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Primary Malignant Melanoma Of Brainstem Medulla Mimicking As Cavernoma, Adnan Naeem, Fatima Mubarak 2019 Aga Khan University

Primary Malignant Melanoma Of Brainstem Medulla Mimicking As Cavernoma, Adnan Naeem, Fatima Mubarak

Department of Radiology

Aim of this case report is to present a rare case of primary malignant melanoma of brain stem at the region of medulla oblongata mimicking as cavernoma. 40-year-old male presented with vertigo, headache, dizziness for 1 month. MRI showed pear shaped T1 hyperintense lesion at medulla oblongata and predominantly hypointense on T2 with focal area of hemorrhage. Lesion showed diffuse enhancement on postcontrast images. On plain CT lesion was Hyperdense. It was initially reported as Cavernoma. Surgical excision of lesion was done with per-op findings of solid, dark maroon colored lesion with hemorrhage. Histopathology showed neoplastic lesion with abundant melanin ...


Adaptive Statistical Iterative Reconstruction-V For Lung Nodule Analysis, Cherry Au, Zhenteng Li, MD, Eric Gingold, MD, Ethan Halpern, MD, Baskaran Sundaram, MD 2019 Thomas Jefferson University

Adaptive Statistical Iterative Reconstruction-V For Lung Nodule Analysis, Cherry Au, Zhenteng Li, Md, Eric Gingold, Md, Ethan Halpern, Md, Baskaran Sundaram, Md

Phase 1

Introduction: Low-dose CT in lung cancer screening has demonstrated benefits in select patients. As the traditional filtered back projection (FBP) technique is limited by poor image quality, adaptive statistical iterative reconstruction-V (ASIR-V) algorithm has been developed to achieve higher image quality with processing efficiency.

Objective: To investigate the impact of various CT scan parameters on the semi-automated measurement of lung nodules using a Computer Aided Detection (CAD) program.

Methods: This IRB-exempt phantom experiment was conducted with a CT scanner capable of ASIR-V algorithm. Eight lung nodules sized 5-12 mm, of solid or ground glass type, were placed inside a multipurpose ...


Network Influence Of The Cerebellum For Predicting Dbs Response In Patients With Advanced Parkinson’S Disease, Lucy Li, Jennifer Muller, Sara Thalheimer, Mackenzie D. Silverman, Mahdi Alizadeh, Tsao-Wei Liang, Kelly Layton, Daniel Kremens, Victor Romo, Feroze Mohamed, Chengyuan Wu 2019 Thomas Jefferson University

Network Influence Of The Cerebellum For Predicting Dbs Response In Patients With Advanced Parkinson’S Disease, Lucy Li, Jennifer Muller, Sara Thalheimer, Mackenzie D. Silverman, Mahdi Alizadeh, Tsao-Wei Liang, Kelly Layton, Daniel Kremens, Victor Romo, Feroze Mohamed, Chengyuan Wu

Phase 1

Introduction: Deep brain stimulation (DBS) is a treatment option for reducing motor symptoms in patients with Parkinson’s Disease (PD) when first-line medication becomes ineffective. Existing literature has hypothesized that the clinical outcome of DBS may depend on brain connectivity profiles of the stimulation site to distant brain regions. However, the potential of brain connectivity profiles to predict response to DBS in PD remains unclear.

Objective: This study aimed to investigate how changes in structural and functional connectivity may relate to patient response to DBS, through the examination of brain network changes using graph theory.

Methods: Ten patients with advanced ...


Effect Of Tort Reform On Diagnostic Imaging Rates, Israel Ojalva, BA, Arthur Hong, MD, MPH 2019 Thomas Jefferson University

Effect Of Tort Reform On Diagnostic Imaging Rates, Israel Ojalva, Ba, Arthur Hong, Md, Mph

Phase 1

Introduction: Defensive medicine, is defined as “order[ing] tests, procedures, or visits, or avoid certain high-risk patients or procedures, primarily (but not solely) because of concern about malpractice liability.” Nearly all physician who fear malpractice litigation have admitted to practicing some degree of defensive medicine. In response, many states have enacted policy reforms to lighten the threat of malpractice on physicians.

Objective: The most common defensive medicine behavior is ordering diagnostic imaging tests when it is potentially unwarranted. Many states have enacted non-economic damage caps from 2000-2010. We explored if these laws had an impact on the rates of diagnostic ...


Is Excision Of Radial Scars Identified On Cnb Necessary?, K. Nimtz, K. Hookim, MD, A. Sevrukov, MD, T. Tsangaris, MD, A. Willis, MD, A. Berger, MD, M. Lazar, MD 2019 Thomas Jefferson University

Is Excision Of Radial Scars Identified On Cnb Necessary?, K. Nimtz, K. Hookim, Md, A. Sevrukov, Md, T. Tsangaris, Md, A. Willis, Md, A. Berger, Md, M. Lazar, Md

Phase 1

Introduction: Quantifying the risk of upgrade to malignancy with radial scars has been an ongoing challenge, as the published upgrade rate varies widely from 0-40%, making management strategy controversial. The lack of consensus on optimal management highlights the need for further analysis. We sought to identify our institutional upgrade rate of radial scar identified on core needle biopsy (CNB).

Methods: A retrospective review of pathology and radiology databases was performed to identify radial scars found on CNB. We excluded patients with malignancy associated with radial scar and those who did not undergo surgical excision. The upgrade rates to malignancy or ...


Deep Learning Based Medical Image Analysis With Limited Data, Jiaxing Tan 2019 The Graduate Center, City University of New York

Deep Learning Based Medical Image Analysis With Limited Data, Jiaxing Tan

All Dissertations, Theses, and Capstone Projects

Deep Learning Methods have shown its great effort in the area of Computer Vision. However, when solving the problems of medical imaging, deep learning’s power is confined by limited data available. We present a series of novel methodologies for solving medical imaging analysis problems with limited Computed tomography (CT) scans available. Our method, based on deep learning, with different strategies, including using Generative Adversar- ial Networks, two-stage training, infusing the expert knowledge, voting based or converting to other space, solves the data set limitation issue for the cur- rent medical imaging problems, specifically cancer detection and diagnosis, and shows ...


Diffusion-Weighted Magnetic Resonance Imaging May Be Useful In Differentiating Fungal Abscess From Malignant Intracranial Lesion: Case Report, Syeda Maheen Batool, Fatima Mubarak, Ather Enam 2019 Aga Khan University

Diffusion-Weighted Magnetic Resonance Imaging May Be Useful In Differentiating Fungal Abscess From Malignant Intracranial Lesion: Case Report, Syeda Maheen Batool, Fatima Mubarak, Ather Enam

Section of Neurosurgery

Background: Diffusion-weighted magnetic resonance has a well-defined role in differentiating between important intracranial lesions. Sometimes, the surgeon is faced with a dilemma of how to diagnose an infectious versus malignant lesion.
Case Description: A 28-year-old male presented to the neurosurgery clinic with complaints of headache and left-sided weakness for 2 weeks. Neurological examination was intact. Magnetic resonance imaging (MRI) scan showed a large infiltrating heterogeneous mass involving the right parietal lobe. On further reviewing, there was homogenous diffusion restriction in the center of lesion. In addition, its aggressive behavior confirmed it to be a fungal abscess.
Conclusions: Correctly identifying an ...


Neuroform Atlas Stent System For The Treatment Of Intracranial Aneurysm: Primary Results Of The Atlas Humanitarian Device Exemption Cohort, Brian T. Jankowitz, Ricardo Hanel, Ashutosh P. Jadhav, David N. Loy, Donald Frei, Adnan H. Siddiqui, Ajit S. Puri, Ahmad Khaldi, Aquilla S. Turk, Adel M. Malek, Eric Sauvageau, Steven W. Hetts, Osama O. Zaidat 2019 UPMC Presbyterian Hospital

Neuroform Atlas Stent System For The Treatment Of Intracranial Aneurysm: Primary Results Of The Atlas Humanitarian Device Exemption Cohort, Brian T. Jankowitz, Ricardo Hanel, Ashutosh P. Jadhav, David N. Loy, Donald Frei, Adnan H. Siddiqui, Ajit S. Puri, Ahmad Khaldi, Aquilla S. Turk, Adel M. Malek, Eric Sauvageau, Steven W. Hetts, Osama O. Zaidat

Radiology Publications

BACKGROUND AND OBJECTIVE: Stent-assisted coil embolization is a well-established treatment of intracranial wide-necked aneurysms. The Neuroform Atlas Stent System is a new generation microstent designed to enhance coil support, conformability, deliverability, and improve deployment accuracy. We present the 1-year efficacy and angiographic results of the Humanitarian Device Exemption (HDE) cohort from the Atlas Investigational Device Exemption (IDE) clinical trial.

METHOD: The Atlas IDE trial is a prospective, multicenter, single-arm, open-label study of unruptured wide-necked intracranial aneurysms treated with the Neuroform Atlas stent and approved coils. The primary efficacy endpoint was the rate of 12-month complete aneurysm angiographic occlusion (Raymond class ...


Excluding Ptv From Lung Volume May Better Predict Radiation Pneumonitis For Intensity Modulated Radiation Therapy In Lung Cancer Patients, Yinnan Meng, Haihua Yang, Wei Wang, Xingni Tang, Caiping Jiang, Yichao Shen, Wei Luo 2019 Enze Medical Health Academy, China

Excluding Ptv From Lung Volume May Better Predict Radiation Pneumonitis For Intensity Modulated Radiation Therapy In Lung Cancer Patients, Yinnan Meng, Haihua Yang, Wei Wang, Xingni Tang, Caiping Jiang, Yichao Shen, Wei Luo

Radiation Medicine Faculty Publications

Background: Lung dose-volume histogram (DVH) in radiotherapy could be calculated from multiple normal lung definitions. The lung dosimetric parameters generated from various approaches are significantly different. However, limited evidence shows which definition should be used to more accurately predict radiation pneumonitis (RP). We aimed to compare the RP prediction accuracy of dosimetric parameters from three lung volume methods in lung cancer patients treated with Intensity-Modulated Radiation Therapy (IMRT).

Methods: We retrospectively reviewed 183 consecutive lung cancer patients treated with IMRT from January 2014 to October 2017. The normal lungs were defined by total bilateral lung volume (Total Lung), excluding PTV ...


Outcomes After Coverage Of Lenticulostriate Vessels By Flow Diverters: A Multicenter Experience, Kathryn M. Wagner, Visish M. Srinivasan, Aditya Srivatsan, Michael G. Ghali Z, Ajith J. Thomas, Alejandro Enriquez-Marulanda, Abdulrahman Y. Alturki, Christopher S. Ogilvy, Maxim Mokin, Anna L. Kuhn, Ajit Puri, Ramesh Grandhi, Stephen Chen, Jeremiah Johnson, Peter Kan 2019 Baylor University

Outcomes After Coverage Of Lenticulostriate Vessels By Flow Diverters: A Multicenter Experience, Kathryn M. Wagner, Visish M. Srinivasan, Aditya Srivatsan, Michael G. Ghali Z, Ajith J. Thomas, Alejandro Enriquez-Marulanda, Abdulrahman Y. Alturki, Christopher S. Ogilvy, Maxim Mokin, Anna L. Kuhn, Ajit Puri, Ramesh Grandhi, Stephen Chen, Jeremiah Johnson, Peter Kan

Radiology Publications

OBJECTIVE: With the increasing use of flow diversion as treatment for intracranial aneurysms, there is a concomitant increased vigilance in monitoring complications. The low porosity of flow diverters is concerning when the origins of vessels are covered, whether large circle of Willis branches or critical perforators. In this study, the authors report their experience with flow diverter coverage of the lenticulostriate vessels and evaluate their safety and outcomes.

METHODS: The authors retrospectively reviewed 5 institutional databases of all flow diversion cases from August 2012 to June 2018. Information regarding patient presentation, aneurysm location, treatment, and outcomes were recorded. Patients who ...


Cancer Of The Esophagus, Rebecca M. Kwait, Richard S. Pieters, Madhavi Toke, Lauren E. Studey, Ali Akalin, Adib R. Karam, Geoffrey Graeber, Lacey J. McIntosh, Anupam Singh 2019 University of Massachusetts Medical School

Cancer Of The Esophagus, Rebecca M. Kwait, Richard S. Pieters, Madhavi Toke, Lauren E. Studey, Ali Akalin, Adib R. Karam, Geoffrey Graeber, Lacey J. Mcintosh, Anupam Singh

Cancer Concepts: A Guidebook for the Non-Oncologist

This chapter in Cancer Concepts: A Guidebook for the Non-Oncologist presents an overview of esophageal cancer, including etiology, epidemiology, screening, pathology, staging, and treatment.


An In-Silico Quality Assurance Study Of Contouring Target Volumes In Thoracic Tumors Within A Cooperative Group Setting, Hesham Elhalawani, Thomas J. Fitzgerald, Fran Laurie, Kenneth Ulin, Roy Decker, Charles R. Thomas Jr., Clifton D. Fuller 2019 University of Texas M.D. Anderson Cancer Center

An In-Silico Quality Assurance Study Of Contouring Target Volumes In Thoracic Tumors Within A Cooperative Group Setting, Hesham Elhalawani, Thomas J. Fitzgerald, Fran Laurie, Kenneth Ulin, Roy Decker, Charles R. Thomas Jr., Clifton D. Fuller

Open Access Articles

Introduction: Target delineation variability is a significant technical impediment in multi-institutional trials which employ intensity modulated radiotherapy (IMRT), as there is a real potential for clinically meaningful variances that can impact the outcomes in clinical trials. The goal of this study is to determine the variability of target delineation among participants from different institutions as part of Southwest Oncology Group (SWOG) Radiotherapy Committee's multi-institutional in-silico quality assurance study in patients with Pancoast tumors as a "dry run" for trial implementation.

Methods: CT simulation scans were acquired from four patients with Pancoast tumor. Two patients had simulation 4D-CT and FDG-FDG ...


Radiation Safety Practices Of Dental Hygienists In The United States, Kimberly Lintag, Ann M. Bruhn, Susan Lynn Tolle, Norou Diawara 2019 Old Dominion University

Radiation Safety Practices Of Dental Hygienists In The United States, Kimberly Lintag, Ann M. Bruhn, Susan Lynn Tolle, Norou Diawara

Dental Hygiene Faculty Publications

Purpose: The As Low As Reasonably Achievable (ALARA) principle was developed to promote awareness and minimization of radiation exposure and is supported by radiation control and professional organizations. The purpose of this study was to determine licensed dental hygienists' current radiation safety practices.

Methods: Data were collected with a 22 item, online survey administered to a convenience sample of 1,500 dental hygienists in the United States. Questions focused on respondents' use of the American Dental Association (ADA) radiographic examination selection guidelines, their individual dental practice policies, and hand-held portable x-ray device use and training. Cross tabulations were obtained using ...


Comparison Of Quantitative Analysis To Qualitative Analysis For Interpretation Of Lower‑Limb Lymphoscintigraphy, Edward Nganga, Khalid Makhdomi 2019 Aga Khan University

Comparison Of Quantitative Analysis To Qualitative Analysis For Interpretation Of Lower‑Limb Lymphoscintigraphy, Edward Nganga, Khalid Makhdomi

Imaging & Diagnostic Radiology, East Africa

Qualitative analysis of lymphoscintigrams is subject to wide variability and may miss subtle differences in ilioinguinal uptake between normal and abnormal limbs. This study compared quantitative analysis to qualitative analysis of lower‑limb lymphoscintigraphy in diagnosing lymphedema. Fifty‑two lymphoscintigrams performed using standardized protocol, 99‑metastable technetium nanocolloid intradermal injection at the first interdigital space, were analyzed quantitatively. Fifty‑three normal and 51 abnormal limbs were analyzed. For each limb, a region of interest (ROI) was drawn around the injection site, and ilioinguinal nodes on the 1.5 h static images and the counts in these ROIs were recorded. Percentage ...


Evaluation Of Plan Quality And Treatment Efficiency For Single-Isocenter/Two-Lesion Lung Stereotactic Body Radiation Therapy, Lana Sanford, Janelle A. Molloy, Sameera S. Kumar, Marcus Randall, Ronald C. McGarry, Damodar Pokhrel 2019 University of Kentucky

Evaluation Of Plan Quality And Treatment Efficiency For Single-Isocenter/Two-Lesion Lung Stereotactic Body Radiation Therapy, Lana Sanford, Janelle A. Molloy, Sameera S. Kumar, Marcus Randall, Ronald C. Mcgarry, Damodar Pokhrel

Radiation Medicine Faculty Publications

Purpose/objectives: To evaluate the plan quality and treatment delivery efficiency of single‐isocenter/two‐lesions volumetric modulated arc therapy (VMAT) lung stereotactic body radiation therapy (SBRT).

Materials/methods: Eight consecutive patients with two peripherally located early stage nonsmall‐cell‐lung cancer (NSCLC) lung lesions underwent single‐isocenter highly conformal noncoplanar VMAT SBRT treatment in our institution. A single‐isocenter was placed between the two lesions. Doses were 54 or 50 Gy in 3 and 5 fractions respectively. Patients were treated every other day. Plans were calculated in Eclipse with AcurosXB algorithm and normalized to at least 95% of the ...


Sparsity Promoting Regularization For Effective Noise Suppression In Spect Image Reconstruction, Wei Zheng, Si Li, Andrzej Krol, C. Ross Schmidtlein, Xueying Zeng, Yuesheng Xu 2019 Old Dominion University

Sparsity Promoting Regularization For Effective Noise Suppression In Spect Image Reconstruction, Wei Zheng, Si Li, Andrzej Krol, C. Ross Schmidtlein, Xueying Zeng, Yuesheng Xu

Mathematics & Statistics Faculty Publications

The purpose of this research is to develop an advanced reconstruction method for low-count, hence high-noise, Single-Photon Emission Computed Tomography (SPECT) image reconstruction. It consists of a novel reconstruction model to suppress noise while conducting reconstruction and an efficient algorithm to solve the model. A novel regularizer is introduced as the nonconvex denoising term based on the approximate sparsity of the image under a geometric tight frame transform domain. The deblurring term is based on the negative log-likelihood of the SPECT data model. To solve the resulting nonconvex optimization problem a Preconditioned Fixed-point Proximity Algorithm (PFPA) is introduced. We prove ...


Metastatic Vertebral Lesion Mimicking An Atypical Hemangioma With Negative 18f-Fdg Positron Emission Tomography-Computed Tomography, Ana Cecilia Belzarena Genovese 2019 Baptist Health Medical Group; Miami Cancer Institute; Miami Orthopedics & Sports Medicine Institute

Metastatic Vertebral Lesion Mimicking An Atypical Hemangioma With Negative 18f-Fdg Positron Emission Tomography-Computed Tomography, Ana Cecilia Belzarena Genovese

All Publications

Atypical hemangiomas of the spine can mimic metastatic lesions on magnetic resonance imaging, therefore making this distinction is a diagnostic challenge. In most cases, this conundrum can usually be solved with positron emission tomography/computed tomography images, because hemangiomas do not usually present with increased uptake while metastatic lesions do. Here we present a case of a patient with a unique diagnosis, myxoid liposarcoma, in which the vertebral metastatic lesion did not present with increased uptake in positron emission tomography/computed tomography scans. While keeping the imaging particularity of this rare sarcoma in mind, proceeding with a biopsy when the ...


Target® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis Of Peri-Procedural And Long-Term Safety And Efficacy Results, Osama O. Zaidat, Alicia C. Castonguay, Ansaar T. Rai, Aamir Badruddin, William J. Mack, Amer K. Alshekhlee, Qaisar A. Shah, Syed I. Hussain, Mouhammed R. Kabbani, Ketan R. Bulsara, Asif M. Taqi, Vallabh Janardhan, Mary S. Patterson, Britany L. Nordhaus, Lucas Elijovich, Ajit S. Puri 2019 Bon Secours Mercy Health St. Vincent Hospital, Toledo, OH

Target® Intracranial Aneurysm Coiling Prospective Multicenter Registry: Final Analysis Of Peri-Procedural And Long-Term Safety And Efficacy Results, Osama O. Zaidat, Alicia C. Castonguay, Ansaar T. Rai, Aamir Badruddin, William J. Mack, Amer K. Alshekhlee, Qaisar A. Shah, Syed I. Hussain, Mouhammed R. Kabbani, Ketan R. Bulsara, Asif M. Taqi, Vallabh Janardhan, Mary S. Patterson, Britany L. Nordhaus, Lucas Elijovich, Ajit S. Puri

Faculty & Staff Scholarship

Background and Purpose: To describe the final results of the TARGET Registry, a multicenter, real-world study of patients with intracranial aneurysms treated with new generation TARGET Coils.

Methods: The TARGET Registry is a prospective, single-arm study with independent medical event monitoring and core-lab adjudication. Patients with de novo intracranial aneurysms were embolized with either TARGET-360° or helical coils in 12 US centers. The primary outcome was aneurysm packing density (PD), which was assessed immediately post-procedure. The secondary outcomes were immediate and long-term aneurysm occlusion rate using the Raymond Scale, and independent functional outcome using the modified Rankin Scale (mRS). A ...


Calibrated Short Tr Recovery Mri For Rapid Measurement Of Brain-Blood Partition Coefficient And Correction Of Quantitative Cerebral Blood Flow, Scott William Thalman 2019 University of Kentucky

Calibrated Short Tr Recovery Mri For Rapid Measurement Of Brain-Blood Partition Coefficient And Correction Of Quantitative Cerebral Blood Flow, Scott William Thalman

Theses and Dissertations--Biomedical Engineering

The high prevalence and mortality of cerebrovascular disease has led to the development of several methods to measure cerebral blood flow (CBF) in vivo. One of these, arterial spin labeling (ASL), is a quantitative magnetic resonance imaging (MRI) technique with the advantage that it is completely non-invasive. The quantification of CBF using ASL requires correction for a tissue specific parameter called the brain-blood partition coefficient (BBPC). Despite regional and inter-subject variability in BBPC, the current recommended implementation of ASL uses a constant assumed value of 0.9 mL/g for all regions of the brain, all subjects, and even all ...


A Revisit To The Pretargeting Concept - A Target Conversion, Guozheng Liu 2018 University of Massachusetts Medical School

A Revisit To The Pretargeting Concept - A Target Conversion, Guozheng Liu

Radiology Publications

Pretargeting is often used as a tumor targeting strategy that provides much higher tumor to non-tumor ratios than direct-targeting using radiolabeled antibody. Due to the multiple injections, pretargeting is investigated less than direct targeting, but the high T/NT ratios have rendered it more useful for therapy. While the progress in using this strategy for tumor therapy has been regularly reviewed in the literature, this review focuses on the nature and quantitative understanding of the pretargeting concept. By doing so, it is the goal of this review to accelerate pretargeting development and translation to the clinic and to prepare the ...


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