January 2024PET-based Response Assessment Criteria for Diffuse Gliomas (PET RANO 1.0): A Report of the RANO Group.
Albert NL, Galldiks N, Ellingson BM, van den Bent MJ, Chang SM, Cicone F, de Groot J, Koh ES, Law I, Le Rhun E, Mair MJ, Minniti G, Rudà R, Scott AM, Short SC, Smits M, Suchorska B, Tolboom N, Traub-Weidinger T, Tonn JC, Verger A, Weller M, Wen PY, Preusser M.
Response Assessment in Neuro-Oncology (RANO) response criteria have been established and were updated in 2023 for MRI-based response evaluation of diffuse gliomas in clinical trials. In addition, PET-based imaging with amino acid tracers is increasingly considered for disease monitoring in both clinical practice and clinical trials. So far, a standardised framework defining timepoints for baseline and follow-up investigations and response evaluation criteria for PET imaging of diffuse gliomas has not been established. Therefore, in this Policy Review, we propose a set of criteria for response assessment based on amino acid PET imaging in clinical trials enrolling participants with diffuse gliomas as defined in the 2021 WHO classification of tumours of the central nervous system. These proposed PET RANO criteria provide a conceptual framework that facilitates the structured implementation of PET imaging into clinical research and, ultimately, clinical routine. To this end, the PET RANO 1.0 criteria are intended to encourage specific investigations of amino acid PET imaging of gliomas.
January 2024Radiologist and Radiology Practice Wellbeing: A Report of the 2023 ARRS Wellness Summit.
Azour L, Goldin JG, Kruskal JB.
In April 2023, the first American Roentgen Ray Society (ARRS) Wellness Summit was held in Honolulu, Hawaii. The Summit was a communal call to action bringing together professionals from the field of radiology to critically review our current state of wellness and reimagine the role of radiology and radiologists to further wellbeing. The in-person and virtual Summit was available free-of-cost to all meeting registrants and included 12 sessions with 44 invited moderators and panelists. The Summit aimed to move beyond simply rehashing the repeated issues and offering theoretical solutions, and instead focus on intentional practice evolution, identifying implementable strategies so that we as a field can start to walk our wellness talk. Here, we first summarize the thematic discussions from the 2023 ARRS Wellness Summit, and second, share several strategic action items that emerged.
January 2024Updated American Urological Association Guidelines for the Management of Benign Prostatic Hyperplasia: Prostatic Artery Embolization Made it into the Guidelines!
Bilhim T, McWilliams JP, Bagla S.
We have read with great interest the updated American Urological Association (AUA) guidelines for the management of benign prostatic hyperplasia (BPH), which now include prostatic artery embolization (PAE) as a treatment alternative for symptomatic patients . This is the culmination of a 15-year effort, beginning with animal studies and early human trials of PAE from 2008 to 2011 [2, 3], further informed by Cardiovascular and Interventional Radiological Society of Europe (CIRSE) and Society of Interventional Radiology (SIR) consensus statements in 2014 and 2019 [4, 5], and ultimately driven by consistently positive results in large cohort studies, randomized controlled trials, and sham studies of PAE [6,7,8,9].
January 2024Hemispheric Epilepsy Surgery for Hemimegalencephaly: The UCLA Experience.
Goel K, Phillips HW, Chen JS, Ngo J, Edmonds B, Ha PX, Wang A, Weil A, Russell BE, Salamon N, Nariai H, Fallah A.
OBJECTIVES: Hemimegalencephaly (HME) is a rare congenital brain malformation presenting predominantly with drug-resistant epilepsy. Hemispheric disconnective surgery is the mainstay of treatment; however, little is known about how postoperative outcomes compare across techniques. Thus we present the largest single-center cohort of patients with HME who underwent epilepsy surgery and characterize outcomes. METHODS: This observational study included patients with HME at University of California Los Angeles (UCLA) from 1984 to 2021. Patients were stratified by surgical intervention: anatomic hemispherectomy (AH), functional hemispherectomy (FH), or less-than-hemispheric resection (LTH). Seizure freedom, functional outcomes, and operative complications were compared across surgical approaches. Regression analysis identified clinical and intraoperative variables that predict seizure outcomes.
January 2024Scapulothoracic Bursitis Appearing as Fluorodeoxyglucose-Avid Subscapular Mass: A Case Report
Huang A, Middleton JJ, Motamedi K.
Overuse or structural bony abnormalities of the scapulothoracic “articulation” make it susceptible to chronic friction, which can lead to bursitis and soft tissue changes. Clinically, scapulothoracic bursitis is associated with pain, crepitus, and scapular snapping. On physical examination, a firm, large subscapular mass may be present, sometimes with rapid growth. Asymptomatic cases without scapular snapping can be clinically indistinguishable from soft tissue tumors of the chest wall. Characteristic imaging findings of scapulothoracic bursitis include a well-circumscribed cystic mass, internal debris, and intralesional hemorrhage. Recognition of these characteristic findings is essential to avoid misinterpretation and unnecessary treatments. Here, we describe a case of an incidentally discovered, asymptomatic, fluorodeoxyglucose (FDG)-avid subscapular mass with typical imaging features of scapulothoracic bursitis. Additional imaging and histopathologic examination of sampled tissue confirmed the diagnosis. To our knowledge, this incidental...
January 2024AASLD Practice Guidance on the Use of TIPS, Variceal Embolization, and Retrograde Transvenous Obliteration in the Management of Variceal Hemorrhage.
Lee EW, Eghtesad B, Garcia-Tsao G, Haskal ZJ, Hernandez-Gea V, Jalaeian H, Kalva SP, Mohanty A, Thabut D, Abraldes JG.
This is a comprehensive guidance on the use of interventional radiology endovascular techniques in the management of variceal hemorrhage from the American Association for the Study of Liver Diseases (AASLD). This guidance document is complementary to the AASLD “Risk Stratification and Management of Portal Hypertension and Varices in Cirrhosis” guidance1 and addresses the recent advancements in these invasive procedures. Although the use of TIPS dates back to the 1980s, several new technical refinements in TIPS stents have occurred in the last few years. The other major addition to the management of gastric variceal hemorrhage in North America has been the introduction of retrograde transvenous obliteration (RTO) in its different forms. The present document aims to equip care providers with an in-depth understanding of the use of TIPS and/or variceal embolization/obliteration in the management of variceal hemorrhage. The goal is to facilitate multidisciplinary discussions between hepatologists, gastroenterologists, interventional radiologists, and surgeons in the selection of endovascular treatments for patients with variceal hemorrhage.
January 2024Primary Synovial Chondromatosis of the Knee in a 12-Year-Old Boy: A Case Report
McNulty CA. Narasimhalu T, Ghahremani Koureh S.
Primary synovial chondromatosis is an uncommon, benign synovial proliferative disorder rarely seen in children. The most commonly affected joint is the knee, followed by the hip. The symptoms of this condition are progressive and insidious and may include pain, joint stiffness, and swelling. Radiography is an appropriate first imaging modality that typically shows multiple calcified loose bodies within the affected joint space. Magnetic resonance imaging should then be performed to evaluate for the presence of noncalcified cartilaginous loose bodies and soft tissue involvement prior to surgical treatment that is necessary to prevent permanent joint damage. The recurrence of primary synovial chondromatosis is common, especially in cases of incomplete surgical excision. We report a case of primary synovial chondromatosis in a child. The diagnostic and the treatment considerations of the case are briefly discussed.
January 2024Maternal Dietary Patterns and Placental Outcomes Among Pregnant Women in Los Angeles.
Meng Q, Del Rosario I, Sung K, Janzen C, Devaskar SU, Carpenter CL, Ritz B.
INTRODUCTION: Epidemiological studies have linked prenatal maternal diet to fetal growth, but whether diet affects placental outcomes is poorly understood. METHODS: We collected past month dietary intake from 148 women in mid-pregnancy enrolled at University of California Los Angeles (UCLA) antenatal clinics from 2016 to 2019. We employed the food frequency Diet History Questionnaire II and generated the Healthy Eating Index-2015 (HEI-2015), the Alternate Healthy Eating Index for Pregnancy (AHEI-P), and the Alternate Mediterranean Diet (aMED). We conducted T2-weighted magnetic resonance imaging (MRI) in mid-pregnancy (1st during 14-17 and 2nd during 19-24 gestational weeks) to evaluate placental volume (cm3) and we measured placenta weight (g) at delivery. We estimated change and 95 % confidence interval (CI) in placental volume and associations of placenta weight with all dietary index scores and diet items using linear regression models.
January 2024pH-Weighted Amine Chemical Exchange Saturation Transfer Echo Planar Imaging Visualizes Infiltrating Glioblastoma Cells.
Patel KS, Yao J, Cho NS, Sanvito F, Tessema K, Alvarado A, Dudley L, Rodriguez F, Everson R, Cloughesy TF, Salamon N, Liau LM, Kornblum HI, Ellingson BM.
BACKGROUND: Given the invasive nature of glioblastoma, tumor cells exist beyond the contrast-enhancing (CE) region targeted during treatment. However, areas of non-enhancing (NE) tumors are difficult to visualize and delineate from edematous tissue. Amine chemical exchange saturation transfer echo planar imaging (CEST-EPI) is a pH-sensitive molecular magnetic resonance imaging technique that was evaluated in its ability to identify infiltrating NE tumors and prognosticate survival. METHODS: In this prospective study, CEST-EPI was obtained in 30 patients and areas with elevated CEST contrast ("CEST+" based on the asymmetry in magnetization transfer ratio: MTRasym at 3 ppm) within NE regions were quantitated. Median MTRasym at 3 ppm and volume of CEST + NE regions were correlated with progression-free survival (PFS). In 20 samples from 14 patients, image-guided biopsies of these areas were obtained to correlate MTRasym at 3 ppm to tumor and non-tumor cell burden using immunohistochemistry.
January 2024Arterial Bypass in the Treatment of Complex Middle Cerebral Artery Aneurysms: Lessons Learned from Forty Patients.
Peeters SF, Colby GP, Kim WJ, Bae WI, Sparks H, Reitz K, Tateshima S, Jahan R, Szeder V, Nour M, Duckwiler GR, Vinuela F, Martin NA, Wang AC.
OBJECTIVE: Complex middle cerebral artery (MCA) aneurysms incorporating parent or branching vessels are often not amenable to standard microsurgical clipping or endovascular embolization treatments. We aim to discuss the treatment of such aneurysms via a combination of surgical revascularization and aneurysm exclusion based on our institutional experience. METHODS: Thirty-four patients with complex MCA aneurysms were treated with bypass and aneurysm occlusion, 5 with surgical clipping or wrapping only, and 1 with aneurysm excision and primary reanastomosis. Bypasses included superficial temporal artery (STA)-MCA, double-barrel STA-MCA, occipital artery-MCA, and external carotid artery-MCA. After bypass, aneurysms were treated by surgical clipping, Hunterian ligation, trapping, or coil embolization.
January 2024Towards a Framework for Interoperability and Reproducibility of Predictive Models.
Rahrooh A, Garlid AO, Bartlett K, Coons W, Petousis P, Hsu W, Bui AAT.
The development and deployment of machine learning (ML) models for biomedical research and healthcare currently lacks standard methodologies. Although tools for model replication are numerous, without a unifying blueprint it remains difficult to scientifically reproduce predictive ML models for any number of reasons (e.g., assumptions regarding data distributions and preprocessing, unclear test metrics, etc.) and ultimately, questions around generalizability and transportability are not readily answered. To facilitate scientific reproducibility, we built upon the Predictive Model Markup Language (PMML) to capture essential information. As a key component of the PREdictive Model Index and Exchange REpository (PREMIERE) platform, we present the Automated Metadata Pipeline (AMP) for conversion of a given predictive ML model into an extended PMML file that autocompletes an ML-based checklist, assessing model elements for interoperability and reproducibility. We demonstrate this pipeline on multiple test cases with three different ML algorithms and health-related datasets, providing a foundation for future predictive model reproducibility, sharing, and comparison.
January 2024Extracranial Internal Carotid Artery Fenestration: A Case Report
Winchester Z, Zhang A, Hathout G.
Fenestration of the internal carotid artery (ICA) is an extremely rare congenital abnormality thought to be secondary to incomplete segmental fusion of vessels at the early stages of their development. Fenestration is usually asymptomatic and often misdiagnosed as arterial dissection. Distinction between the two can be challenging on both magnetic resonance angiography and computed tomography angiography, and digital subtraction angiography must often be utilized for precise characterization of the abnormalities. Certain imaging features, namely the length of the involved arterial segment, the regularity of luminal contour, the symmetry of arterial limbs, and the absence/presence of fusiform dilatation of either limb, produced by noninvasive angiography have the potential to help distinguish between an ICA fenestration and dissection. We report a case of an asymptomatic, true fenestration of a short segment of ICA and discuss its imaging characteristics.