subspecialties, prompt engineering methods, GPT model versions, and input modalities. METHODS: Searches in PubMed and SCOPUS identified 163 articles, of which 16 met inclusion criteria after excluding irrelevant topics and non-board exam evaluations. Data extracted included subspecialty topics, accuracy, question count, GPT model, input modality, prompting strategies, and access dates. Statistical analyses included two-proportion z-tests, a binomial generalized linear model (GLM), and meta-regression with random effects (Stata v18.0, R v4.3.1).

September 2025

Raymond C, Yao J, Kolkovsky ALL, Feiweier T, Clifford B, Meyer H, Zhong X, Han F, Cho NS, Sanvito F, Oshima S, Salamon N, Liau LM, Patel KS, Everson RG, Cloughesy TF, Ellingson BM.

PURPOSE: Sodium neuroimaging provides unique insights into the cellular and metabolic properties of brain tumors. However, at 3T, sodium neuroimaging MRI's low signal-to-noise ratio (SNR) and resolution discourages routine clinical use. We evaluated the recently developed Anatomically constrained GAN using physics-based synthetic MRI artifacts" (ATHENA) for high-resolution sodium neuroimaging of brain tumors at 3T. We hypothesized the model would improve the image quality while preserving the inherent sodium information. METHODS: 4,573 proton MRI scans from 1,390 suspected brain tumor patients were used for training. Sodium and proton MRI datasets from Twenty glioma patients were collected for validation. Twenty-four image-guided biopsies from seven patients were available for sodium-proton exchanger (NHE1) expression evaluation on immunohistochemistry. High-resolution synthetic sodium images were generated using the ATHENA model, then compared to native sodium MRI and NHE1 protein expression from image-guided biopsy samples.

September 2025

Qiu W, Patel Z, Emert B, Ghazikhanian V.

Histiocytoses are rare disorders characterized by abnormal proliferation of histiocytic cells in tissues and organs. They have a broad clinical spectrum and are traditionally categorized as Langerhans cell histiocytosis (LCH) and non-Langerhans cell histiocytosis (N-LCH), but recent evidence highlights a molecular and clinical overlap between LCH and a type of N-LCH known as Erdheim-Chester disease (ECD). While both disorders have distinct features, up to 20% of ECD patients may present with concurrent LCH lesions. Overlap between LCH and ECD is increasingly recognized, but reports of imaging of this phenomenon are scarce. Here, we present a rare case of directly contiguous LCH and ECD lesions in a 69-year-old woman and discuss the radiologic and histopathologic findings as well as the classification of these findings within the revised histiocytosis system.

September 2025

Wu C, Wang L, Wang N, Shiao S, Dou T, Hsu YC, Christodoulou AG, Xie Y, Li D.

urpose To improve the generalizability of pathologic complete response prediction following neoadjuvant chemotherapy using deep learning-based retrospective pharmacokinetic quantification of early treatment dynamic contrast-enhanced MRI. Materials and Methods This multicenter retrospective study included breast MRI data from four publicly available datasets of patients with breast cancer acquired from May 2002 to November 2016. Pharmacokinetic quantification was performed using a previously developed deep learning model for clinical multiphasic dynamic contrast-enhanced MRI datasets. Radiomic analysis was performed on pharmacokinetic quantification maps and conventional enhancement maps. These data, together with clinicopathologic variables and shape-based radiomic analysis, were subsequently applied for pathologic complete response prediction using logistic regression. Prediction performance was evaluated by area under the receiver operating characteristic curve (AUC).

September 2025

Wu C, Wang L, Wang N, Shiao S, Dou T, Hsu YC, Christodoulou AG, Xie Y, Li D.

Purpose To improve the generalizability of pathologic complete response prediction following neoadjuvant chemotherapy using deep learning-based retrospective pharmacokinetic quantification of early treatment dynamic contrast-enhanced MRI. Materials and Methods This multicenter retrospective study included breast MRI data from four publicly available datasets of patients with breast cancer acquired from May 2002 to November 2016. Pharmacokinetic quantification was performed using a previously developed deep learning model for clinical multiphasic dynamic contrast-enhanced MRI datasets. Radiomic analysis was performed on pharmacokinetic quantification maps and conventional enhancement maps. These data, together with clinicopathologic variables and shape-based radiomic analysis, were subsequently applied for pathologic complete response prediction using logistic regression. Prediction performance was evaluated by area under the receiver operating characteristic curve (AUC).

August 2025

Amara D, Melehy A, Ebaid S, Kaldas FM, Farmer DG, Stock P, Bui AAT, Mehta N, Agopian VG.

BACKGROUND: Balancing the probability of transplant and waitlist dropout in patients with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) using MELD exception points has been an enduring challenge. The advent of normothermic machine perfusion (NMP) has the potential to increase access to transplantation in patients with primary hepatic malignancies. METHODS: Using the Scientific Registry of Transplant Recipients database, this study evaluated the impact of widespread availability of NMP on access to liver transplantation in transplant oncology. Waitlist outcomes and transplant characteristics between patients with HCC and CCA after the implementation of acuity circles but before the widespread NMP availability (pre-NMP era, February 2020 to September 2021) were compared to those after widespread NMP availability (NMP era, September 2021 to September 2023) based on waitlist date.

August 2025

Chen Z, Hu Z, Xie Y, Li D, Christodoulou AG.

PURPOSE: The clinical value of quantitative MRI hinges on its measurement repeatability. Deep learning methods to reconstruct undersampled quantitative MRI can accelerate reconstruction but do not aim to promote quantitative repeatability. This study proposes a repeatability-encouraging self-supervised learning (SSL) reconstruction method for quantitative MRI. METHODS: The proposed SSL reconstruction network minimized cross-data-consistency between two equally sized, mutually exclusive temporal subsets of k-t-space data, encouraging repeatability by enabling each subset's reconstruction to predict the other's k-t-space data. The method was evaluated on cardiac MR Multitasking T1 mapping data and compared with supervised learning methods trained on full 60-s inputs (Sup60) and on split 30-s inputs (Sup30/30). Reconstruction quality was evaluated on full 60-s inputs, comparing results to iterative wavelet-regularized references using Bland-Altman limits of agreement (LOAs). Repeatability was evaluated by splitting the 60-s data into two 30-s inputs, evaluating T1 differences between reconstructions from the two halves of the scan.

August 2025

Ding PX, Li L, Lee EW.

August 2025

Hermann EA, Yang JX, Angelini E, Balte P, Bluemke DA, Carr J, Derlin K, Gomes AS, Habibi M, Hoffman EA, Johns C, Kawut SM, Kiely DG, Laine A, Lima JAC, Prince MR, Smith B, Vogel-Claussen J, Watson K, Wild JM, Swift AJ, Barr RG.

BACKGROUND: COPD is traditionally associated with pulmonary hypertension, but treatments targeting elevated pulmonary artery pressure in COPD have largely failed, possibly due to an incomplete understanding of subphenotypes of the disease. RESEARCH QUESTION: Are novel machine-learned CT emphysema subtypes associated with specific cardiac hemodynamic profiles? STUDY DESIGN AND METHODS: The Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited participants with and without COPD aged 50 to 79 years with ≥ 10 pack-years of smoking and without clinical cardiovascular disease, predominantly from MESA and a lung cancer screening cohort. COPD and COPD severity were defined by standard spirometric criteria. CT emphysema subtypes were defined by unsupervised machine learning in an independent study and labeled on chest CT scans. Hemodynamics were estimated on cardiac MRI using validated equations. Linear regression models were weighted by the inverse probability of sampling and adjusted for potential confounders.

August 2025

Hung ALY, Zhao K, Pang K, Zheng H, Du X, Miao Q, Terzopoulos D, Sung K.

The automatic segmentation of prostate MRI often produces inconsistent performance because certain image slices are more difficult to segment than others. In this paper, we show that consistency can be improved using Conditional Random Fields (CRFs), which refine the segmentation results by considering pixel relationships pairwise. In practice, however, conventional CRFs are susceptible to noise and MRI intensity shifts due to their use of simple binary potentials involving spatial distance and intensity difference. Such heuristic potential functions are hardly expressive, limiting the network from extracting more relevant information and having more stable potential calculations. We propose a novel end-to-end Neural CRF (NCRF) model that utilizes learnable binary potential functions based on deep image features. Experiments show that our NCRF is a better model for prostate zonal segmentation than state-of-the-art CRF models. The NCRF improves segmentation accuracy in both the prostate transition zone and peripheral zone such that segmentation results are consistent across all the prostate slices, which can improve the performance of downstream tasks such as prostate cancer detection and segmentation.

August 2025

Li XM, Nguyen T, Sparks HD, Sung K, Chiang J.

Quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is emerging as a valuable tool for assessing tumor and parenchymal perfusion in the liver, playing a developing role in locoregional therapies (LRTs) for hepatocellular carcinoma (HCC). This review explores the conceptual underpinnings and early investigational stages of DCE-MRI for LRTs, including thermal ablation, transarterial chemoembolization (TACE), and transarterial radioembolization (TARE). Preclinical and early-phase studies suggest that DCE-MRI may offer valuable insights into HCC tumor microvasculature, treatment response, and therapy planning. In thermal ablation therapies, DCE-MRI provides a quantitative measurement of tumor microvasculature and perfusion, which can guide more effective energy delivery and estimation of ablation margins. For TACE, DCE-MRI parameters are proving their potential to describe treatment efficacy and predict recurrence, especially when combined with adjuvant therapies. I

August 2025

Liebeskind DS, Luff MK, Bracard S, Guillemin F, Jahan R, Jovin TG, Majoie CBLM, Mitchell PJ, van der Lugt A, Menon BK, San Roman L, Campbell B, Muir KW, Hill MD, Dippel DWJ, Saver JL, Demchuk AM, Davalos A, White P, Brown SB, Goyal M; HERMES Collaborators.

BACKGROUND: Robust collateral circulation has been linked with better reperfusion and clinical outcomes. It remains unclear how individual assessments of collateral circulation may be translated into clinical practice. METHODS: The pooled Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials (HERMES) angiography dataset was analyzed by a centralized, independent imaging core blinded to other clinical data. Conventional angiography was acquired immediately prior to endovascular therapy. Collaterals were graded with the American Society of Interventional and Therapeutic Neuroradiology/Society of Interventional Radiology (ASITN) system and associated with baseline patient characteristics, reperfusion, and day 90 modified Rankin Score (mRS). Both 90-day all-cause mortality and day 90 mRS were modeled via multivariable logistic regression.

August 2025

Maqsood MH, Zhang RS, Rosenfeld K, Moriarty JM, Rosovsky RP, Horowitz JM, Alviar CL, Bangalore S.

Pulmonary embolism response teams (PERTs) are being increasingly used for the management of patients admitted with acute pulmonary embolism (PE) and are endorsed by societal guidelines. Whether PERT improves outcomes remains unknown. The objective of this meta-analysis was to compare the outcomes of patients with acute PE treated by a PERT versus no PERT. A systematic review and study level meta-analysis was conducted by searching PubMed and EMBASE databases from inception until November 10, 2024 and included studies evaluating efficacy of PERT vs no PERT in patients admitted for acute PE. Outcomes included all-cause mortality (in-hospital and 30-day mortality), major and clinically relevant bleeding, advanced therapies utilization, length of stay (LOS), and 30-day readmission. Twenty-four retrospective observational studies met the inclusion criteria, comprising 15,809 patients (mean age 61.6 years with 49% male) with acute PE of which 6228 were treated with a PERT and 9,581 without a PERT. Lower all-cause mortality (in-hospital or 30-day mortality) (odds ratio [OR] = 0.72; 95% CI: 0.56 to 0.93; 24 studies), major or clinically relevant bleeding (OR = 0.60; 95% CI: 0.42 to 0.86; 15 studies), higher utilization of advanced therapies (OR = 3.16; 95% CI: 1.81 to 5.49; 19 studies), and lower hospital LOS (MD = -1.49; 95% CI: -2.59 to -0.39; 14 studies) were seen in the patients treated by a PERT compared to those not treated by a PERT. In this large meta-analysis of observational studies comparing outcomes in patients treated by PERT versus not treated by PERT, there were significantly lower short-term mortality, lower major or clinically relevant bleeding, higher utilization of advanced therapies and lower hospital length of stay with the existence of PERT. PERT should be the standard of care for the management of patients with acute PE.

August 2025

Matson SM, Kim GHJ, Humphries SM, Roth MD, Goldin J, Tashkin DP, Leng M, England BR, Lee JS, Volkmann ER.

BACKGROUND: The defining radiological features of autoimmune interstitial lung disease (ILD) are ground glass opacification (GGO) and fibrosis. The associations between these features and physiological response to immunomodulation remain unclear. METHODS: This study leveraged three autoimmune ILD cohorts: two with systemic sclerosis (SSc) and one with rheumatoid arthritis (RA) which were selected for inherent differences in fibrotic extents/patterns. Linear regression models examined associations between baseline quantitative GGO, fibrosis, their ratio and forced vital capacity (FVC)%-predicted changes after 12 months of immunomodulatory therapy.

August 2025

Matsumoto S, Imamura H, Takayanagi A, Fukumitsu R, Goto M, Sunohara T, Fukui N, Omura Y, Akiyama T, Fukuda T, Go K, Kajiura S, Shigeyasu M, Asakura K, Horii R, Naramoto Y, Nishii R, Yamamoto Y, Sakai C, Imahori T, Kaneko N, Tateshima S, Sakai N.

BackgroundAn exchange maneuver is useful for the delivery of devices to target vessels. However, hemorrhagic complications can occur due to vessel perforation during an exchange maneuver. In addition, the exchange is often challenging due to unfavorable anatomy. Center Wire is an exchange-length wire with a nondetachable stent that was developed to improve navigation and stability during exchange maneuvers. The aim of this study is to investigate the safety and efficacy of Center Wire of the anchor wire technique during neuroendovascular treatment.MethodsTen patients with intracranial aneurysms were treated after signing a Certified Review Board-approved consent. Anchor wire technique was used in all patients to navigate catheters to the target vessel for aneurysm treatment.ResultsAnchor wire technique was successfully applied in all 10 cases using Center Wire. One device-related incident of vasospasm occurred which was asymptomatic. No device-related dissection, perforation, or thromboembolic events occurred. One patient had intraoperative aneurysm rupture during coil placement which was treated immediately without clinical consequences. Two patients had postoperative ischemic strokes due to thrombotic occlusion of branches originating from the aneurysm which were unrelated to the device.ConclusionsThis first-in-human trial of Center Wire demonstrated the safety and efficacy of the anchor wire technique for neuroendovascular treatment in a strictly regulated prospective registry trial.

August 2025

Park J, Bang S, Han K, Kwon JH, Kim MD, Won JY, Kim GM, Lee EW.

PURPOSE: To evaluate factors contributing to technical failure in stent placement for malignant portal vein (PV) occlusion from pancreatic and biliary malignancies and compare effectiveness and safety of bare-metal stents (BMSs) and stent grafts (SGs). MATERIALS AND METHODS: The study included 69 patients with malignant PV occlusion who underwent 74 stent placement procedures between January 2018 and March 2023. Clinical and laboratory parameters were compared between technical success (n = 64) and failure (n = 10) cases and between BMS (n = 48) and SG (n = 16) groups. Clinical success, stent patency, and overall survival (OS) were compared between the 2 groups. Risk factors for stent occlusion and procedure-related adverse events were evaluated.

August 2025

Prochilo G, Li C, Miliotou E, Nakasone R, Pfeffer A, Beaman C, Kaneko N, Liebeskind DS, Hinman JD.

Intracranial atherosclerotic disease (ICAD) is a major cause of stroke globally, with mechanisms presumed to be shared with atherosclerosis in other vascular regions. Due to the scarcity of relevant animal models, testing biological hypotheses specific to ICAD is challenging. We developed a workflow to create patient-specific models of the middle cerebral artery (MCA) from neuroimaging studies, such as CT angiography. These models, which can be endothelialized with human endothelial cells and subjected to flow forces, provide a reproducible ICAD model. Using imaging from the SAMMPRIS clinical trial, we validated this novel model. Computational fluid dynamics flow velocities correlated strongly with particle-derived flow, regardless of stenosis degree. Post-stenotic flow disruption varied with stenosis severity. Single-cell RNA-seq identified flow-dependent endothelial gene expression and specific endothelial subclusters in diseased MCA segments, including upregulated genes linked to atherosclerosis. Confocal microscopy revealed flow-dependent changes in endothelial cell proliferation and morphology in vessel segments related to stenosis. This platform, rooted in the specific anatomy of cerebral circulation, enables detailed modeling of ICAD lesions and pathways. Given the high stroke risk associated with ICAD and the lack of effective treatments, these experimental models are crucial for developing new ICAD-related stroke therapies.

August 2025

Riskin-Jones HH, Raman AG, Kulkarni R, Arnold CW, Sisk A, Felker E, Lu DS, Marks LS, Raman SS.

PURPOSE: We analyzed the additional value of systematic biopsy (SB) to MR-Ultrasound fusion biopsy (MRgFbx) for detection of clinically significant prostate cancer (csPCa), as increased sampling may cause increased morbidity. MATERIALS AND METHODS: This retrospective study cohort was comprised of 1229 biopsy sessions between July 2016 and May 2020 in men who had a Prostate Imaging-Reporting and Data System (PI-RADSv2) category ≥ 3 lesion on 3 Tesla multiparametric MRI (3TmpMRI) and subsequent combined biopsy (CB; MRgFbx and SB) for suspected prostate cancer (PCa). Cancer detection rates (CDR) were calculated for CB, MRgFbx and SB in the study cohort and sub-cohorts stratified by biopsy history and PI-RADSv2 category. For 927 men with unilateral MR-visible lesions, SB CDR was additionally calculated for contralateral (SBc) and ipsilateral (SBi) subcohorts.

August 2025

Sanvito F, Nocera G, Wang Z, Shiuan E, Sun L, Oshima S, Kim A, Kryukov I, Shao G, Cho NS, Salamon N, Ellingson BM, Prins R, Kim W, Yao J.

BACKGROUND: MRI-derived apparent diffusion coefficient (ADC) and contrast-enhancement (CE) may represent noninvasive biomarkers to evaluate microstructural tissue changes and histopathological immune cell infiltration induced by immune checkpoint inhibitors (ICI). METHODS: One hundred and twenty-five lesions across 93 patients were analyzed. ADC (reflecting water diffusivity) and CE T1-subtraction maps (reflecting blood-brain barrier permeability) tumor values were used for bivariate histograms of ADC and CE, and to quantify voxel fractions belonging to highADC-highCE and lowADC-lowCE quadrants. The association between ICI exposure and voxel frequency in ADC-CE quadrants was evaluated with multivariate mixed-effects models accounting for corticosteroid exposure and other variables. In a subset of patients (n = 23), the association between immune cell counts (CD45 + cell density) from tissue samples and ADC-CE phenotypes was tested.

August 2025

Wang Z, Solomon A, Lupo JM, Yao J.

Huntington's disease (HD) is a progressive neurodegenerative disorder caused by cytosine-adenine-guanine repeat expansion in the huntingtin (HTT) gene, leading to widespread brain atrophy and white matter degeneration. Although cortico-striatal pathways have been extensively studied, the dentato-rubro-thalamic tract (DRTT), a key cerebellar efferent pathway integrating motor and cognitive functions, remains largely unexplored, despite increasing evidence of cerebellar involvement in these functions. By investigating microstructural alterations along the DRTT, we aim to elucidate its role in HD progression and its association with motor and cognitive impairments, providing insights into the potential contribution of the DRTT to disease severity and clinical outcomes. We retrospectively analyzed 1392 scans from 638 participants across three multinational HD cohorts (TRACK-HD/ON, PREDICT-HD, and IMAGE-HD) with standardized inclusion criteria, and applied the HD-ISS to categorize disease stages. Probabilistic tractography was performed on diffusion MRI data to reconstruct ipsilateral and decussating DRTT pathways ending in the motor or pre-frontal cortices, with fractional anisotropy (FA) and mean diffusivity (MD) values extracted along 100 nodes per tract. Along-tract analyses were conducted using linear mixed-effects models to assess group differences and correlations with motor and cognitive scores, while controlling for covariates. Significantly decreased FA and increased MD were observed in premanifest HD (PM, HD-ISS Stage 0 and 1) and manifest HD (HD, HD-ISS Stage 2 and 3) groups and over time compared to healthy controls (HC) across multiple regions along the DRTT, particularly in the dentate nucleus region and dentate nucleus-red nucleus projection. These microstructural changes were correlated to the greater motor and cognitive impairments. Conversely, the DRTT thalamo-cortical projection exhibited an opposite pattern, with higher FA in PM and HD than in HC. Both FA and MD were also positively correlated with motor score within this segment. Along-tract analysis revealed microstructural disruptions across DRTT in both premanifest and manifest HD individuals, suggesting that the DRTT plays a role in HD progression. Our findings also highlight the value of assessing regional changes along the tract. These segment-specific white matter alterations provide additional insights into HD pathology and may serve as biomarkers for motor and cognitive impairments in HD.

August 2025

Yu TT, Hoyt AC, Joines MM, Fischer CP, Yaghmai N, Chalfant JS, Chow L, Mortazavi S, Sears CD, Sayre J, Elmore JG, Hsu W, Milch HS.

BACKGROUND: European studies suggest that artificial intelligence (AI) can reduce interval breast cancers. Research on interval breast cancer classification and AI's effectiveness in the United States, however, particularly using digital breast tomosynthesis and annual screening, is limited. We aimed to mammographically classify interval breast cancers and assess AI performance using a 12-month screening interval. METHODS: From digital mammography and digital breast tomosynthesis screening mammograms acquired between 2010 and 2019 at a US tertiary-care academic center, we identified interval breast cancers diagnosed less than 12 months after a negative mammogram. At least 3 breast radiologists retrospectively classified interval breast cancers as missed-reading error, minimal signs-actionable, minimal signs-nonactionable, true interval, occult, or missed-technical error. A deep-learning AI tool assigned risk scores ranging from 1 to 10 to the negative index screening mammograms, with scores of 8 or higher considered "flagged." Statistical analysis evaluated associations among interval breast cancer types and AI exam scores, AI markings, and patient and tumor characteristics.

July 2025

Daida A, Panchavati S, Oana S, Kanai S, Zhang Y, Ding Y, Rajsekar RR, Salamon N, Sankar R, Fallah A, Hussain SA, Roychowdhury V, Speier W, Nariai H.

Objective: Although the role of subcortical structures in the generation of epileptic spasms has been proposed, supporting evidence remains limited. This study aimed to provide neurophysiological evidence of thalamocortical network involvement during epileptic spasms. Methods: We analyzed four patients (ages 2.7-16.9 years) with epileptic spasms who underwent intracranial electroencephalography (EEG) monitoring with thalamic sampling in preparation for potential neurostimulation. Epileptic spasms were initially assessed using visual inspection and time-frequency analysis. We then evaluated undirected connectivity through coherence analysis and directed connectivity using spectral Granger causality analysis between the thalamus and the seizure-onset zone, focusing on ictal connectivity changes in both slow (0.5-10 Hz) and fast (10-80 Hz) frequency bands. In addition, phase-amplitude coupling was assessed with a modulation index to examine the interaction between ictal slow and fast band activities.

July 2025

Hu Z, Chen Z, Cao T, Lee HL, Xie Y, Li D, Christodoulou AG.

Purpose: To develop a deep subspace learning network that can function across different pulse sequences. Methods: A contrast-invariant component-by-component (CBC) network structure was developed and compared against previously reported spatiotemporal multicomponent (MC) structure for reconstructing MR Multitasking images. A total of 130, 167, and 16 subjects were imaged using T₁, T₁-T₂, and T₁-T₂-T₂*-fat fraction (FF) mapping sequences, respectively. We compared CBC and MC networks in matched-sequence experiments (same sequence for training and testing), then examined their cross-sequence performance and generalizability by unmatched-sequence experiments (different sequences for training and testing). A "universal" CBC network was also evaluated using mixed-sequence training (combining data from all three sequences). Evaluation metrics included image normalized root mean squared error and Bland-Altman analyses of end-diastolic maps, both versus iteratively reconstructed references.

July 2025

Keskin K, Cui SX, Li B, Gross JS, Acharya J, Buser Z, Lieberman JR, Hargreaves BA, Nayak KS.

PURPOSE: To compare 0.55 T and 3 T MRI for imaging patients with titanium total hip arthroplasty (THA). Patients with orthopedic metallic implants often require diagnostic imaging to evaluate adjacent tissues. MRI performance measures, including artifact levels and SNR, vary with field strength. METHODS: Six patients with titanium THA were scanned with similar protocols at 0.55 T and 3 T, including proton density (PD) weighted turbo spin echo (TSE), PD TSE with view-angle tilting (TSE + VAT), PD slice encoding for metal artifact correction (SEMAC), and short tau inversion recovery with SEMAC (STIR-SEMAC). Images from both field strengths were scored by two readers and qualitatively and quantitatively compared.

July 2025

Khot R, Ganeshan D, Sundaram KM, Depetris JN, Ludwig DR.

Biliary and peribiliary cystic lesions represent a diverse group of abnormalities, often discovered incidentally during imaging for unrelated conditions. These lesions, typically asymptomatic, necessitate precise imaging modalities to characterize their nature and determine subsequent clinical actions, such as follow-up imaging, biopsy, or surgical referral. The anatomic location of these cystic lesions, whether biliary or peribiliary, influences both diagnostic and prognostic outcomes. Biliary cystic lesions, such as mucinous cystic neoplasms, intraductal papillary neoplasms of the bile duct, and Caroli disease, require careful monitoring due to their propensity to develop malignancy. In contrast, peribiliary cysts are often associated with chronic liver disease and may indicate disease progression through a gradual increase in cyst size. Accurate differentiation of these lesions from other clinical entities that have overlapping features on imaging, such as microabscesses, bilomas, Langerhans cell histiocytosis, neurofibromatosis, and vascular anomalies such as cavernous transformation of the portal vein, is essential given the divergent management for each. This article focuses on intrahepatic biliary and peribiliary cystic lesions and their mimics, highlighting their imaging characteristics with an emphasis on magnetic resonance imaging and magnetic resonance cholangiopancreatography, differential diagnosis, potential associated complications, and clinical management.

July 2025

Sanvito F, Kryukov I, Yao J, Teraishi A, Raymond C, Gao J, Miller C, Nghiemphu PL, Lai A, Liau LM, Patel K, Everson RG, Eldred BSC, Prins RM, Nathanson DA, Salamon N, Cloughesy TF, Ellingson BM.

PURPOSE: Recurrent glioblastomas showing a survival benefit from anti-VEGF agents are known to exhibit a distinct diffusion MRI phenotype. We aim to characterize advanced imaging features of this glioblastoma subset. METHODS: MRI scans from 87 patients with IDH-wildtype glioblastoma were analyzed. All patients had completed standard chemoradiation and were anti-VEGF-naïve. Contrast-enhancing tumor segmentations were used to extract: the lowest peak of the double gaussian distribution of apparent diffusion coefficient values (ADCL) calculated from diffusion MRI, relative cerebral blood flow (rCBV) values from perfusion MRI, MTRasym @ 3ppm from pH-weighted amine CEST MRI, quantitative T₂ and T₂* relaxation times (qT₂ and qT₂*), T_1w subtraction map values, and contrast-enhancing tumor volume. Lesions were categorized as high- or low-ADC_L using a cutoff of 1240 µm²/s, according to previous studies.

July 2025

Zhang T, Ding R, Luong KD, Hsu W.

OBJECTIVE: Although the role of subcortical structures in the generation of epileptic spasms has been proposed, supporting evidence remains limited. This study aimed to provide neurophysiological evidence of thalamocortical network involvement during epileptic spasms. METHODS: We analyzed four patients (ages 2.7-16.9 years) with epileptic spasms who underwent intracranial electroencephalography (EEG) monitoring with thalamic sampling in preparation for potential neurostimulation. Epileptic spasms were initially assessed using visual inspection and time-frequency analysis. We then evaluated undirected connectivity through coherence analysis and directed connectivity using spectral Granger causality analysis between the thalamus and the seizure-onset zone, focusing on ictal connectivity changes in both slow (0.5-10 Hz) and fast (10-80 Hz) frequency bands. In addition, phase-amplitude coupling was assessed with a modulation index to examine the interaction between ictal slow and fast band activities.

June 2025

Chalian H, Askarinejad A, Salmanipour A, Jolfayi AG, Bedayat A, Ordovas K, Asadian S.

BACKGROUND: Systemic sclerosis (SSc) is an immune dysregulation disorder affecting multiple organs. Cardiac involvement, prevalently myocardial, is associated with poor outcomes in SSc patients. Several investigations explored the role of cardiac magnetic resonance (CMR) imaging in the diagnosis of scleroderma-related cardiomyopathy and analyzed the clinical, radiologic, and pathologic correlations utilizing CMR examinations. However, fewer studies investigated the role of traditional and novel CMR parameters, including functional values, strain, late gadolinium enhancement (LGE), and parametric mapping variables, in predicting outcomes in SSc patients. We aimed to review the literature to seek for the role of different CMR features in outcome prediction of SSc patients. METHODS: We systematically reviewed PubMed/Medline, EMBASE, Web of Science, and Scopus databases to find publications that analyzed the prognostic value of CMR-derived parameters for adverse events, particularly all-cause mortality, in SSc patients published from January of 1960, up to the May 1, 2023. In this regard, we excluded the reviews, editorials, case reports, and case series. Also, we excluded the studies with the target population possessing obstructive coronary artery disease, other rheumatologic conditions, moderate to severe pulmonary hypertension and history of intervention for arrhythmia. Two of the authors principally extracted data, and disagreements were resolved through consensus. Information from each investigation was registered. Two of the authors utilized the Quality in Prognostic Studies (QUIPS) tool for risk of bias assessment, and a third reviewer was involved in cases of inconsistencies. Consequently, the main findings of the conducted projects were outlined and depicted in tables.

June 2025

Li D, Syriani DA, Gupta S, Hui J, Hanley J, Sayre J, Tse G, Hao F, Bahrami S, Felker E, Douek M, Lu D, McWilliams J, Raman S.

PURPOSE: Percutaneous ultrasound-guided renal biopsy is essential for diagnosing medical renal disorders in transplant kidneys. A variety of techniques have been advocated. The purpose of this study is to evaluate the safety and efficacy of two different coaxial techniques and biopsy devices. METHODS: This single-center dual-arm, observation study cohort included 1831 consecutive transplant kidney biopsies performed over a 68-month period. Two coaxial techniques were used, distinguished by whether the 17 gauge (G) coaxial needle was advanced into the renal cortex (intracapsular technique; IC) or to the edge of the cortex (extracapsular technique; EC). One of two needle types could be used with either technique: an 18G side-cutting (Bard Max-Core or Mission) or an 18G end-cutting (Biopince Ultra) needle. In all cases, the cortical tangential technique was used to reduce the risk of central artery transgression and unnecessary medullary sampling. Patients were monitored for 30 days post-procedurally and complications were evaluated using the SIR adverse event classification.

June 2025

Shyn PB, Patel MD, Itani M, Gupta AC, Burgan CM, Planz V, Galgano SJ, Lamba R, Raman SS, Yoshikawa MH.

This paper is a multi-institutional review of image-guided renal parenchymal biopsies. Among the topics covered are indications, preprocedural considerations, biopsy technique, complications, and postprocedural management. Both native kidney and transplant kidney biopsies are considered in this review.

June 2025

Te TT, Bui AAT, Fung CH, Boland MR.

BACKGROUND: There is evidence of increased risk of cognitive disability due to short sleep duration and adverse Social Determinants of Health (SDoH). To determine whether spatial associations (correlation between spatially distributed variables within a given geographic area) exist between neighborhoods with short sleep duration and cognitive disability across the United States (US) after adjusting for other factors. We conducted a spatial analysis using a spatial lag model at the neighborhood-level with the census tract as unit-of-analysis within each state in the US. We aggregated our results nationally using a weighted analysis to adjust for the number of census tracts per state. This study used Centers for Disease Control and Prevention (CDC) data on short sleep duration, cognitive disability and other health factors. We used 2021-2022 neighborhood-level data from the CDC and US Census Bureau adjusting for social determinants of health (SDoH) and demographics, excluding Florida due to inconsistencies in data availability. Our exposure variable was self-reported short sleep defined by the CDC ("sleep less than 7 hours per 24 hour period"). Our outcome was self-reported cognitive disability defined by the CDC ("difficulty concentrating, remembering, or making decision"). We adjusted for other factors including 'health outcomes', 'preventive practices', and the CDC's Social Vulnerability Index.

June 2025

Tian J, Ha YJ, Lee JS, Lee EY, Goldin JG, Kim GJ.

BACKGROUND: Analyzing longitudinal real-world data with nonuniform study-time intervals is challenging. This study aimed to identify subgroups in heterogeneous clinical courses of idiopathic inflammatory myopathies-associated interstitial lung disease (IIM-ILD) using a growth rate model and to assess their prognostic significance. METHODS: In this retrospective cohort study, 243 chest high-resolution computed tomography (HRCT) scans from 80 patients with IIM-ILD were analyzed using a computer-aided quantification system to estimate quantitative lung fibrosis (QLF) scores. Longitudinal patterns were identified through a growth-rate model, and a landmark survival analysis was performed using the last HRCT date as an anchor.

June 2025

Toussie D, Azour L, Garrana S, Platt S, Osei K, Asare B, Zinzuwadia S, Voutsinas N, Zhou F, Czum JM.

Pulmonary high attenuation may be caused by calcification or ossification, both of which are common phenomena with distinct pathogeneses, histologies, and radiologic appearances. Pulmonary calcification is divided into metastatic pulmonary calcification (MPC), caused by systemic hypercalcemia, and dystrophic pulmonary calcification (DPC), caused by local lung injury. MPC often demonstrates diffuse calcified nodules, which can be subtle and amorphous on CT images, with associated sandlike, fine ground-glass, or consolidative opacities. Conversely, DPC often appears nodular and is localized to areas of lung injury and thus is associated with other signs of lung damage, such as prior infection, fibrosis, or scarring. In contrast to calcification, pulmonary ossification is not a consequence of a localized or systemic metabolic abnormality but instead is found in the setting of chronic lung disease, which induces fibroblast-to-osteoblast transformation and bone deposition. Pulmonary ossification can be divided into nodular (NPO) and dendriform (DPO) patterns. NPO often appears as multiple small well-defined round nodules that are uniform in size and appearance. NPO classically is seen with chronic venous congestion in a subpleural predominant distribution and increasingly is recognized in pathologic findings in the setting of fibrosing interstitial lung disease (ILD). DPO appears more commonly as peripheral irregular branching opacities and can be seen with ILD. Additionally, pulmonary calcification or ossification can occur in association with protein deposition disease, including pulmonary amyloidosis, or in benign neoplasms or metastatic malignancies. Pulmonary alveolar microlithiasis is a distinct entity relating to phosphate metabolism. Pulmonary calcification and ossification can provide insight into patients' underlying disease processes and clinical context for radiologic study interpretation. ©RSNA, 2025 Supplemental material is available for this article.

June 2025

Xu H, Renella P, Badiyan R, Hindosh ZR, Elisarraras FX, Zhu B, Satou GM, Husain M, Finn JP, Hsu W, Nguyen KL.

OBJECTIVES: Congenital heart disease (CHD) patients with single ventricle physiology (SVP) have heterogeneous characteristics that challenge cohort classification. We aim to develop a phenotyping algorithm that accurately identifies SVP patients using electronic health record (EHR) data. MATERIALS AND METHODS: We used ICD-9 and ICD-10 codes for initial classification, then enhanced the algorithm with domain expertise, imaging reports, and progress notes. The algorithm was developed using a cohort of 1020 patients who underwent magnetic resonance imaging scans and tested in a separate cohort of 2500 CHD patients with adjudication. Validation was performed in a holdout group of 22 500 CHD patients. We evaluated performance using accuracy, sensitivity, precision, and F1 score, and compared it to a published algorithm for SVP using the same dataset.

May 2025

Albert NL, Galldiks N, Ellingson BM, van den Bent MJ, Chang SM, Cicone F, Koh ES, Law I, Le Rhun E, Mair MJ, Werner JM, Berghoff AS, Furtner J, Minniti G, Scott AM, Short SC, Ivanidze J, Johnson DR, Suchorska B, Tolboom N, Tonn JC, Verger A, Galanis E, Brastianos PK, Wen PY, Weller M, Lin NU, Preusser M.

Novel diagnostic and therapeutic opportunities are needed to improve medical care and outcome of patients with brain metastases, a frequent and severe complication of several cancer types. Currently, magnetic resonance imaging (MRI) is the primary method used for detection, treatment planning and disease monitoring in patients with brain metastases, but this method has limitations. These limitations mean that MRI can inform on lesion size but cannot directly measure the activity or viability of tumor tissue. Positron emission tomography (PET) imaging, however, can visualize metabolically active tumor cells and is therefore increasingly incorporated into cancer care to assess tumor burden and response to treatment. Here, we define the PET Response Assessment in Neuro-Oncology (RANO) for brain metastasis (BM) 1.0 criteria for metabolic response assessment of brain metastases using amino acid PET. By introducing an innovative endpoint for next-generation clinical trials, the PET RANO BM 1.0 criteria aim to facilitate development of novel therapies for patients with brain metastases.

May 2025

Araujo-Espinoza G, Dajani AH, Ghazikhanian V, Salituro A, Kremen TJ Jr.

A 22-year-old right hand–dominant male competitive intercollegiate water polo player with no prior history of right brachium muscle injury was participating in riding a foil board while being towed behind a boat. During a maneuver, the tow line of the boat became tangled and circumferentially wrapped around his right brachium at which time he was dragged off the foil board and towed for several seconds until the boat stopped. He had immediate pain and was taken to the emergency room for evaluation of significant brachium swelling and ecchymosis; however, he was neurovascularly intact with no signs of acute compartment syndrome.

May 2025

Athreya S, Melehy A, Suthahar SSA, Ivezić V, Radhachandran A, Sant VR, Moleta C, Zheng H, Patel M, Masamed R, Livhits M, Yeh M, Arnold CW, Speier W.

OBJECTIVE: Indeterminate cytology (Bethesda III and IV) represents 15-30% of biopsied thyroid nodules and require additional diagnostic testing. Molecular testing (MT) is a commonly used diagnostic tool that evaluatesmalignancy risk through next generation sequencing of fine needle aspiration (FNA) samples. While MT achieves high sensitivity (97-100%) in ruling out malignancy, its specificity and positive predictive value (PPV) remain relatively low. This study proposes a multimodal deep learning model that integrates ultrasound (US) imaging with MT to improve risk stratification by enhancing PPV while maintaining high sensitivity. Combining these modalities leverages complementary information from both molecular and imaging data, addressing limitations in current approaches and offering a robust framework for evaluating indeterminate nodules. METHODS: We retrospectively analyzed 333 patients with indeterminate thyroid nodules (259 benign, 74 malignant) at UCLA Medical Center between 2016 and 2022. We evaluated four configurations: whole frame US images, 256 x 256 patches, 128 x 128 patches, and an ensemble model combining the first three configurations. The clinical baseline consisted of Bethesda cytology and MT results. Models were assessed using five fold cross validation stratified by surgical outcomes.

May 2025

Daida A, Ding Y, Zhang Y, Oana S, Panchavati S, Edmonds BD, Ahn SS, Salamon N, Sankar R, Fallah A, Staba RJ, Engel J Jr, Speier W, Roychowdhury V, Nariai H.

OBJECTIVE: To investigate high-frequency activities (HFA) associated with thalamic sleep spindles. METHODS: We studied a cohort of ten pediatric patients with medication resistant epilepsy who were identified as potential candidates for thalamic neuromodulation. These patients had thalamic sampling as well as presumed epileptogenic zones, using stereotactic EEG (SEEG) with a sampling frequency of 2,000 Hz. We quantified the summated high-frequency activity (HFA) in the fast ripple band associated with sleep spindles using 20-minute scalp EEG and SEEG recordings during non-REM sleep and analyzed its correlation with spindle characteristics.

May 2025

Dawar R, Grimm LJ, Sonnenblick EB, Dontchos BN, Coffey K, Goudreau S, Reig B, Jacobs SA, Shah Z, Mullen L, Dialani V, Dawar R, Sayre J, Dodelzon K, Parikh JR, Milch HS.

OBJECTIVE: Assess current practices and plans regarding home workstations and remote diagnostic breast imaging in the United States. METHODS: A 43-question survey relating to remote breast imaging was distributed to Society of Breast Imaging members from July 6, 2023, through August 2, 2023. A descriptive summary of responses was performed. Pearson's chi-squared test was used to compare demographic variables of respondents and questions of interest.

May 2025

de la Fuente MI, Touat M, van den Bent MJ, Preusser M, Peters KB, Young RJ, Huang RY, Ellingson BM, Capper D, Phillips JJ, Halasz LM, Shih HA, Rudà R, Lim-Fat MJ, Blumenthal DT, Weller M, Arakawa Y, Whittle JR, Ducray F, Reardon DA, Bi WL, Minniti G, Rahman R, Hervey-Jumper S, Chang SM, Wen PY.

Isocitrate dehydrogenase (IDH)-mutant gliomas are the most common malignant primary brain tumors in young adults. This condition imposes a substantial burden on patients and their caregivers, marked by neurocognitive deficits and high mortality rates due to tumor progression, coupled with significant morbidity from current treatment modalities. Although surgery, radiation therapy, and chemotherapy improve survival, these treatments can adversely affect cognitive function, quality of life, finances, employment status, and overall independence. Consequently, there is an urgent need for innovative strategies that delay progression and the use of radiation therapy and chemotherapy. The recent Federal Drug Administration (FDA) approval of vorasidenib, a brain-penetrant small molecule targeting mutant IDH1/2 proteins, heralds a shift in the therapeutic landscape for IDH-mutant gliomas. In this review, we address the role of vorasidenib in the treatment of IDH-mutant gliomas, providing a roadmap for its incorporation into daily practice. We discuss ongoing clinical trials with vorasidenib and other IDH inhibitors, as single-agent or in combination with other therapies, as well as current challenges and future directions.

May 2025

Ding R, Luong KD, Rodriguez E, da Silva ACAL, Hsu W.

In computational pathology, extracting and representing spatial features from gigapixel whole slide images (WSIs) are fundamental tasks, but due to their large size, WSIs are typically segmented into smaller tiles. A critical aspect of analyzing WSIs is how information across tiles is aggregated to predict outcomes such as patient prognosis. We introduce a model that combines a message-passing graph neural network (GNN) with a state space model (Mamba) to capture both local and global spatial relationships among the tiles in WSIs. The model's effectiveness was demonstrated in predicting progression-free survival among patients with early-stage lung adenocarcinomas (LUAD). We compared the model with other state-of-the-art methods for tile-level information aggregation in WSIs, including statistics-based, multiple instance learning (MIL)-based, GNN-based, and GNN-transformer-based aggregation. Our model achieved the highest c-index (0.70) and has the largest number of parameters among comparison models yet maintained a short inference time. Additional experiments showed the impact of different types of node features and different tile sampling strategies on model performance. Code: https://github.com/rina-ding/gat-mamba.

May 2025

Expert Panel on Musculoskeletal Imaging; Bartolotta RJ, Ha AS, Bateni CP, Chen KC, Dvorzhinskiy A, Flug J, Geannette CS, Karagulle Kendi AT, Laur O, Levenson RB, Mujahid N, Panginikkod S, Plant GM, Plotkin BE, Shih RD, Wessell DE.

Acute hip pain can be related to any combination of hip fracture, dislocation, and/or soft tissue injury. These injuries require timely diagnosis to avoid associated complications, such as osteonecrosis or prolonged immobility. Imaging plays a crucial role in the evaluation of these injuries, noting that hip fractures cannot be reliably diagnosed or excluded via physical examination alone. Radiographs are the initial imaging modality of choice for acute hip pain. Several recent studies have evaluated specific scenarios in which cross-sectional imaging (CT and/or MRI) should also be obtained-these scenarios will be reviewed as separate variants within this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

May 2025

Expert Panel on Musculoskeletal Imaging; Laur O, Ha AS, Bartolotta RJ, Avery R, Bateni CP, Chen KC, Dvorzhinskiy A, Flug J, Geannette CS, Hinkle T, Hogrefe C, Plotkin BE, Todd MJ, Chang EY.

Trauma is a predominant cause of acute shoulder pain, commonly secondary to fractures (clavicle, scapula, or proximal humerus) or soft tissue injuries (typically involving the rotator cuff, acromioclavicular ligaments, or labroligamentous complex). Radiography is the imaging modality of choice for initial assessment of acute shoulder pain and identification of potential fractures. In cases where radiographs yield normal or inconclusive results, additional imaging modalities such as ultrasound, MRI, or CT of the shoulder without contrast, or MR or CT arthrography, may be useful to diagnose the underlying pathology. These modalities aid in the detection of conditions including nondisplaced fractures, tears of the labrum and rotator cuff, as well as detailed assessment of soft tissue and bony injury following glenohumeral joint dislocation. This document presents a comprehensive review of the evidence supporting or refuting the use of various imaging modalities in diagnosing acute shoulder pain. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

May 2025

Expert Panel on Neurological Imaging; Ivanidze J, Shih RY, Utukuri PS, Ajam AA, Auron M, Chang SM, Jordan JT, Kalnins A, Kuo PH, Ledbetter LN, Pannell JS, Pollock JM, Sheehan J, Soares BP, Soderlund KA, Wang LL, Burns J.

Brain tumors represent a complex and clinically diverse disease group, whose management is particularly dependent on neuroimaging given the wide range of differential diagnostic considerations and clinical scenarios. The introduction of advanced brain imaging tools into clinical practice makes it paramount for all treating physicians to recognize the range and understand the appropriate application of various conventional and advanced imaging modalities. The imaging recommendations for neuro-oncologic clinical scenarios involving screening in patients with increased genetic risk, screening in patients with systemic malignancy, pretreatment evaluation in patients with intra- and extraaxial brain tumors, posttreatment-surveillance in patients with known brain tumors after completion of therapy, and subsequent workup in the context of suspected radiographic progression are encompassed by this document. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

May 2025

Fortes PA, Janzen C, Lei MYY, Vangala S, Sung K, Devaskar SU, Sullivan PS.

Objectives: Before the Amsterdam Placental Workshop Group Consensus Statement, standardization in placental pathology assessment did not exist. This study evaluated the Amsterdam criteria's utility in correlating ischemic placental disease (IPD) with placental pathologic lesions in a cohort of largely unsubmitted term placentas with favorable outcomes. Methods: In this prospective case-controlled study at a single institution, all placentas were examined using Amsterdam protocols for gross sampling and microscopic review by 2 reviewers who were blinded to clinical history. Pathologic findings including hypoxic and chronic villitis of unknown etiology (VUE) scores were correlated with IPD status and whether the placenta was submitted to pathology using either a χ² test or Fisher exact test, as appropriate.

May 2025

Ghovvati M, Jain S, Cheng GZ, Kaneko N, Boys JA, Imahori T, De Maeseneer T, Haghniaz R, Cameron RB, Weiss AS, Annabi N.

Treatment of injuries to soft elastic organs is often hindered by challenging anatomical features and limitations of existing sealant materials, which may lack adequate tissue adhesion, elasticity, biocompatibility, and effective hemostatic properties. To address these clinical challenges, we developed an injectable elastic sealant formulated with methacryloyl-modified human recombinant tropoelastin (MeTro) and Laponite silicate nanoplatelets (SNs). We optimized the hydrogel formulation for mechanical properties, adhesion, biocompatibility, and hemostatic properties and used visible light for cross-linking to improve safety. MeTro/SN hydrogels had increased tissue adhesion strength and burst pressure in vitro and ex vivo compared with MeTro alone or commercial sealants. The addition of SNs to the hydrogels facilitated faster blood clotting in vitro without increasing hemolysis. Applied to incisional injuries on rat lungs or aortas, MeTro/SN had burst pressures comparable to those of native tissue and greater than those of MeTro after a 7-day in vivo application. On porcine lungs, MeTro/SN also supported effective lung sealing and burst pressure similar to native lung 14 days after injury sealing. In a rodent tail hemostasis model, MeTro/SN reduced bleeding compared with MeTro. In an injured porcine lung model, early hemostasis was better than the tested commercial sealants. The results demonstrated that MeTro/SN provided effective tissue sealing and promoted hemostasis in a time frame that minimized blood loss without causing a major inflammatory response. These findings highlight the translational potential of our engineered sealant with biomimetic mechanics, durable tissue adhesion, and rapid hemostasis as a multipronged approach for the sealing and repair of traumatic injuries to soft organs.

May 2025

Kim GH, Zhang X, Brown MS, Poole L, Goldin J.

OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is a progressive interstitial lung disease. Chest high-resolution CT (HRCT) is instrumental in IPF management, and the Quantitative Lung Fibrosis (QLF) score is a computer-assisted metric for quantifying lung disease using HRCT. This study aimed to assess the change in QLF score associated with a minimum clinically important difference (MCID) of IPF symptoms and physiological lung function, and also determine the MCID of QLF change associated with all-cause mortality to serve as an imaging biomarker to confirm disease progression and response to therapy. DESIGN AND STUDY SETTING: We conducted post hoc analyses of prospective data from two IPF phase II studies of pamrevlumab, a fully human monoclonal antibody that binds to and inhibits connective tissue growth factor activity. PARTICIPANTS: Overall, 152 patients with follow-up visits after week 24. METHODS: We used the anchor-based Jaeschke's method to estimate the MCID of the QLF score that corresponded with the already established MCID of St. George's Respiratory Questionnaire (SGRQ) and percent-predicted forced vital capacity (ppFVC). We also conducted a Cox regression analysis to establish a sensitive and robust MCID of the QLF score in predicting all-cause mortality.

May 2025

Lin Y, Hoyt AC, Manuel VG, Inkelas M, Maehara CK, Ayvaci MUS, Ahsen ME, Hsu W.

Artificial intelligence (AI) shows promise in clinical tasks, yet its integration into workflows remains underexplored. This study proposes an AI-aided same-day diagnostic imaging workup to reduce recall rates following abnormal screening mammograms and alleviate patient anxiety while waiting for the diagnostic examinations. Using discrete simulation, we found minimal disruption to the workflow (a 4% reduction in daily patient volume or a 2% increase in operating time) under specific conditions: operation from 9 am to 12 pm with all radiologists managing all patient types (screenings, diagnostics, and biopsies). Costs specific to the AI-aided same-day diagnostic workup include AI software expenses and potential losses from unused pre-reserved slots for same-day diagnostic workups. These simulation findings can inform the implementation of an AI-aided same-day diagnostic workup, with future research focusing on its potential benefits, including improved patient satisfaction, reduced anxiety, lower recall rates, and shorter time to cancer diagnoses and treatment.

May 2025

McNulty C, Gerras J, Bradley D, Chalfant J, Yaghmai N, Fischer C, Rashid M, Li B, Sayre J, Milch H, Chan T.

Breast radiology is a unique field that combines diagnostic imaging with patient interaction. Breast radiologists deliver results and recommendations to patients, whether good news (such as a benign finding) or bad news (such as a biopsy recommendation). Since many breast imaging centers task the radiologist with delivering results to the patient immediately after reviewing their diagnostic imaging, knowing how to explain imaging findings in layman's terms while offering empathy in a calm and professional demeanor is critical. These conversations can be challenging due to patient anxiety, radiologist burnout, and increasing patient volumes resulting in limited time to speak to each patient.

May 2025

Wells JR, Christianson O, Gress DA, Gingold E, Jacobs J, Boedeker K, Ramirez-Giraldo JC, Yu L, McNitt-Gray M, Samei E.

CMS has adopted a new CT quality measure seeking to discourage excessive radiation dose while preserving image quality. The measure score is expressed as the percentage of qualifying studies that exceed predetermined thresholds, indicating inadequate image quality (based on image noise) or excessive radiation dose. The measure has been incorporated into the major CMS quality-based payment programs, impacting hospitals and clinician payments; measure reporting began in January 2025. After measure development, practitioners identified a spectrum of concerns and impediments, prompting the American Association of Physicists in Medicine to convene a multidisciplinary expert panel to provide further guidance. The panel identified 20 issues and ambiguities in the measure specifications, stemming from metrology concerns, unconventional terminology, and inconsistencies with practice standards or norms; these issues relate to themes of applicability, categories and metrics, informatics, performance expectations, and meta considerations. In this article, the panel presents these issues and ambiguities with associated recommendations to promote the measure's intentions. These recommendations include greater data access (e.g., to the measure's source data and to reporting elements for audit support) and a more holistic treatment of image quality. The panel ultimately urges a shift toward open-source, open-access, consensus-based, and community-owned strategies to ensure CT quality and safety.

May 2025

Young RP, Scott RJ, Callender T, Duan F, Billings P, Aberle DR, Gamble GD.

BACKGROUND: Epidemiological studies suggest lung cancer results from the combined effects of smoking and genetic susceptibility. The clinical application of polygenic risk scores (PRSs), derived from combining the results from multiple germline genetic variants, have not yet been explored in a lung cancer screening cohort. METHODS: This was a post hoc analysis of 9191 non-Hispanic white subjects from the National Lung Screening Trial (NLST), a sub-study of high-risk smokers randomised to annual computed tomography (CT) or chest X-ray (CXR) and followed for 6.4 years (mean). This study's primary aim was to examine the relationship between a composite polygenic risk score (PRS) calculated from 12 validated risk genotypes and developing or dying from lung cancer during screening. Validation was undertaken in the UK Biobank of unscreened ever-smokers (N = 167,796) followed for 10 years (median).

May 2025

Zabihollahy F, Wu HH, Sisk AE, Reiter RE, Raman SS, Fleshner NE, Yousef GM, Sung K.

PURPOSE: To develop and evaluate a novel deep learning-based approach for registering presurgical MR and whole-mount histopathology (WMHP) images of the prostate. MATERIALS & METHODS: This retrospective study included patients who underwent prostate MRI before radical prostatectomy between July 2016 and June 2020. High-resolution ex vivo MRI was used as a reference to assess the structural relationship between in vivo MRI and WMHP. An Anatomy-Aware Morph model, a hybrid attention and convolutional neural network-based approach, was developed for multimodality prostate image registration. The pipeline included a module to estimate and correct distortion and motion between the prostate specimen and outside the human body. The dataset was divided into 270 and 45 patients for training and testing, respectively. Registration accuracy was evaluated using Dice similarity coefficient (DSC), Hausdorff distance, and target registration error.

May 2025

Zhao C, Lee YT, Melehy A, Kim M, Yang JZ, Zhang C, Kim J, Zhang RY, Lee J, Kim H, Ju Y, Tsai YJ, Zhou XJ, Han SB, Sadeghi S, Finn RS, Saab S, Lu DS, Chiang J, Park JH, Brennan TV, Wisel SA, Alsudaney M, Kuo A, Ayoub WS, Kim H, Trivedi HD, Wang Y, Vipani A, Kim IK, Todo T, Steggerda JA, Voidonikolas G, Kosari K, Nissen NN, Saouaf R, Singal AG, Sim MS, Elashoff DA, You S, Agopian VG, Yang JD, Tseng HR, Zhu Y.

BACKGROUND: There are no validated biomarkers for assessing hepatocellular carcinoma (HCC) treatment response (TR). Extracellular vesicles (EVs) are promising circulating biomarkers that may detect minimal residual disease in patients with treated HCC. METHODS: We developed the HCC EV TR Score using HCC EV Digital Scoring Assay involving click chemistry-mediated enrichment of HCC EVs, followed by absolute quantification of HCC EV-specific genes by RT-digital PCR. Six HCC EV-specific genes were selected and validated through i) a comprehensive data analysis pipeline with an unprecedentedly large collection of liver transcriptome datasets (n = 9,160), ii) RNAscope validation on HCC tissues (n = 6), and iii) a pilot study on early- or intermediate-stage HCC and liver cirrhosis patients (n = 70). The performance of HCC EV TR Score was assessed in a phase-2 retrospective case-control study (n = 100).

April 2025

Beaman C, Molaie A, Ghochani Y, Fukuda K, Peterson C, Kaneko N, Nour M, Szeder V, Colby GP, Tateshima S, Jahan R, Duckwiler G.

BACKGROUND: Spinal epidural arteriovenous fistulas (SEDAVFs) are rarely diagnosed vascular malformations that can cause spinal cord compression and congestive myelopathy. METHODS: This is a single-center, retrospective case series of patients with SEDAVFs who underwent observation or treatment at UCLA medical center between 1993 and 2023.

April 2025

Jalili MH, Chung A, Bradley D, Hassani C, Prosper AE, Finn JP, Bedayat A.

Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease and imaging plays a key role in diagnosis, pre-operative planning and follow up, with MRI as the gold standard for imaging in these patients despite echocardiography being more widely available. While static MRI sequences are suitable for evaluation of anatomical structures, dynamic imaging is required for volume and flow measurements through valves, chambers, and surgical conduits. Newer techniques with 4D data acquisitions allow for feasible 2D cine reconstruction in desired planes. Ferumoxytol, a blood pool contrast agent with long intravascular half-life, facilitates acquisition of 4D flow and 4D MUSIC (multiphase, steady-state imaging with contrast) sequences, eliminating need for repeated contrast administrations. In this article we review conglomerate of TOF anomalies, their historical and current surgical managements with respective devices, as well as cutting-edge MRI techniques for their evaluation.

Spring 2025

Lanuti M, Suh RD, Criner GJ, Mazzone PJ, Marshall MB, Tong B, Merritt RE, Wolf A, Keshavarz H, Loo BW, Mak RH, Brunelli A, Walsh G, Liptay M, Wafford QE, Murthy S, Pettiford B, Rocco G, Luketich J, Schuchert MJ, Varghese TK, D'Amico TA, Swanson SJ, Pennathur A; AATS Clinical Practice Standards Committee: Thoracic Surgery.

Image-guided thermal ablation (IGTA) applied to pulmonary pathology is an alternative to surgery in high-risk patients with stage I non-small cell lung cancer (NSCLC). Its application to lung neoplasm was first introduced in 2001 and has been implemented to treat metastatic disease to the lung or in select medically inoperable patients with peripheral stage I NSCLC. IGTA may also be an alternative to treat stage I NSCLC in non-operable patients with interstitial lung disease in whom a radiation modality is deemed too high risk. There are 3 methods of delivery: radiofrequency ablation (RFA), microwave ablation and cryoablation. Observational series and some prospective trials have shown safety and efficacy across all three modalities. Despite accumulating experience, there are no large randomized clinical trials comparing the outcomes of lung IGTA to alternative locoregional therapies (eg, stereotactic body radiotherapy or sublobar pulmonary resection) for the treatment of stage I NSCLC. Because IGTA is a local therapy, a higher risk of locoregional recurrence is inherently understood as compared with anatomic resection. In the literature, primary tumor control after RFA ranges from 47 to 90% and is dependent on tumor size and proximity to bronchovascular structures. Local failure ranges from 10 to 47%, and tumors ≥3 cm have the highest rate of local recurrence. The most prevalent side effects are pneumothorax and reactive pleural effusion; hemorrhage is uncommon. Of note, observational series show no significant loss of lung function after IGTA. This expert review contextualizes limitations, complications and outcomes of IGTA in patients with stage I NSCLC.

Spring 2025

Merritt RE, Brunelli A, Walsh G, Murthy S, Schuchert MJ, Varghese TK, Lanuti M, Wolf A, Keshavarz H, Loo BW, Suh RD, Mak RH, Criner GJ, Mazzone PJ, Liptay M, Wafford QE, Marshall MB, Tong B, Pettiford B, Rocco G, Luketich J, D'Amico TA, Swanson SJ, Pennathur A; AATS Clinical Practice Standards Committee: Thoracic Surgery.

Sublobar resection offers a parenchymal-sparing surgical alternative to lobectomy and includes wedge resection and segmentectomy. Sublobar resection has been historically utilized in high-risk patients with compromised lung function; however, the technique is becoming more prevalent for normal-risk patients with peripheral stage IA non-small cell lung cancer (NSCLC) <2 cm. In this article, we summarize the technique of sublobar resection, the importance of surgical margins and lymph node sampling, patient selection, perioperative complications, outcomes, and the impact of sublobar resection on the quality of life. There is limited data on short-term and long-term outcomes after sublobar resection for stage I NSCLC in high-risk patients. Results from randomized clinical trials (RCTs) of sublobar resection have been variable. We have summarized the results of the ACOSOG Z4032 RCT, which compared outcomes in high-risk patients who underwent sublobar resection alone versus sublobar resection with brachytherapy for stage I NSCLC. In addition, we have summarized recent findings of the CALGB/Alliance 140503 RCT comparing sublobar resection and lobectomy, which suggested that disease-free survival after sublobar resection in patients with small (<2 cm) peripheral stage IA NSCLC was non-inferior to lobectomy, and another RCT (JCOG 0802) of segmentectomy vs. lobectomy for small peripheral clinical stage IA NSCLC, where segmentectomy was associated with better overall survival despite a higher local recurrence rate. Sublobar resection is primarily performed with minimally invasive approaches, including robotic-assisted and video-assisted thoracoscopic techniques. From an oncologic perspective, obtaining adequate surgical margins and performing an adequate lymph node evaluation are critical for good outcomes after sublobar resection.

April 2025

Pang K, Miao Q, Hung ALY, Zhao K, Oh E, Ramirez R, Brisbane W, Sung K.

Micro-ultrasound (MicroUS) is a novel imaging technology with the potential to provide a low-cost and high-resolution approach for prostate cancer diagnosis. However, MicroUS is acquired in a non-uniform, fan-shaped sweep, where voxel size varies with distance from the probe and across slice angles. This irregular voxel distribution complicates reformatting into other imaging planes, making it challenging to conduct joint evaluations with other modalities such as MRI and histopathology. Existing interpolation-based reformatting methods lead to poor image resolution and introduce severe artifacts. In this paper, we propose MPR-Diff, a self-supervised diffusion model for super-resolution-based multi-planar reformation in prostate MicroUS imaging. Our method addresses the lack of high-resolution reference in the target plane by extracting simulated training patches from acquired slices. We performed both a quantitative evaluation and an expert reader study, demonstrating that our approach significantly enhances image resolution and reduces artifacts, thereby increasing the potential diagnostic value of MicroUS. Codbe is available at https://github.com/Calvin-Pang/MPR-Diff.

Spring 2025

Pennathur A, Lanuti M, Merritt RE, Wolf A, Keshavarz H, Loo BW, Suh RD, Mak RH, Brunelli A, Criner GJ, Mazzone PJ, Walsh G, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Pettiford B, Rocco G, Luketich J, Schuchert MJ, Varghese TK, D'Amico TA, Swanson SJ; AATS Clinical Practice Standards Committee: Thoracic Surgery.

A significant proportion of patients with stage I non-small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published an expert consensus document detailing important considerations in determining who is at high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients. After systematic review of the literature, treatment options for high-risk patients with stage I NSCLC were reviewed by an AATS expert panel. Expert consensus statements and vignettes pertaining to treatment selection were then developed using discussion and a modified Delphi method. The expert panel identified sublobar resection, stereotactic ablative radiotherapy (SABR), and image-guided thermal ablation (IGTA) as modalities applicable in the treatment of high-risk patients with stage I NSCLC. The panel also identified lung-nodule-related factors that are important to consider in treatment selection. Using this information, the panel formulated 14 consensus statements and 5 vignettes illustrating clinical scenarios. This article summarizes important factors to consider in treatment selection using these modalities, which are applicable in high-risk patients with stage I NSCLC. The choice of which modality (sublobar resection, SABR, or IGTA) is optimal in high-risk patients with stage I NSCLC is complex, but a surgical approach is generally favored when deemed safe. SABR and IGTA are reasonable options in select patients. SABR is more commonly used than IGTA and is likely the next-best choice. A multi-disciplinary review of patient and tumor characteristics is essential for achieving an optimal decision. The clinical treatment decision should also take patient perspectives, preferences, and quality of life into consideration.

Spring 2025

Pennathur A, Lanuti M, Merritt RE, Wolf A, Keshavarz H, Loo BW, Suh RD, Mak RH, Brunelli A, Criner GJ, Mazzone PJ, Walsh G, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Pettiford B, Rocco G, Luketich J, Schuchert MJ, Varghese TK, D'Amico TA, Swanson SJ; AATS Clinical Practice Standards Committee: Thoracic Surgery.

OBJECTIVES: A significant proportion of patients with stage I non-small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) previously published important considerations in determining which patients are considered high risk. The current objective was to evaluate treatment options and important factors to consider during treatment selection for these high-risk patients. METHODS: The AATS Clinical Practice Standards Committee assembled an expert panel to review treatment options for high-risk patients with stage I NSCLC. After a systematic search of the literature identification of lung-nodule-related factors to consider in treatment selection, the panel developed expert consensus statements and vignettes using a modified Delphi method. A 75% consensus was required for approval.

Spring 2025

Pennathur A, Lanuti M, Merritt RE, Wolf A, Keshavarz H, Loo BW, Suh RD, Mak RH, Brunelli A, Criner GJ, Mazzone PJ, Walsh G, Liptay M, Wafford QE, Murthy S, Marshall MB, Tong B, Pettiford B, Rocco G, Luketich J, Schuchert MJ, Varghese TK, D&aps;Amico TA, Swanson SJ; AATS Clinical Practice Standards Committee: Thoracic Surgery.

A significant proportion of patients with stage I non–small cell lung cancer (NSCLC) are considered at high risk for complications or mortality after lobectomy. The American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) previously published important considerations in determining who is at high risk for complications or mortality after lobectomy. The CPSC then approached the important question of treatment selection for these high-risk patients.2 Lung-nodule-related factors ascertained using clinical imaging are widely used in decision making prior to lung cancer treatment. Therefore, one objective of our expert consensus approach was to evaluate important lung-nodule-related factors to consider in treatment selection for high-risk patients with stage I NSCLC.

April 2025

Raymond C, Yao J, Clifford B, Feiweier T, Oshima S, Telesca D, Zhong X, Meyer H, Everson RG, Salamon N, Cloughesy TF, Ellingson BM.

BACKGROUND AND PURPOSE: This study utilizes a physics-based approach to synthesize realistic MR artifacts and train a deep learning generative adversarial network (GAN) for use in artifact reduction on EPI, a crucial neuroimaging sequence with high acceleration that is notoriously susceptible to artifacts. MATERIALS AND METHODS: A total of 4,573 anatomical MR sequences from 1,392 patients undergoing clinically indicated MRI of the brain were used to create a synthetic data set using physics-based, simulated artifacts commonly found in EPI. By using multiple MRI contrasts, we hypothesized the GAN would learn to correct common artifacts while preserving the inherent contrast information, even for contrasts the network has not been trained on. A modified Pix2PixGAN architecture with an Attention-R2UNet generator was used for the model. Three training strategies were employed: (1) An "all-in-one" model trained on all the artifacts at once; (2) a set of "single models", one for each artifact; and a (3) "stacked transfer learning" approach where a model is first trained on one artifact set, then this learning is transferred to a new model and the process is repeated for the next artifact set. Lastly, the "Stacked Transfer Learning" model was tested on ADC maps from single-shot diffusion MRI data in N = 49 patients diagnosed with recurrent glioblastoma to compare visual quality and lesion measurements between the natively acquired images and AI-corrected images.

Spring 2025

Wolf A, Loo BW, Mak RH, Liptay M, Pettiford B, Rocco G, Lanuti M, Merritt RE, Keshavarz H, Suh RD, Brunelli A, Criner GJ, Mazzone PJ, Walsh G, Wafford QE, Murthy S, Marshall MB, Tong B, Luketich J, Schuchert MJ, Varghese TK, D'Amico TA, Pennathur A, Swanson SJ; AATS Clinical Practice Standards Committee: Thoracic Surgery.

Stereotactic ablative radiotherapy (SABR) has emerged as an alternative, non-surgical treatment for high-risk patients with stage I non-small cell lung cancer (NSCLC) with increased use over time. The American Association for Thoracic Surgery (AATS) Clinical Practice Standards Committee (CPSC) assembled an expert panel and conducted a systematic review of the literature evaluating the results of SABR, which is also referred to as stereotactic body radiation therapy (SBRT) or stereotactic radiosurgery (SRS), prior to developing treatment recommendations for high-risk patients with stage I NSCLC based on expert consensus. Publications detailing the findings of 16 prospective studies of SABR and 14 retrospective studies of SABR for the management of early-stage lung cancer in 54,697 patients were identified by systematic review of the literature with further review by members of our expert panel. Medical inoperability (93-95%) was the primary reason for utilizing SABR. The median rate of histologically confirmed cancer in treated patients was 67% (range 57-86%). In retrospective studies and prospective studies, the most common dosing regimens were 48-54Gy in 3-5 fractions and 44-66Gy in 3-5 fractions respectively. The median follow-up after SABR was 30 months (range 15-50). The complications, oncological results and quality of life after SABR in high-risk patients with early-stage NSCLC are summarized in this Expert Review article. Further prospective randomized trials are needed and are currently underway to compare outcomes after SABR with outcomes after sublobar resection to fully evaluate treatment options applicable this high-risk group of patients.

April 2025

Wright K, Mederos MA, Riahi IR, Naini BV, Depetris J, Girgis MD.

Malignant biliary obstruction can, in rare cases, arise from metastases to the biliary tree from distant primary tumors. This phenomenon often poses a diagnostic challenge, as bile duct metastases may clinically and radiologically mimic primary biliary tumors, such as cholangiocarcinoma. We present a unique case of solitary, synchronous intraductal biliary metastasis in a patient with colorectal adenocarcinoma that led to biliary obstruction. The patient initially presented with a new diagnosis of colon cancer at the hepatic flexure and was found, on cross-sectional imaging, to have biliary obstruction due to an intraductal mass. Initially, the nature of the intraductal lesion was uncertain; however, it was ultimately confirmed through histopathological examination to be metastatic colorectal adenocarcinoma. This case underscores the difficulty of distinguishing metastatic biliary obstruction from primary biliary tumors and highlights the importance of considering metastatic disease in atypical presentations of biliary masses. We discuss several key radiologic and histopathological features that may help differentiate intraductal colorectal adenocarcinoma metastases from primary biliary tumors.

March 2025

Ann P, Nguyen K, Li R, Ghazikhanian V

Calcium pyrophosphate deposition (CPPD) disease is a common condition that results in intra-articular and periarticular deposition of calcium pyrophosphate crystals. Tendon tear, however, is infrequently reported in these cases. The factors contributing to tendon tear in patients with CPPD disease may include crystal-induced prolonged inflammation that could cause chronic tendinous attrition, anatomical and biomechanical factors that could compromise tendon structural integrity, and/or degenerative tendon changes that might be caused by co-occurring diabetic tendinopathy. We report a case of a high-grade partial tear of the biceps femoris tendon in a patient with type 2 diabetes and CPPD disease.

March 2025

Ayobi A, Davis A, Chang PD, Chow DS, Nael K, Tassy M, Quenet S, Fogola S, Shabe P, Fussell D, Avare C, Chaibi Y.

BACKGROUND AND PURPOSE: ASPECTS is a long-standing and well-documented selection criterion for acute ischemic stroke treatment; however, the interpretation of ASPECTS is a challenging and time-consuming task for physicians with notable interobserver variabilities. We conducted a multireader, multicase study in which readers assessed ASPECTS without and with the support of a deep learning (DL)-based algorithm to analyze the impact of the software on clinicians' performance and interpretation time. MATERIALS AND METHODS: A total of 200 NCCT scans from 5 clinical sites (27 scanner models, 4 different vendors) were retrospectively collected. The reference standard was established through the consensus of 3 expert neuroradiologists who had access to baseline CTA and CTP data. Subsequently, 8 additional clinicians (4 typical ASPECTS readers and 4 senior neuroradiologists) analyzed the NCCT scans without and with the assistance of CINA-ASPECTS (Avicenna.AI), a DL-based, FDA-cleared, and CE-marked algorithm designed to compute ASPECTS automatically. Differences were evaluated in both performance and interpretation time between the assisted and unassisted assessments.

March 2025

Chien A, Vinuela F, Szeder V, Colby G, Jahan R, Wang A, Tateshima S, Duckwiler G, Salamon N.

BACKGROUND: Patterns of change in cerebrovascular (CV) morphology associated with aging are highly relevant to the incidence and progression of CV disease, particularly stroke. Intracranial aneurysms (IA), a leading cause of hemorrhagic stroke, are linked with factors such as blood flow, arterial stiffness, and inflammation that may also drive other changes in CV morphology. We worked with a cohort of longitudinally-imaged IA patients to construct the first longitudinal atlas of CV morphology and studied its relationship with disease. METHODS: 110 IA patients, ranging from 19 to 84 years old at IA detection, were monitored using 3D magnetic resonance angiography (MRA) for a mean of 6.11 (2.60) years with 3.6 (1.3) scans per patient. Using 405 image studies, we applied a machine learning diffeomorphic shape analysis to construct a longitudinal atlas of the cerebral arteries which defined a general trajectory of CV morphological change vs. age. This was paired with a centerline analysis to verify changes in individual arteries.

March 2025

Kafali SG, Bolster BD Jr, Shih SF, Delgado TI, Deshpande V, Zhong X, Adamos TR, Ghahremani S, Calkins KL, Wu HH.

BACKGROUND: Conventional liver magnetic resonance elastography (MRE) requires breath-holding (BH) to avoid motion artifacts, which is challenging for children. While radial free-breathing (FB)-MRE is an alternative for quantifying liver stiffness (LS), previous methods had limitations of long scan times, acquiring two slices in 5 minutes, and not resolving motion during reconstruction. PURPOSE: To reduce FB-MRE scan time to 4 minutes for four slices and to investigate the impact of self-gated (SG) motion compensation on FB-MRE LS quantification in terms of agreement, intrasession repeatability, and technical quality compared to conventional BH-MRE.

March 2025

Keshavarz P, Nezami N, Yazdanpanah F, Khojaste-Sarakhsi M, Mohammadigoldar Z, Azimi M, Hajati A, Ebrahimian Sadabad F, Chiang J, McWilliams JP, Lu DSK, Raman SS.

PURPOSE: To perform a systematic literature review of the efficacy of different AI models to predict HCC treatment response to transarterial chemoembolization (TACE), including overall survival (OS) and time to progression (TTP). METHODS: This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines until May 2, 2024.

March 2025

Lin Y, Hoyt AC, Manuel VG, Inkelas M, Ayvaci MUS, Ahsen ME, Hsu W.

INTRODUCTION: Risk-stratified screening (RSS) scheduling may facilitate more effective use of same-day diagnostic testing for potentially abnormal mammograms, thereby reducing the need for follow-up appointments ("recall"). Our simulation study assessed the potential impact of RSS scheduling on patients recommended for same-day diagnostics. METHODS: We used a discrete event simulation to model workflow at a high-volume breast imaging center, incorporating artificial intelligence (AI)-triaged same-day diagnostic workups after screening mammograms. The RSS design sequences patients in the daily screening schedule using cancer risk categories developed from Tyrer-Cuzick and deep learning model scores. We compared recall variance, required hours of operation to accommodate all patients, and patient wait times using traditional (random) and RSS schedules.

March 2025

Lopez Kolkovsky AL, Wang C, Yao J, Ellingson BM.

MRI in vivo is a powerful clinical diagnosis tool as it allows acquiring noninvasively images with an ample range of contrasts. Advanced imaging techniques such as chemical exchange saturation transfer (CEST) allow measuring metabolic information including pH. Sodium tissue concentration, which can be measured by ²³Na MRI, is sensitive to changes in different pathological conditions. The routine clinical application of these techniques is limited by the required additional scan time. Multinuclear interleaved techniques allow reducing the total acquisition scan time by performing the pulse sequence elements of a ¹H imaging sequence during the idle times typically used in ²³Na MRI to allow magnetization recovery and reduce T1 weighting. An interleaved radial amine CEST and sodium (INTERLACED) pulse sequence was developed on a clinical scanner to simultaneously map acidity or T2* decay with ²³Na signal, reducing the total scan time by 46% relative to sequential mononuclear acquisitions and without introducing any significant bias, as demonstrated in vitro. Dynamic INTERLACED measures were performed in the leg during a 5-min plantar flexion exercise and during a second plantar flexion exercise immediately followed by a 5-min voluntary isometric contraction.

March 2025

Tada DK, Kim GH, Goldin JG, Teng P, Vyapari K, Banola A, Abtin F, McNitt-Gray M, Brown MS.

PURPOSE: We aim to develop and validate a prediction model using a previously developed fully automated quantitative fissure integrity score (FIS) extracted from pre-treatment CT images to identify suitable candidates for endobronchial valve (EBV) treatment. APPROACH: We retrospectively collected 96 anonymized pre- and post-treatment chest computed tomography (CT) exams from patients with moderate to severe emphysema and who underwent EBV treatment. We used a previously developed fully automated, deep learning-based approach to quantitatively assess the completeness of each fissure by obtaining the FIS for each fissure from each patient's pre-treatment CT exam. The response to EBV treatment was recorded as the amount of targeted lobe volume reduction (TLVR) compared with target lobe volume prior to treatment as assessed on the pre- and post-treatment CT scans. EBV placement was considered successful with a TLVR of ≥ 350 cc. The dataset was split into a training set (N = 58) and a test set (N = 38) to train and validate a logistic regression model using fivefold cross-validation; the extracted FIS of each patient's targeted treatment lobe was the primary CT predictor. Using the training set, a receiver operating characteristic (ROC) curve analysis and predictive values were quantified over a range of FIS thresholds to determine an optimal cutoff value that would distinguish complete and incomplete fissures, which was used to evaluate predictive values of the test set cases.

March 2025

Yadav A, Welland S, Hoffman JM, Hyun J Kim G, Brown MS, Prosper AE, Aberle DR, McNitt-Gray MF, Hsu W.

OBJECTIVE. The study aims to systematically characterize the effect of CT parameter variations on images and lung radiomic and deep features, and to evaluate the ability of different image harmonization methods to mitigate the observed variations. APPROACH. A retrospective in-house sinogram dataset of 100 low-dose chest CT scans was reconstructed by varying radiation dose (100%, 25%, 10%) and reconstruction kernels (smooth, medium, sharp). A set of image processing, convolutional neural network (CNNs), and generative adversarial network-based (GANs) methods were trained to harmonize all image conditions to a reference condition (100% dose, medium kernel). Harmonized scans were evaluated for image similarity using peak signal-to-noise ratio (PSNR), structural similarity index measure (SSIM), and learned perceptual image patch similarity (LPIPS), and for the reproducibility of radiomic and deep features using concordance correlation coefficient (CCC).

March 2025

Zhao Z, Lee HL, Ruan D, Ming Z, Han F, Bedayat A, Christodoulou AG, Finn JP, Nguyen KL.

BACKGROUND: The rotating Cartesian k-space multiphase steady-state imaging with contrast (ROCK-MUSIC) pulse sequence enables acquisition of whole-heart, cardiac phase-resolved images in pediatric congenital heart disease (CHD) without reliance on the ventilator gating signal. Multidimensional reconstruction with low rank tensor (LRT) has shown promise for resolving complex cardiorespiratory motion. PURPOSE: To enhance ROCK-MUSIC by resolving cardiorespiratory phases using LRT reconstruction and to enable semi-automatic hyperparameter tuning by developing an image quality scoring model.

March 2025

Zheng HW, Bui AAT, Ensrud KE, Wright NC, Manson JE, Watts NB, Johnson KC, Shadyab AH, Crandall CJ.

IMPORTANCE: For younger postmenopausal women, clinical guidelines recommend using osteoporosis risk prediction tools to identify candidates with low bone mineral density (BMD). However, the performance of these tools is not well quantified. OBJECTIVE: To examine the performance of Osteoporosis Risk Assessment Instrument (ORAI) and Osteoporosis Index of Risk (OSIRIS), compared with Osteoporosis Self-Assessment Tool (OST), in identifying the presence of osteoporotic BMD in younger postmenopausal women. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study used data from the Women's Health Initiative Bone Density Substudy, which was conducted at 3 clinical centers in Tucson and Phoenix, Arizona; Pittsburgh, Pennsylvania; and Birmingham, Alabama. Participants were healthy postmenopausal women aged 50 to 64 years with BMD measurements evaluated using the 3 risk prediction tools: OSIRIS, ORAI, and OST. Risk factors and other participant characteristics were compared across osteoporosis status. Data were collected from October 1993 to December 1998 and analyzed between September 23, 2023, and April 10, 2024.

February 2025

Akre S, Cohen ZD, Welborn A, Zbozinek TD, Balliu B, Craske MG, Bui AAT.

This study examines the relationship between self-reported and physiologically measured sleep quality and their impact on neurocognitive performance in individuals with depression. Using data from 249 participants with medium to severe depression monitored over 13 weeks, sleep quality was assessed via retrospective self-report and physiological measures from consumer smartphones and smartwatches. Correlations between self-reported and physiological sleep measures were generally weak. Machine learning models revealed that self-reported sleep quality could detect all depression symptoms measured using the Patient Health Questionnaire-14, whereas physiological sleep measures detected "sleeping too much" and low libido. Notably, only self-reported sleep disturbances correlated significantly with neurocognitive performance, specifically with processing speed. Physiological sleep was able to detect changes in self-reported sleep, medication use, and sleep latency. These findings emphasize that self-reported and physiological sleep quality are not measuring the same construct, and both are important to monitor when studying sleep quality in relation to depression.

February 2025

Chen IE, Tsui B, Zhang H, Qiao JX, Hsu W, Nour M, Salamon N, Ledbetter L, Polson J, Arnold C, BahrHossieni M, Jahan R, Duckwiler G, Saver J, Liebeskind D, Nael K.

BACKGROUND: Accurate estimation of ischemic core on baseline imaging has treatment implications in patients with acute ischemic stroke (AIS). Machine learning (ML) algorithms have shown promising results in estimating ischemic core using routine noncontrast computed tomography (NCCT). OBJECTIVE: We used an ML-trained algorithm to quantify ischemic core volume on NCCT in a comparative analysis to pretreatment magnetic resonance imaging (MRI) diffusion-weighted imaging (DWI) in patients with AIS. METHODS: Patients with AIS who had both pretreatment NCCT and MRI were enrolled. An automatic segmentation ML approach was applied using Brainomix software (Oxford, UK) to segment the ischemic voxels and calculate ischemic core volume on NCCT. Ischemic core volume was also calculated on baseline MRI DWI. Comparative analysis was performed using Bland-Altman plots and Pearson correlation.

February 2025

Ellingson BM, Okobi Q, Chong R, Plawat R, Zhao E, Gafita A, Sonni I, Chun S, Filka E, Yao J, Telesca D, Li S, Li G, Lai A, Nghiemphu P, Czernin J, Nathanson DA, Cloughesy TF.

BACKGROUND: To demonstrate the potential value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) as a rapid, non-invasive metabolic imaging surrogate for pharmacological modulation of EGFR signaling in EGFR-driven GBM, we synchronously conducted a preclinical imaging study using patient-derived orthotopic xenograft (PDOX) models and validated it in a phase II molecular imaging study in recurrent GBM (rGBM) patients using osimertinib. METHODS: A GBM PDOX mouse model study was performed concurrently with an open-label, single-arm, single-center, phase II study of osimertinib (NCT03732352) that enrolled 12 patients with rGBM with EGFR alterations. Patients received osimertinib daily and 3 18F-FDG PET scans: two 24 h apart prior to dosing, and one 48 h after dosing.

February 2025

Grossman SA, Romo CG, Ye X, Kral B, Strowd RE, Lesser G, Raymond C, Iacoboni M, Desideri S, Fisher J, Danda N, Ellingson BM.

BACKGROUND: The blood-brain barrier (BBB) severely limits the delivery of therapeutic agents to the brain. Regadenoson, a Food and Drug Administration-approved adenosine A2 agonist, transiently increases BBB permeability in rodents to a 70 kDa dextran. This multi-institutional, NIH-funded study examined regadenoson's ability to transiently alter BBB permeability in patients with gliomas. METHODS: Adults with supratentorial gliomas at low risk for regadenoson complications were treated with 1 of the 7 dose levels known to be safe in humans. Successful BBB disruption was defined as a 10-fold increase in vascular permeability (K trans ) relative to historic benchmarks. This was assessed by dynamic contrast-enhanced perfusion on magnetic resonance imaging in normal-appearing white matter (NAWM) changes in NAWM and non-enhancing tumors were also quantified using contrast-enhanced T1 subtraction maps.

February 2025

Hubbard L, Mathevosian S, Yoshida T, Hassani C, Jalili MH, Finn JP, Bedayat A.

PURPOSE: To evaluate ferumoxytol-enhanced magnetic resonance angiography (FE-MRA) for assessment of endoleaks in patients with abdominal aortic aneurysms (AAA) and chronic kidney disease (CKD) status post endovascular aneurysm repair (EVAR). METHODS: Of 1854 patients who underwent FE-MRA at a single institution between 03/21/2014 and 08/21/2023, 21 patients with a history of AAA and CKD status post EVAR were retrospectively identified (IRB #13-001341). Multiplanar pre- and post-contrast HASTE, T1-VIBE, and high-resolution breath-held 3D MRA sequences were obtained, where a dose of 4 mg/kg of Ferumoxytol was infused over six minutes. All examinations were performed on either a Siemens 3.0 T Prisma Fit, a Siemens 3.0 T TIM Trio, or a Siemens 1.5 T Avanto MRI scanner. Image post-processing was performed using OsiriX and Vitrea software for endoleak identification and display.

February 2025

Husain M, Dalrymple T, Schultz M, Prosper A, Levi D, Van Arsdell G.

A lung hilum Kasai-like anastomosis, of either the atrium or a conduit, is a feasible option for repair of hilar pulmonary vein obstruction in patients with recurrent and distal PVO.

February 2025

Oshima S, Kim A, Sun XR, Rifi Z, Cross KA, Fu KA, Salamon N, Ellingson BM, Bari AA, Yao J.

BACKGROUND AND PURPOSE: Precise and individualized targeting of the ventral intermediate thalamic nucleus for the MR-guided focused ultrasound is crucial for enhancing treatment efficacy and avoiding undesirable side effects. In this study, we tested the hypothesis that the spatial relationships between Thalamus Optimized Multi Atlas Segmentation derived segmentations and the post-focused ultrasound lesion can predict post-operative side effects in patients treated with MR-guided focused ultrasound. MATERIALS AND METHODS: We retrospectively analyzed 30 patients (essential tremor, n = 26; tremor-dominant Parkinson's disease, n = 4) who underwent unilateral ventral intermediate thalamic nucleus focused ultrasound treatment. We created ROIs of coordinate-based indirect treatment target, focused ultrasound-induced lesion, and thalamus and ventral intermediate thalamic nucleus segmentations. We extracted imaging features including 1) focused ultrasound-induced lesion volumes, 2) overlap between lesions and thalamus and ventral intermediate thalamic nucleus segmentations, 3) distance between lesions and ventral intermediate thalamic nucleus segmentation and 4) distance between lesions and the indirect standard target. These imaging features were compared between patients with and without post-operative gait/balance side effects using Wilcoxon rank-sum test. Multivariate prediction models of side effects based on the imaging features were evaluated using the receiver operating characteristic analyses.

February 2025

Qi X, Kim WJ, Samarage HM, Goel K, Zarrin D, Nael K, Wang AC, Johnson J, Colby GP.

BACKGROUND: Endovascular transmural targeting of cervical and cranial perivascular structures is a novel approach for minimally invasive delivery of therapeutics. Components of the autonomic nervous system are in close anatomic proximity to major cervical vasculature and, therefore, represent potential targets for intervention. The superior cervical ganglion (SCG) is a discrete structure of interest for this approach, as sympathetic blockade may have therapeutic effects for various conditions. Variability of SCG location and its relationship to large cervical vessels, and the feasibility of endovascular transmural targeting has not been elucidated. METHODS: In this retrospective study, computed tomography angiography of head and neck from patients with subarachnoid hemorrhage or cerebral aneurysms were reviewed. SCG dimensions and spatial relationship to cervical vessels were measured. Measured anatomic parameters were used to determine endovascular transmural accessibility of the SCG from various cervical vessels.

February 2025

Rajan SS, Yamal JM, Wang M, Saver JL, Jacob AP, Gonzales NR, Ifejika N, Parker SA, Ganey C, Gonzalez MO, Lairson DR, Bratina PL, Jones WJ, Mackey JS, Lerario MP, Navi BB, Alexandrov AW, Alexandrov A, Nour M, Spokoyny I, Bowry R, Czap AL, Grotta JC.

OBJECTIVE: Given the high disease and cost burden of ischemic stroke, evaluating the clinical efficacy and cost-effectiveness of new approaches to prevent and treat ischemic stroke is critical. Effective ischemic stroke management depends on timely administration of thrombolytics after stroke onset. This study evaluates the cost-effectiveness associated with the use of mobile stroke units (MSUs) to expedite tissue plasminogen activator (tPA) administration, as compared with standard management through emergency medical services (EMS). METHODS: This study is a prospective, multicenter, alternating-week, cluster-controlled trial of MSU versus EMS. One-year and life-time cost-effectiveness analyses, using the incremental cost-effectiveness ratio (ICER) method, were performed from the perspective of CMS's Medicare. Quality-adjusted life years (QALYs) estimated using patient-reported EQ-5D-5L data were used as the effectiveness measure. Health care utilizations were converted to costs using average national Medicare reimbursements. ICERs excluding patients with pre-existing disability, and limited to stroke-related costs were also calculated.

February 2025

Reinier K, Chugh HS, Uy-Evanado A, Heckard E, Mathias M, Bosson N, Calsavara VF, Slomka PJ, Elashoff DA, Bui AAT, Chugh SS.

BACKGROUND: Out-of-hospital sudden cardiac arrest (SCA) is a major cause of mortality and improved risk prediction is needed. The Observational Study of Sudden Cardiac Arrest Risk (OSCAR) is an electronic health records (EHR)-based cohort study of patients receiving routine medical care in the Cedars-Sinai Health System (CSHS) in Los Angeles County, CA designed to evaluate predictors of SCA. This paper describes the rationale, objectives, and study design for the OSCAR cohort. METHODS AND RESULTS: The OSCAR cohort includes 379,833 Los Angeles County residents with at least one patient encounter at CSHS in each of two consecutive calendar years from 2016 to 2020. We obtained baseline cohort characteristics from the EHR from 2012 until the start of follow-up, including demographics, vital signs, clinical diagnoses, cardiac tests and imaging, procedures, laboratory results, and medications.

February 2025

Ross MK, Clark EJ, Chan W, Kafashzadeh D, Radparvar I, Gao E, Gomez A, Tran M, Sim MS, Rong G, Friedman S, Szilagyi PG, Ryan G, Bui AAT.

INTRODUCTION: This study evaluates our new EHR-integrated patient portal for asthma care (PAC) management module for parents of children with asthma. The module includes a previsit asthma intake questionnaire via the portal. The parent answers are integrated into the provider's clinic progress note to support clinical decision-making. Our goals were to measure the functionality and usability of the PAC module and to understand facilitators and barriers to its use for parents. METHODS: Parents of children ages 0-11 years old (n = 45) completed the PAC module's asthma intake questionnaires prior to their upcoming pediatric pulmonology clinic visit. To assess functionality, provider progress notes were manually reviewed to measure the amount of key asthma-related data captured. Differences in percent data captured with and without the PAC module were compared. Electronic surveys capture demographics, usability data (the System Usability Scale [SUS]), and open-ended experiential feedback about the module. Analysis included descriptive statistics for demographics and usability, as well as the constant comparative method for open-ended feedback.

February 2025

Sanvito F, Yao J, Cho NS, Raymond C, Telesca D, Pope WB, Everson RG, Salamon N, Boxerman JL, Cloughesy TF, Ellingson BM.

BACKGROUND AND PURPOSE: Normalized relative cerebral blood volume (nrCBV) and percentage of signal recovery (PSR) computed from dynamic susceptibility contrast (DSC) perfusion imaging are useful biomarkers for differential diagnosis and treatment response assessment in brain tumors. However, their measurements are dependent on DSC acquisition factors, and CBV-optimized protocols technically differ from PSR-optimized protocols. This study aimed to generate "synthetic" DSC data with adjustable synthetic acquisition parameters using dual-echo gradient-echo (GE) DSC datasets extracted from dynamic spin-and-gradient-echo echoplanar imaging (dynamic SAGE-EPI). Synthetic DSC was aimed at: 1) simultaneously create nrCBV and PSR maps using optimal sequence parameters, 2) compare DSC datasets with heterogeneous external cohorts, and 3) assess the impact of acquisition factors on DSC metrics. MATERIALS AND METHODS: Thirty-eight patients with contrast-enhancing brain tumors were prospectively imaged with dynamic SAGE-EPI during a non-preloaded single-dose contrast injection and included in this cross-sectional study. Multiple synthetic DSC curves with desired pulse sequence parameters were generated using the Bloch equations applied to the dual-echo GE data extracted from dynamic SAGE-EPI datasets, with or without optional preload simulation.

February 2025

Swaminathan AC, Weber JM, Todd JL, Palmer SM, Neely ML, Whelan TP, Kim GHJ, Leonard TB, Goldin J.

BACKGROUND: The prognostic value of patterns and quantitative measures of lung fibrosis on high-resolution computed tomography (HRCT) in patients identified as having progressive pulmonary fibrosis (PPF) has not been established. We investigated whether HRCT patterns and quantitative scores were associated with risk of progression in patients with PPF. METHODS: Patients enrolled in the ILD-PRO Registry had an interstitial lung disease (ILD) other than idiopathic pulmonary fibrosis, reticular abnormality and traction bronchiectasis, and met criteria for ILD progression. HRCT images taken between 24 months prior to enrollment and 90 days after enrollment were analyzed using a machine learning algorithm to derive quantitative scores. Associations were assessed between HRCT pattern (usual interstitial pneumonia [UIP]-like versus other patterns) and tertiles of quantitative scores and measures of disease severity at enrollment, and between these patterns/tertiles at enrollment and ILD progression (relative decline in forced vital capacity [FVC] % predicted ≥ 10%, lung transplant, or death) over a median follow-up of 17.3 months.

February 2025

Wei S, Shrestha L, Melendez-Corres G, Brown MS.

The right internal jugular line (RIJL) is a type of central venous catheter (CVC) inserted into the right internal jugular vein to deliver medications and monitor vital functions in ICU patients. The placement of RIJL is routinely checked by a clinician in a chest X-ray (CXR) image to ensure its proper function and patient safety. To reduce the workload of clinicians, deep learning-based automated detection algorithms have been developed to detect CVCs in CXRs. Although RIJL is the most widely used type of CVCs, there is a paucity of investigations focused on its accurate segmentation and tip localization. In this study, we propose a deep learning system that integrates an anatomical landmark segmentation, an RIJL segmentation network, and a postprocessing function to segment the RIJL course and detect the tip with accuracy and precision. We utilized the nnU-Net framework to configure the segmentation network. The entire system was implemented on the SimpleMind Cognitive AI platform, enabling the integration of anatomical knowledge and spatial reasoning to model relationships between objects within the image. Specifically, the trachea was used as an anatomical landmark to extract a subregion in a CXR image that is most relevant to the RIJL. The subregions were used to generate cropped images, which were used to train the segmentation network. The segmentation results were recovered to original dimensions, and the most inferior point's coordinates in each image were defined as the tip. With guidance from the anatomical landmark and customized postprocessing, the proposed method achieved improved segmentation and tip localization compared to the baseline segmentation network: the mean average symmetric surface distance (ASSD) was decreased from 2.72 to 1.41 mm, and the mean tip distance was reduced from 11.27 to 8.29 mm.

January 2025

Chiang J, Raman SS, Ramakrishnan A, Keshavarz P, Sayre JW, McWilliams JP, Finn RS, Agopian VG, Choi G, Lu DSK.

PURPOSE: To correlate preablation needle biopsy-acquired histopathologic grade of Liver Imaging Reporting and Data System (LI-RADS) 5 hepatocellular carcinoma (HCC) with postablation local tumor control rate, intrahepatic distant tumor progression-free survival, and overall survival. MATERIALS AND METHODS: This single-center, retrospective cohort study included adult patients with LI-RADS 5 HCC who underwent a preablation core needle biopsy within 3 months prior to thermal ablation from January 2015 to December 2022. Histopathologic grade from the needle biopsy was evaluated as predictor of local tumor control rate, intrahepatic distant tumor progression-free survival, and overall survival. Kaplan-Meier survival curves were compared using the Gehan generalized Wilcoxon test.

January 2025

Drews E, Yearwood A, Padia SA, Moriarty JM, McWilliams JP, Tse G, Haber ZM.

A new conformable embolic agent (Obsidio; Boston Scientific, Marlborough, Massachusetts) is indicated for embolizing hypervascular tumors and treating peripheral vessel bleeding. It is a non-Newtonian hydrogel that becomes less viscous when shear force is applied. This retrospective study examined the safety and effectiveness of the shear-thinning embolic in a single-academic-center experience. Technical and clinical success, and adverse events were assessed. Twenty-seven patients were treated with the shear-thinning embolic in 39 vessels over 28 procedures. Technical success was achieved in 37 (95%) of 39 vessels, with clinical success in 26 (93%) of 28 procedures. There was 1 treatment-related severe adverse event (3.6%): left gastric artery embolization resulting in ischemia and subtotal gastrectomy (Grade 4). Two patients (7.1%) had mild adverse events. Initial experience showed effectiveness of this shear-thinning embolic; however, this embolic behaved differently from conventional liquid embolics, and operator training is required for safe use.

January 2025

Goiffon RJ, Depetris J, Dageforde LA, Kambadakone A.

The kidney is the most common solid organ transplant globally and rates continue to climb, driven by the increasing prevalence of end stage renal disease (ESRD). Compounded by advancements in surgical techniques and immunosuppression leading to longer graft survival, radiologists evermore commonly evaluate kidney transplant patients and candidates, underscoring their role along the transplant process. Multiphase computed tomography (CT) with multiplanar and 3D reformatting is the primary method for evaluating renal donor candidates, detailing renal size, vascular/collecting system anatomy, and identifying significant pathologies such as renal vascular diseases and nephrolithiasis. Ultrasound is the preferred initial postoperative imaging modality for graft evaluation due to its low cost, accessibility, noninvasiveness, and lack of radiation. CT and magnetic resonance imaging (MRI) may be useful adjunctive imaging techniques in diagnosing transplant pathology when ultrasound alone is not diagnostic. Kidney transplant complications are categorized by an approximate timeline framework, aiding in differential diagnosis based on onset, duration, and severity and include perinephric fluid collections, graft compression, iatrogenic injuries, vascular compromise, graft rejection, and neoplastic processes. This review discusses imaging strategies and important findings along the transplant timeline, from donor assessment to long-term recipient complications.

January 2025

Kim DH, Chen L, Lamba A, Abtin F, Genshaft S, Quirk M, Suh R.

PURPOSE: To evaluate the effectiveness of track cautery for lung microwave ablation (MWA) to reduce postprocedural adverse events (AE). MATERIALS AND METHODS: Patients who underwent percutaneous lung MWA between 2012 and 2021 were divided into 2 cohorts: patients in whom track cautery was conducted during antenna removal and patients in whom the antenna was simply removed. Patient demographics, treatment history, tumor characteristics, and ablation details were collected. Postprocedural AEs including immediate, enlarging, and delayed pneumothorax (PTX), pleural effusion, and reinterventions were recorded. Univariate and multivariate logistic regression models were used to identify factors associated with AEs.

January 2025

Kim DHS, Sonni I, Grogan T, Sisk A, Murthy V, Hsu W, Sung K, Lu DS, Reiter RE, Raman SS.

Purpose To determine which quantitative 3-T multiparametric MRI (mpMRI) parameters correlate with and help predict the presence of aggressive large cribriform pattern (LCP) and intraductal carcinoma (IDC) prostate cancer (PCa) at whole-mount histopathology (WMHP). Materials and Methods This retrospective study included 130 patients (mean age ± SD, 62.6 years ± 7.2; 100% male) with 141 PCa lesions who underwent preoperative prostate 3-T mpMRI, radical prostatectomy, and WMHP between January 2019 and December 2022. Lesions at WMHP were matched to 3-T mpMRI lesions with American College of Radiology Prostate Imaging Reporting and Data System version 2.1 scores of at least 3 or higher, and the following parameters were derived: apparent diffusion coefficient (ADC), volume transfer constant, rate constant, and initial area under the curve (iAUC). Each lesion was categorized into three subcohorts with increasing aggressiveness: LCP negative and IDC negative (subcohort 1), LCP positive and IDC negative (subcohort 2), and LCP positive and IDC negative (subcohort 3). Analysis of variance was performed to assess differences, Jonckheere test was performed to establish trends, and a classification and regression tree (CART) was used to establish a prediction model.

January 2025

Ming Z, Pogosyan A, Christodoulou AG, Finn JP, Ruan D, Nguyen KL.

BACKGROUND: Irregular cardiac motion can render conventional segmented cine MRI nondiagnostic. Clustering has been proposed for cardiac motion binning and may be optimized for complex arrhythmias. PURPOSE: To develop an adaptive cluster optimization method for irregular cardiac motion, and to generate the corresponding time-resolved cine images.

January 2025

Pang K, Zhao K, Hung ALY, Zheng H, Yan R, Sung K.

Medical images often require rescaling to various spatial resolutions to ensure interpretations at different levels. Conventional deep learning-based image super-resolution (SR) enhances the fixed-scale resolution. Implicit neural representation (INR) is a promising way of achieving arbitrary-scale image SR. However, existing INR-based methods require the repeated execution of the neural network (NN), which is slow and inefficient. In this paper, we present Neural Explicit Representation (NExpR) for fast arbitrary-scale medical image SR. Our algorithm represents an image with an explicit analytical function, whose input is the low-resolution image and output is the parameterization of the analytical function. After obtaining the analytical representation through a single NN inference, SR images of arbitrary scales can be derived by evaluating the explicit functions at desired coordinates. Because of the analytical explicit representation, NExpR is significantly faster than INR-based methods. In addition to speed, our method achieves on-par or better image quality than other strong competitors. Extensive experiments on Magnetic Resonance Imaging (MRI) datasets, including ProstateX, fastMRI, and our in-house clinical prostate dataset, as well as the Computerized Tomography (CT) dataset, specifically the Medical Segmentation Decathlon (MSD) liver dataset, demonstrate the superiority of our method. Our method reduces the rescaling time from the order of 1 ms to the order of 0.01 ms, achieving an over 100× speedup without losing the image quality. Code is available at https://github.com/Calvin-Pang/NExpR.

January 2025

Plimpton SR, Milch H, Sears C, Chalfant J, Hoyt A, Fischer C, Hsu W, Joines M.

OBJECTIVE: There are limited data on the application of artificial intelligence (AI) on nonenriched, real-world screening mammograms. This work aims to evaluate the ability of AI to detect false negative cancers not detected at the time of screening when reviewed by the radiologist alone. METHODS: A commercially available AI algorithm was retrospectively applied to patients undergoing screening full-field digital mammography (FFDM) or digital breast tomosynthesis (DBT) at a single institution from 2010 to 2019. Ground truth was established based on 1-year follow-up data. Descriptive statistics were performed with attention focused on AI detection of false negative cancers within these subsets.

January 2025

Ranade M, Foster MT 3rd, Brady PS, Sokol SI, Butty S, Klein A, Maholic R, Safar A, Patel T, Zlotnick D, Gans D, Pollak J, Ferrera D, Stegman B, Basra S, Moriarty J, Keeling B.

BACKGROUND: There is a need for additional data to assess procedural efficacy and risks associated with mechanical thrombectomy for treating pulmonary embolism (PE) due to its increased utilization and diversity of patient populations presenting with PE. This study evaluated the safety and efficacy of percutaneous mechanical aspiration thrombectomy with the AlphaVac F1885 System (AngioDynamics) in patients with acute intermediate-risk PE. METHODS: Patients with acute intermediate-risk PE and a right ventricular (RV)/left ventricular (LV) diameter ratio of ≥0.9 were eligible for enrollment in this prospective, multicenter, single-arm study. The primary effectiveness end point was reduction in the RV/LV ratio at 48 hours. The primary safety end point was the rate of major adverse events (MAEs) defined as subjects who experienced major bleeding, device-related deaths, clinical deterioration, or pulmonary vascular or cardiac injury within 48 hours postprocedurally.

January 2025

Rink JS, Szabo K, Hoyer C, Saver JL, Nour M, Audebert HJ, Kunz WG, Froelich MF, Heinzl A, Tschalzev A, Hoffmann J, Schoenberg SO, Tollens F.

BACKGROUND AND PURPOSE: Investigating the cost-effectiveness of future mobile stroke unit (MSU) services with respect to local idiosyncrasies is essential for enabling large-scale implementation of MSU services. The aim of this study was to assess the cost-effectiveness for varying urban German settings and modes of operation. METHODS: Costs of different operating times together with different personnel configurations were simulated. Different possible catchment zones, ischemic stroke incidence, circadian distribution, rates of alternative diagnoses, as well as missed cases were incorporated to model case coverage and patient numbers. Based on internationally reported clinical outcomes of MSUs, a 5-year Markov model was applied to analyze the cost-effectiveness for the different program setups.

January 2025

Sarma MK, Saucedo A, Sadananthan SA, Darwin CH, Felker ER, Raman S, Velan SS, Thomas MA.

BACKGROUND/OBJECTIVES: This study evaluated metabolites and lipid composition in the calf muscles of Type 2 diabetes mellitus (T2DM) patients and age-matched healthy controls using multi-dimensional MR spectroscopic imaging. We also explored the association between muscle metabolites, lipids, and intra-abdominal fat in T2DM. METHODS: Participants included 12 T2DM patients (60.3 ± 8.6 years), 9 age-matched healthy controls (AMHC) (60.9 ± 7.8 years), and 10 young healthy controls (YHC) (28.3 ± 1.8 years). We acquired the 2D MR spectra of calf muscles using an enhanced accelerated 5D echo-planar correlated spectroscopic imaging (EP-COSI) technique and abdominal MRI with breath-hold 6-point Dixon sequence.

January 2025

Sevco TJ, Patel MK, Deurdulian C.

Carotid ultrasound is the primary noninvasive method for detecting, grading, and monitoring internal carotid artery (ICA) stenosis. Major components of carotid Doppler ultrasound include assessment of ICA stenosis using Doppler velocity criteria, spectral waveform analysis, and assessment of ICA stenosis. Recently, the Intersocietal Accreditation Commission Vascular Testing put forth new modified Society of Radiologists in Ultrasound criteria with a higher peak systolic velocity threshold of 180 cm/s for 50% to 69% ICA stenosis. Additional emerging techniques, including 3D imaging, contrast-enhanced ultrasound, and superb microvascular imaging, may help identify vulnerable plaque and thus help further risk-stratify patients in the future.

January 2025

Unterrainer LM, Hope TA, Fendler WP, Grogan T, Ndlovu H, Armstrong W, Barbato F, Benz MR, Rettig MB, Kishan AU, Sathekge M, Herrmann K, Czernin J, Calais J.

High-volume disease (HVD) and low-volume disease (LVD) definitions in metastatic hormone-sensitive prostate cancer (mHSPC) patients are based on conventional imaging (CI) (CT/MRI with bone scan [BS]) according to CHAARTED criteria. HVD and LVD definitions are associated with overall survival and are used for treatment decisions. It remains unknown how these definitions transfer to prostate-specific membrane antigen (PSMA) PET imaging. The aim of this retrospective multicenter study was to compare the CI-based disease volume criteria to PSMA PET-based volume definitions in a CHAARTED-like cohort. METHODS: mHSPC patients from 5 international sites who underwent PSMA PET/CT or PSMA PET/MRI and BS within a time interval of 100 d and without initiation of a new therapy between the 2 scans were retrospectively included in the analysis. CHAARTED HVD and LVD criteria were applied to BS, CT, MRI, and PSMA PET. HVD was defined by the presence of visceral metastases or at least 4 bone metastases (with ≥1 beyond the spine or pelvis). Whole-body (WB) tumor burden was estimated with the automated bone scan index (aBSI, EXINI v2.0) on BS and with the WB PSMA PET-positive tumor volume (PSMA-TV) on PSMA PET, respectively.

January 2025

Wood DE, Kazerooni EA, Aberle DR, Argento C, Baines J, Boer B, Brown LM, Donington J, Eapen GA, Ferguson JS, Hou L, Klippenstein D, Kolansky AS, Kumar R, Leard LE, Leung ANC, Mazzone P, Merritt RE, Norris K, Onaitis M, Pipavath S, Puri V, Raz D, Reddy C, Reid ME, Sandler KL, Sands J, Schabath MB, Sears CR, Studts JL, Tanoue L, Thacker AL, Tong BC, Travis WD, Wei B, Westover K, McCullough B, Ramakrishnan S.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Lung Cancer Screening provide criteria for selecting individuals for screening and offer recommendations for evaluating and managing lung nodules detected during initial and subsequent annual screening. These NCCN Guidelines Insights focus on recent updates to the NCCN Guidelines for Lung Cancer Screening.

January 2025

Zabihollahy F, Miao Q, Naim S, Sonni I, Vangala S, Kim H, Hsu W, Sisk A, Reiter R, Raman SS, Sung K.

BACKGROUND: Understanding the characteristics of multiparametric MRI (mpMRI) in patients from different racial/ethnic backgrounds is important for reducing the observed gaps in clinical outcomes. PURPOSE: To investigate the diagnostic performance of mpMRI and quantitative MRI parameters of prostate cancer (PCa) in African American (AA) and matched White (W) men.