Radiology Commons^™

Multidisciplinary Approach To Diagnostic Radiology Education: A Novel Educational Intervention For Turkish Medical Students, Parth Patel, Emre Altınmakas, Görkem Ayas, Rachel Stanietzky, Madeline L. Stewart, Abdelrahman Elshikh, Disha Ram, Hrishika Bhosale, Mohamed Eltaher, Serageldin Kamel, Munevver N. Duran, Umut Yücel, Mohamed Badawy, Scott Rohren, Khaled M. Elsayes

School of Medicine Faculty Publications

Teleconferencing can facilitate a multidisciplinary approach to teaching radiology to medical students. This study aimed to determine whether an online learning approach enables students to appreciate the interrelated roles of radiology and other specialties during the management of different medical cases. Turkish medical students attended five 60-90-minute online lectures delivered by radiologists and other specialists from the United States and Canada through Zoom meetings between November 2020 and January 2021. Student ambassadors from their respective Turkish medical schools recruited their classmates with guidance from the course director. Students took a pretest and posttest to assess the knowledge imparted from each …

Spinal Cord Watershed Infarction After Surgery, Gia Nguyen, Giang-Kim Nguyen, Fanny Emilia Morón

Faculty, Staff and Students Publications

Spinal cord watershed infarction is a rare phenomenon due to the rich collateral blood supply to the organ. It often occurs in elderly patients with preexisting atherosclerotic disease in the setting of global hypoperfusion, such as thoracoabdominal surgery, dissection, coagulopathies, or idiopathic. We present a case of spinal cord infarction (SCI) in both longitudinal and transverse watershed areas as a complication of postoperative blood loss. In addition, we demonstrate the imaging evolution of spinal cord infarct in the subacute phase with peripheral enhancement due to the breakdown of the blood-spinal cord barrier.

Jacc: Advances Expert Panel Perspective: Shared Decision-Making In Multidisciplinary Team-Based Cardiovascular Care, Elizabeth M Perpetua, Roseanne Palmer, Viet T Le, Sana M Al-Khatib, Craig J Beavers, Joshua A Beckman, Biykem Bozkurt, Megan Coylewright, Caroline Lloyd Doherty, Kimberly A Guibone, Marian Hawkey, Patricia A Keegan, James N Kirkpatrick, Jessica Laperle, Sandra B Lauck, Glenn Levine, Brian R Lindman, Michael J Mack, Andrea L Price, Susan Strong, Janet F Wyman, Quentin R Youmans, Martha Gulati

Faculty, Staff and Students Publications

Shared decision-making (SDM) and multidisciplinary team-based care delivery are recommended across several cardiology clinical practice guidelines. However, evidence for benefit and guidance on implementation are limited. Informed consent, the use of patient decision aids, or the documentation of these elements for governmental or societal agencies may be conflated as SDM. SDM is a bidirectional exchange between experts: patients are the experts on their goals, values, and preferences, and clinicians provide their expertise on clinical factors. In this Expert Panel perspective, we review the current state of SDM in team-based cardiovascular care and propose best practice recommendations for multidisciplinary team implementation …

Intratumoral Injection Of Immunotherapeutics: State Of The Art And Future Directions, Rahul A Sheth, Eric Wehrenberg-Klee, Sapna P Patel, Kristy K Brock, Nicos Fotiadis, Thierry De Baère

Faculty, Staff and Student Publications

Systemic immunotherapies have led to tremendous progress across the cancer landscape. However, several challenges exist, potentially limiting their efficacy in the treatment of solid tumors. Direct intratumoral injection can increase the therapeutic index of immunotherapies while overcoming many of the barriers associated with systemic administration, including limited bioavailability to tumors and potential systemic safety concerns. However, challenges remain, including the lack of standardized approaches for administration, issues relating to effective drug delivery, logistical hurdles, and safety concerns specific to this mode of administration. This article reviews the biologic rationale for the localized injection of immunotherapeutic agents into tumors. It also …

Editorial For "Parallel Cnn-Deep Learning Clinical-Imaging Signature For Assessing Pathologic Grade And Prognosis Of Soft Tissue Sarcoma Patients", Pegah Khosravi

Publications and Research

No abstract provided.

Unlikely Cohabitants: A Collision Tumor Of Metastatic Small Cell Lung Carcinoma And Adrenal Adenoma, Michael Demeritt, Savanna Atwal, Stefan Johnson, Kevin Lightner, Joel Thompson

Advances in Clinical Medical Research and Healthcare Delivery

This case report is the second known publication of a very specific collision tumor, where small cell lung cancer metastasized to an adrenal adenoma. The focus is primarily on multimodal radiologic findings of the developing neoplasm, including CT, MRI, and FDG PET/CT. These findings are compared with established diagnostic criteria for adrenal adenomas and metastases, as identified by the literature and content expert review. Epidemiological data regarding collision tumors is discussed, as well as proposed treatment strategies. Similar topics are elucidated for small cell lung carcinoma. Reporting of this collision tumor adds to the relatively thin body of knowledge of …

Scanless Two-Photon Voltage Imaging, Ruth R Sims, Imane Bendifallah, Christiane Grimm, Aysha S Mohamed Lafirdeen, Soledad Domínguez, Chung Yuen Chan, Xiaoyu Lu, Benoît C Forget, François St-Pierre, Eirini Papagiakoumou, Valentina Emiliani

Faculty, Staff and Students Publications

Two-photon voltage imaging has long been heralded as a transformative approach capable of answering many long-standing questions in modern neuroscience. However, exploiting its full potential requires the development of novel imaging approaches well suited to the photophysical properties of genetically encoded voltage indicators. We demonstrate that parallel excitation approaches developed for scanless two-photon photostimulation enable high-SNR two-photon voltage imaging. We use whole-cell patch-clamp electrophysiology to perform a thorough characterization of scanless two-photon voltage imaging using three parallel illumination approaches and lasers with different repetition rates and wavelengths. We demonstrate voltage recordings of high-frequency spike trains and sub-threshold depolarizations from neurons …

Postoperative Bioactive Adrenomedullin Is Associated With The Onset Of Ards And Adverse Outcomes In Patients Undergoing Open Thoracoabdominal Aortic Surgery, Panagiotis Doukas, Oliver Hartmann, Jelle Frankort, Birte Arlt, Hanif Krabbe, Michael Johan Jacobs, Andreas Greiner, Jan Paul Frese, Alexander Gombert

Faculty, Staff and Student Publications

Cytokine-mediated systemic inflammation after open thoracoabdominal aortic aneurysm (TAAA) repairs plays a pivotal role in disrupting circulatory homeostasis, potentially leading to organ dysfunction. The bioactive form of adrenomedullin (bio-ADM) is a peptide hormone with immunomodulatory and vasomotor effects, making it a potential diagnostic agent in these cases. This retrospective, bicentric study, conducted between January 2019 and December 2022, recruited 36 elective open TAAA repair patients in two German centres. Serum and plasma samples were collected at multiple time points to measure bio-ADM levels. The primary objective was to evaluate the association of bio-ADM levels with the onset of acute respiratory …

A “Fishy” Situation, Rare Pathogen And Presentation In Prosthetic Valve Infective Endocarditis, Nichole Schtupak, Patrick Kennedy, Darko Pucar, Linda Godinez, Jodi-Ann Chin, Kristen Selema, Dipan Uppa, Antonio Lewis, Marcelo Helguera

DMSc Student Publications

Lactococcus garviae (L. garviae) is a gram-positive coccus belonging to the Streptococcaceae family. While primarily a pathogen in fish farms causing hemorrhagic sepsis, it can act as a rare opportunistic pathogen in humans. A 2021 case report by Bravo et al. documented less than 30 cases of infective endocarditis caused by L. garviae worldwide at that time. This case report describes the 27th documented case globally and 7th documented case in the USA of L. garviae causing infective endocarditis of a prosthetic valve.
L. garviae is found in unpasteurized dairy products, raw fish, and meat (pork, beef, and …

Labrad : Vol 49, Issue 1 - June 2024, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• EDITORIAL
• ARTICLES
• Empowering Donors Through Technology
• Impact of Clinical Laboratories on Greenhouse gas emissions
• Embracing Digitalization and Sustainability: Streamlining Laboratory Reporting
• Accelerating Productivity and Performance: Transition from Transcribers to Working with Speech Recognition.
• ECO-Friendly Molecular Pathology Laboratory Practices
• Let’s Work to Build A Sustainable Histopathology Lab
• Laboratory Sustainability -Things to Promote Eco-Conscious Laboratory Environment
• A Guide to Develop the current and future Eco-Friendly Molecular Lab practices
• The Role of Microbiology Laboratories in Seaweed Reduction and Sustainable Agar Production
• The Role of Behavioral Change in Reducing Energy Use in Microbiology Laboratories
• Reducing Pathology’s Environmental Impact – What can we do?
• Water …

Longitudinal Changes In The Carotid Arteries Of Head And Neck Cancer Patients Following Radiation Therapy: Results From A Prospective Serial Imaging Biomarker Characterization Study, Efstratios Koutroumpakis, Abdallah Sherif Radwan Mohamed, Peter Chaftari, David I Rosenthal, Dorothy Gujral, Christopher Nutting, Serageldin Kamel, Mohamed A Naser, Peter Kim, Roland Bassett, Clifton D Fuller, Elie Mouhayar, Md Anderson Head Neck Radiation Oncology Cardiovascular Working Group

Faculty, Staff and Student Publications

INTRODUCTION: We prospectively evaluated morphologic and functional changes in the carotid arteries of patients treated with unilateral neck radiation therapy (RT) for head and neck cancer.

METHODS: Bilateral carotid artery duplex studies were performed at 0, 3, 6, 12, 18 months and 2, 3, 4, and 5 years following RT. Intima media thickness (IMT); global and regional circumferential, as well as radial strain, arterial elasticity, stiffness, and distensibility were calculated.

RESULTS: Thirty-eight patients were included. A significant difference in the IMT from baseline between irradiated and unirradiated carotid arteries was detected at 18 months (median, 0.073 mm vs -0.003 mm; …

Thyroid Cartilage Metastases From Prostate Cancer On 18f Psma Pet Ct: A Case Series, Poonamjeet Loyal, Samuel Gitau, Khalid Makhdomi

Imaging & Diagnostic Radiology, East Africa

Prostate cancer metastases to the thyroid cartilage is an extremely rare phenomenon. We report three cases of advanced prostate carcinoma with metastases to the thyroid cartilage identified on 18F prostate-specific membrane antigen-1007 (PSMA-1007) positron emission tomography (PET)/computed tomography (CT). The pathophysiology and possibility for under-reporting are also discussed. Prostate cancer metastases to the larynx should be considered in the differential diagnosis of thyroid cartilage lesions in patients with advanced prostate cancer and is associated with poor prognosis.

A New Computed Tomography Score-Based Staging For Melioidosis Pneumonia To Predict Progression, Yang Chen, Dehuai He, Yehua Wu, Xiangying Li, Kaifu Yang, Yuefu Zhan, Jianqiang Chen, Xiaobo Zhou

Faculty, Staff and Student Publications

infectious disease prevalent in tropical regions. Chest computed tomography (CT) has emerged as a valuable tool for assessing the severity and progression of lung involvement in melioidosis pneumonia. However, there persists a need for the quantitative assessment of CT characteristics and staging methodologies to precisely anticipate disease progression. This study aimed to quantitatively extract CT features and evaluate a CT score-based staging system in predicting the progression of melioidosis pneumonia.

Methods: This study included 97 patients with culture-confirmed melioidosis pneumonia who presented between January 2002 and December 2021. Lung segmentation and annotation of lesions (consolidation, nodules, and cavity) were used …

Adding 6 Months Of Androgen Deprivation Therapy To Postoperative Radiotherapy For Prostate Cancer: A Comparison Of Short-Course Versus No Androgen Deprivation Therapy In The Radicals-Hd Randomised Controlled Trial, Chris C Parker, Noel W Clarke, Adrian D Cook, Howard Kynaston, Charles N Catton, William R Cross, Peter M Petersen, Rajendra A Persad, Fred Saad, Lorna C Bower, John Logue, Heather Payne, Silvia Forcat, Cindy Goldstein, Claire Murphy, Juliette Anderson, Maroie Barkati, David M Bottomley, Jennifer Branagan, Ananya Choudhury, Peter W M Chung, Lyn Cogley, Chee L Goh, Peter Hoskin, Vincent Khoo, Shawn C Malone, Lindsey Masters, Stephen L Morris, Abdenour Nabid, Aldrich D Ong, Rakesh Raman, Kathryn L Tarver, Alison C Tree, Jane Worlding, James P Wylie, Anjali M Zarkar, Wendy R Parulekar, Mahesh K B Parmar, Matthew R Sydes, Radicals Investigators

Faculty, Staff and Student Publications

BACKGROUND: Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear.

METHODS: RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy …

Cardiovascular Imaging, Climate Change, And Environmental Sustainability., Suvai Gunasekaran, Andrew Szava-Kovats, Thomas Battey, Jonathan Gross, Eugenio Picano, Subha V Raman, Emil Lee, Malenka M Bissell, Mirvat Alasnag, Adrienne E Campbell-Washburn, Kate Hanneman

Heart and Vascular Articles

Environmental exposures including poor air quality and extreme temperatures are exacerbated by climate change and are associated with adverse cardiovascular outcomes. Concomitantly, the delivery of health care generates substantial atmospheric greenhouse gas (GHG) emissions contributing to the climate crisis. Therefore, cardiac imaging teams must be aware not only of the adverse cardiovascular health effects of climate change, but also the downstream environmental ramifications of cardiovascular imaging. The purpose of this review is to highlight the impact of climate change on cardiovascular health, discuss the environmental impact of cardiovascular imaging, and describe opportunities to improve environmental sustainability of cardiac MRI, cardiac …

Blunt Cerebrovascular Injury (Bcvi): Universal Cta Neck Screening At Level 2 Trauma Center, Tamine Gogel

Doctor of Nursing Practice Projects

Blunt Cerebrovascular Injury (BCVI) refers to injuries to the vessels supplying blood to the brain, primarily carotid and vertebral arteries, and can result from trauma, resulting in stroke by vessel dissection, thrombus formation, embolization, and hemorrhage. Timely identification is crucial for effective intervention and improved outcomes. This doctoral project proposes the implementation of universal screening using Computed Tomography Angiography (CTA) of the neck during initial workup for blunt force trauma at a Level II ACS-verified trauma center. The primary objective is to mitigate potential delays in diagnosing and treating BCVI, thereby reducing the likelihood of complications. Patients ≥ 15 years …

Early Outcomes Of Mr-Guided Sbrt For Patients With Recurrent Pancreatic Adenocarcinoma, Spencer Poiset, Sophia Shah, Louis Cappelli, Rani Anné, Karen Mooney, Maria Werner-Wasik, Talya Laufer, James Posey, Daniel Lin, Atrayee Mallick, Harish Lavu, Babar Bashir, Charles Yeo, Adam Mueller

Kimmel Cancer Center Faculty Papers

BACKGROUND: Local treatment options for locally recurrent pancreatic adenocarcinoma (LR-PAC) are limited, with median survival time (MST) of 9-13 months (mos) following recurrence. MRI-guided stereotactic body radiation therapy (MRgSBRT) provides the ability to dose escalate while sparing normal tissue. Here we report on the early outcomes of MRgSBRT for LR-PAC.

METHODS: Patients with prior resection of pancreatic adenocarcinoma with local recurrence treated with MRgSBRT at a single tertiary referral center from 5-2021 to 2-2023 were identified from our prospective database. MRgSBRT was delivered to 40-50 Gy in 4-5 fractions with target and OAR delineation per institutional standards. Endpoints included local …

Vascular Risk Profile And Changes Of Arterial Hypertension After Surgical Revascularization In Adult Moyamoya Patients, Patrick Haas, Lucas Moritz Wiggenhauser, Jonas Tellermann, Helene Hurth, Daniel Feucht, Marcos Tatagiba, Nadia Khan, Constantin Roder

Faculty, Staff and Student Publications

Moyamoya disease (MMD) is a rare stenoocclusive cerebral vasculopathy often treated by neurosurgical revascularization using extracranial-intracranial bypasses to prevent ischemic or hemorrhagic events. Little is known about the vascular risk profile of adult MMD patients compared to the general population. We therefore analyzed 133 adult MMD patients and compared them with data from more than 22,000 patients from the German Health Update database. Patients with MMD showed an age- and sex-adjusted increased prevalence of arterial hypertension, especially in women between 30 and 44 years and in patients of both sexes between 45 and 64 years. Diabetes mellitus was diagnosed significantly …

An International Phantom Study Of Inter-Site Variability In Technetium-99m Image Quantification: Analyses From The Target Radioembolization Study, Grace Keane, Rob Van Rooij, Marnix Lam, S Cheenu Kappadath, Bilal Kovan, Stephanie Leon, Matthew Dreher, Kirk Fowers, Hugo De Jong

Faculty, Staff and Student Publications

BACKGROUND: Personalised multi-compartment dosimetry based on [

RESULTS: Regarding the LSF, inter-site variation with planar site-specific protocols was minimal, as determined by comparing computed LSF between sites (interquartile range 9.6-10.1%). A standardised protocol did not improve variation (interquartile range 8.4-9.0%) but did improve mean accuracy compared to the site-specific protocols (5.0% error for standardised protocol vs 8.8% error for site-specific protocols). Regarding the CRC, inter-system variation was notable for site-specific SPECT protocols and could not be improved by the standardised protocol (CRC interquartile range for 37 mm sphere 0.5-0.7 and 0.6-0.8 respectively), however the standardised protocol did improve accuracy of …

Outcomes And Pattern Of Care For Spinal Myxopapillary Ependymoma In The Modern Era-A Population-Based Observational Study, Chenyang Wang, Michael K Rooney, Christopher Alvarez-Breckenridge, Thomas H Beckham, Caroline Chung, Brian S De, Amol J Ghia, David Grosshans, Nazanin K Majd, Mary F Mcaleer, Susan L Mcgovern, Robert Y North, Arnold C Paulino, Subha Perni, Jay P Reddy, Laurence D Rhines, Todd A Swanson, Claudio E Tatsui, Martin C Tom, Debra N Yeboa, Jing Li

Faculty, Staff and Student Publications

(1) Background: Myxopapillary ependymoma (MPE) is a rare tumor of the spine, typically slow-growing and low-grade. Optimal management strategies remain unclear due to limited evidence given the low incidence of the disease. (2) Methods: We analyzed data from 1197 patients with spinal MPE from the Surveillance, Epidemiology, and End Results (SEER) database (2000-2020). Patient demographics, treatment modalities, and survival outcomes were examined using statistical analyses. (3) Results: Most patients were White (89.9%) with a median age at diagnosis of 42 years. Surgical resection was performed in 95% of cases. The estimated 10-year overall survival was 91.4%. Younger age (hazard ratio …