Radiology Commons^™

Advances In The Radiological Evaluation Of And Theranostics For Glioblastoma, Grayson W Hooper, Shehbaz Ansari, Jason M Johnson, Daniel T Ginat

Faculty, Staff and Student Publications

Imaging is essential for evaluating patients with glioblastoma. Traditionally a multimodality undertaking, CT, including CT cerebral blood profusion, PET/CT with traditional fluorine-18 fluorodeoxyglucose (18F-FDG), and MRI have been the mainstays for diagnosis and post-therapeutic assessment. However, recent advances in these modalities, in league with the emerging fields of radiomics and theranostics, may prove helpful in improving diagnostic accuracy and treating the disease.

Automated Lung Ultrasound Pulmonary Disease Quantification Using An Unsupervised Machine Learning Technique For Covid-19, Hersh Sagreiya, Michael A Jacobs, Alireza Akhbardeh

Faculty, Staff and Student Publications

COVID-19 is an ongoing global health pandemic. Although COVID-19 can be diagnosed with various tests such as PCR, these tests do not establish pulmonary disease burden. Whereas point-of-care lung ultrasound (POCUS) can directly assess the severity of characteristic pulmonary findings of COVID-19, the advantage of using US is that it is inexpensive, portable, and widely available for use in many clinical settings. For automated assessment of pulmonary findings, we have developed an unsupervised learning technique termed the calculated lung ultrasound (CLU) index. The CLU can quantify various types of lung findings, such as A or B lines, consolidations, and pleural …

Brain Arteriovenous Malformations: The Long Way Ahead In Physics, Chemistry And Mr-Angiography Practice Before Fully Replacing Digital Subtraction Angiography., Subhendra N. Sarkar

Publications and Research

Typically, only high field systems are equipped with stronger gradients and short RF pulse designs, a must for high temporal resolution that are also responsible for high SAR, high susceptibility as well as neurostimulation. Gradient induced image noise tends to be high at 3T. Often vendors try to ameliorate such increased image noise with multi-channel head arrays and aggressive filter designs allowing an appearance of high SNR and CNR quality; however, the achievable SNR and CNR in the AVM remain limited as the analyzed articles by Zhuo et al seem to have in common. A short term solution to harvest …

A Multidimensional Connectomics- And Radiomics-Based Advanced Machine-Learning Framework To Distinguish Radiation Necrosis From True Progression In Brain Metastases, Yilin Cao, Vishwa S Parekh, Emerson Lee, Xuguang Chen, Kristin J Redmond, Jay J Pillai, Luke Peng, Michael A Jacobs, Lawrence R Kleinberg

Faculty, Staff and Student Publications

We introduce tumor connectomics, a novel MRI-based complex graph theory framework that describes the intricate network of relationships within the tumor and surrounding tissue, and combine this with multiparametric radiomics (mpRad) in a machine-learning approach to distinguish radiation necrosis (RN) from true progression (TP). Pathologically confirmed cases of RN vs. TP in brain metastases treated with SRS were included from a single institution. The region of interest was manually segmented as the single largest diameter of the T1 post-contrast (T1C) lesion plus the corresponding area of T2 FLAIR hyperintensity. There were 40 mpRad features and 6 connectomics features extracted, as …

Persistent Foci Of Infection: A Case Of Two Mycotic Aneurysms Separated In Time In A Patient With Infective E. Faecalis Endocarditis, Julia C. Stone, Joel Thompson, Joseph Hatem, Evan Basha

Advances in Clinical Medical Research and Healthcare Delivery

This is a case report of a patient who presented with mycotic aneurysms of two different blood vessels at separate hospital visits following a diagnosis of infective endocarditis.

Median Arcuate Ligament Syndrome: A Rare Cause Of Abdominal Pain That Is Difficult To Identify, Mark E. Eskander, Matthew Thrall, Joel P. Thompson

Advances in Clinical Medical Research and Healthcare Delivery

Median arcuate ligament syndrome (MALS) is a rare disease that occurs when the celiac artery is compressed by the median arcuate ligament. Patients with MALS typically present with non-specific symptoms that overlap with more common diseases. As a result, patients may undergo extensive workup and unnecessary treatments before being properly diagnosed with MALS. In this case we present a 23-year-old female with chronic postprandial abdominal pain that persisted despite undergoing a cholecystectomy. This case highlights the symptoms and imaging findings needed to diagnose MALS and thus prevent unnecessary surgical interventions.

Leser-Trélat Sign As A Marker For Underlying Pancreatic Cancer, Kalpit Modi, Richard Chen, Layla Abubshait

Einstein Health Papers

Case Presentation: Early diagnosis and rapid treatment of cancer is essential for good clinical outcomes for patients. In this case, an 85-year-old man presented with failure to thrive and was noted to have rapid-onset, multiple seborrheic keratoses (Leser-Trélat sign) on his chest and back. He was ultimately diagnosed with pancreatic cancer using computed tomography.

Discussion: Leser-Trélat sign is a rare cutaneous marker for underlying malignancy. Identification of this sign can help guide diagnostic imaging and lab work to identify an occult internal malignancy, resulting in more rapid diagnosis, earlier treatment, and potentially better clinical outcomes.

A Case Of Combined Pulmonary Vein Isolation (Pvi) And Watchman Implant Through Hepatic Vein In A Patient With Interrupted Inferior Vena Cava (Ivc), Sameh Girgis, Negar Niknam, Zabeer Bhatti, Jalal Mohsin, Ahmed Kamel Abdel Aal, Ramesh Hariharan, Khashayar Hematpour

Faculty, Staff and Student Publications

This case report describes a successful procedure involving pulmonary vein isolation (PVI) and left atrial appendage (LAA) closure with a watchman device in a 78-year-old male with atrial fibrillation and an interrupted inferior vena cava. Due to the vascular anomaly, a transhepatic approach was used, which proved successful.

Evaluation Of Bone And Muscle Quality In Laying Hens Using Quantitative, Radiographic, Computed Tomographic, Biomechanical, And Tissue Level Measures, Cerano Harrison

All Dissertations

Bone quality is an important measure of welfare in laying hens for researchers, veterinarians, and commercial producers who bear the responsibility of providing them with care. Breeding practices that have resulted in high egg productivity of laying hen strains have resulted in an increased susceptibility to developing osteoporosis. Osteoporosis, a decrease in mineralized bone, is accompanied by increased bone fragility that can lead to potentially painful bone fractures that can inhibit some aspects of the birds natural living, respiration and flight being two examples. Current methods of examining laying hen bone quality involve the implementation of diagnostic imaging and biomechanical …

Mird Pamphlet No 28, Part 2: Comparative Evaluation Of Mirdcalc Dosimetry Software Across A Compendium Of Diagnostic Radiopharmaceuticals, Lukas M Carter, Juan C Ocampo Ramos, Edmond A Olguin, Justin L Brown, Daniel Lafontaine, Derek W Jokisch, Wesley E Bolch, Adam L Kesner

Faculty, Staff and Student Publications

Radiopharmaceutical dosimetry is usually estimated via organ-level MIRD schema-style formalisms, which form the computational basis for commonly used clinical and research dosimetry software. Recently, MIRDcalc internal dosimetry software was developed to provide a freely available organ-level dosimetry solution that incorporates up-to-date models of human anatomy, addresses uncertainty in radiopharmaceutical biokinetics and patient organ masses, and offers a 1-screen user interface as well as quality assurance tools. The present work describes the validation of MIRDcalc and, secondarily, provides a compendium of radiopharmaceutical dose coefficients obtained with MIRDcalc. Biokinetic data for about 70 currently and historically used radiopharmaceuticals were obtained from the …

Auto-Segmentation In Pancreatic And Liver Radiation Therapy, Cenji Yu

Dissertations and Theses (Open Access)

Background

Gastrointestinal cancers exhibit a high mortality rate compared to other cancer types. Among these, pancreatic cancer ranks as the fourth leading cause of cancer-related deaths worldwide. The five-year survival rate remains alarmingly low at a mere 9%. Hepatocellular carcinoma (HCC), another aggressive form of cancer, is rapidly becoming the primary cause of cancer-related deaths in the United States. The treatment of both liver cancer and pancreatic cancer heavily relies on a multidisciplinary approach. Innovative treatment strategies involving dose-escalated regimens, such as stereotactic body radiation therapy (SBRT), are emerging as an important pillar of the management of liver and pancreatic …

Multi-Parametric Mri For Radiotherapy Simulation, Tian Li, Jihong Wang, Yingli Yang, Carri K Glide-Hurst, Ning Wen, Jing Cai

Faculty, Staff and Student Publications

Magnetic resonance imaging (MRI) has become an important imaging modality in the field of radiotherapy (RT) in the past decade, especially with the development of various novel MRI and image-guidance techniques. In this review article, we will describe recent developments and discuss the applications of multi-parametric MRI (mpMRI) in RT simulation. In this review, mpMRI refers to a general and loose definition which includes various multi-contrast MRI techniques. Specifically, we will focus on the implementation, challenges, and future directions of mpMRI techniques for RT simulation.

Predicting Severity Of Radiation Induced Lymphopenia In Individual Proton Therapy Patients For Varying Dose Rate And Fractionation Using Dynamic 4-Dimensional Blood Flow Simulations, Lucas Mccullum, Jungwook Shin, Stella Xing, Chris Beekman, Jan Schuemann, Theodore Hong, Dan Duda, Radhe Mohan, Steven H Lin, Camilo M Correa-Alfonso, Sean Domal, Julia Withrow, Wesley Bolch, Harald Paganetti, Clemens Grassberger

Faculty, Staff and Student Publications

PURPOSE: Radiation-induced lymphopenia has gained attention recently as the result of its correlation with survival in a range of indications, particularly when combining radiation therapy (RT) with immunotherapy. The purpose of this study is to use a dynamic blood circulation model combined with observed lymphocyte depletion in patients to derive the in vivo radiosensitivity of circulating lymphocytes and study the effect of RT delivery parameters.

METHODS AND MATERIALS: We assembled a cohort of 17 patients with hepatocellular carcinoma treated with proton RT alone in 15 fractions (fx) using conventional dose rates (beam-on time [BOT], 120 seconds) for whom weekly absolute …

Growth Hormone Deficiency: When Is Mri Imaging Indicated?, Haya Azouz, Kurt Tech, M Bassem Dekelbab

Conference Presentation Abstracts

Objectives The diagnosis of Growth Hormone Deficiency (GHD) is made with a combination of clinical assessment, measurement of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels, and GH stimulation tests. Provocative (stimulation) GH testing is indicated for most patients to confirm a diagnosis of GHD. Traditionally, most pediatric endocrinologists defined a "normal" response by a serum GH concentration of >10 ng/ml. After the clinical and biochemical diagnosis of GHD is made, it is typical to obtain an MRI of the brain with narrow cuts through the hypothalamic-pituitary area. The aim of our study is to …

The Mastery Lifestyle Intervention To Reduce Biopsychosocial Risks For Pregnant Latinas And African Americans And Their Infants: Protocol For A Randomized Controlled Trial, Berta H Ganizada, Koen D Reesink, Shaiv Parikh, Mitch J F G Ramaekers, Asim C Akbulut, Pepijn J M H Saraber, Gijs P Debeij, Mumc-Taa Student Team, Armand M Jaminon, Ehsan Natour, Roberto Lorusso, Joachim E Wildberger, Barend Mees, Geert Willem Schurink, Michael J Jacobs, Jack Cleutjens, Ingrid Krapels, Alexander Gombert, Jos G Maessen, Ryan Accord, Tammo Delhaas, Simon Schalla, Leon J Schurgers, Elham Bidar

Faculty, Staff and Student Publications

Current management guidelines for ascending thoracic aortic aneurysms (aTAA) recommend intervention once ascending or sinus diameter reaches 5-5.5 cm or shows a growth rate of >0.5 cm/year estimated from echo/CT/MRI. However, many aTAA dissections (aTAAD) occur in vessels with diameters below the surgical intervention threshold ofMoreover, during aTAA repair surgeons observe and experience considerable variations in tissue strength, thickness, and stiffness that appear not fully explained by patient risk factors. To improve the understanding of aTAA pathophysiology, we established a multi-disciplinary research infrastructure: The Maastricht acquisition platform for studying mechanisms of tissue-cell crosstalk (MAPEX). The explicit scientific focus of the …

Clinical Outcomes And Tumor Microenvironment Response To Radiofrequency Ablation Therapy: A Systematic Review And Meta-Analysis, Lauren E. Mueller, Peter P. Issa, Mohammad Hosny Hussein, Rami M. Elshazli, Muhib Haidari, Youssef Errami, Mohamed Shama, Manal S. Fawzy, Emad Kandil, Eman Toraih

School of Medicine Faculty Publications

Background: Radiofrequency ablation (RFA) utilizes minimally invasive high-energy current to precisely ablate tumor cells. It has been utilized in many cancer types including thyroid, lung, and liver cancer. It has been shown to provide adequate ablative margins with minimal complications; however, incomplete RFA may lead to recurrence of tumor. The underlying cellular mechanism and behavior of ablated cancer tissue is poorly understood. Methods: A systematic review was performed, searching EMBASE, Web of Science, PubMed, and Scopus for studies published up to July 2022 and reported following PRISMA guidelines. Collection was performed by two groups of investigators to avoid risk of …

Longitudinal Diffusion And Volumetric Kinetics Of Head And Neck Cancer Magnetic Resonance On A 15 T Mr-Linear Accelerator Hybrid System: A Prospective R-Ideal Stage 2a Imaging Biomarker Characterization/Pre-Qualification Study, Joint Head And Neck Radiation Therapy-Mri Development Cooperative, Mr-Linac Consortium Head And Neck Tumor Site Group

Faculty, Staff and Student Publications

Objectives: We aim to characterize the serial quantitative apparent diffusion coefficient (ADC) changes of the target disease volume using diffusion-weighted imaging (DWI) acquired weekly during radiation therapy (RT) on a 1.5 T MR-Linac and correlate these changes with tumor response and oncologic outcomes for head and neck squamous cell carcinoma (HNSCC) patients as part of a programmatic R-IDEAL biomarker characterization effort.

Methods:Thirty patients with HNSCC who received curative-intent RT at MD Anderson Cancer Center, were included. Baseline and weekly MRI were obtained, and various ADC parameters were extracted from the regions of interest (ROIs). Baseline and weekly ADC parameters were …

Analysis Of Performance And Failure Modes Of The Iroc Proton Liver Phantom, Hunter Mehrens, Paige Taylor, Paola Alvarez, Stephen Kry

Faculty, Staff and Student Publications

Purpose: To analyze trends in institutional performance and failure modes for the Imaging and Radiation Oncology Core’s (IROC’s) proton liver phantom.

Materials and Methods: Results of 66 phantom irradiations from 28 institutions between 2015 and 2020 were retrospectively analyzed. Univariate analysis and random forest models were used to associate irradiation conditions with phantom results. Phantom results included pass/fail classification, average thermoluminescent dosimeter (TLD) ratio of both targets, and percentage of pixels passing gamma of both targets. The following categories were evaluated in terms of how they predicted these outcomes: irradiation year, treatment planning system (TPS), TPS algorithm, treatment machine, number …

The Neutralization Of The Eosinophil Peroxidase Antibody Accelerates Eosinophilic Mucin Decomposition, Panagiotis Doukas, Jan Paul Frese, Thorsten Eierhoff, Gabriel Hellfritsch, Ben Raude, Michael J Jacobs, Andreas Greiner, Alexander Oberhuber, Alexander Gombert

Faculty, Staff and Student Publications

Acute kidney injury (AKI) is a common complication after complex aortic procedures and it is associated with relevant mortality and morbidity. Biomarkers for early and specific AKI detection are lacking. The aim of this work is to investigate the reliability of the NephroCheck bedside system for diagnosing stage 3 AKI following open aortic surgery. In this prospective, multicenter, observational study,- https://clinicaltrials.gov/ct2/show/NCT04087161 -we included 45 patients undergoing open thoracoabdominal aortic repair. AKI risk (AKIRisk-Index) was calculated from urine samples at 5 timepoints: baseline, immediately postoperatively and at 12, 24, 48, and 72 h post-surgery. AKIs were classified according to the KDIGO …

Opportunistic Detection Of Type 2 Diabetes Using Deep Learning From Frontal Chest Radiographs, Ayis Pyrros, Stephen M. Borstelmann, Ramana Mantravadi, Zachary Zaiman, Kaesha Thomas, Brandon Price, Eugene Greenstein, Nasir Siddiqui, Melinda Willis, Ihar Shulhan, John Hines-Shah, Jeanne M. Horowitz, Paul Nikolaidis, Matthew P. Lungren, Jorge Mario Rodríguez-Fernández, Judy Wawira Gichoya, Sanmi Koyejo, Adam E. Flanders, Nishith Khandwala, Amit Gupta, John W. Garrett, Joseph Paul Cohen, Brian T. Layden, Perry J. Pickhardt, William Galanter

Department of Radiology Faculty Papers

Deep learning (DL) models can harness electronic health records (EHRs) to predict diseases and extract radiologic findings for diagnosis. With ambulatory chest radiographs (CXRs) frequently ordered, we investigated detecting type 2 diabetes (T2D) by combining radiographic and EHR data using a DL model. Our model, developed from 271,065 CXRs and 160,244 patients, was tested on a prospective dataset of 9,943 CXRs. Here we show the model effectively detected T2D with a ROC AUC of 0.84 and a 16% prevalence. The algorithm flagged 1,381 cases (14%) as suspicious for T2D. External validation at a distinct institution yielded a ROC AUC of …