Research Publications

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

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.