You are here

Gupta, Rajan Tilak

Overview:

Abdominal Imaging; Multiparametric MR imaging of prostate cancer; MR imaging of the hepatobiliary system; Applications of dual energy CT in the abdomen and pelvis

Positions:

Associate Professor of Radiology

Radiology, Abdominal Imaging
School of Medicine

Assistant Professor in the Department of Surgery

Surgery, Urology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2003

M.D. — Northwestern University

News:

Grants:

Quantitative Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) of Bone Marrow In Acute Myeloid Leukemia

Administered By
Radiology, Abdominal Imaging
AwardedBy
Bayer Healthcare Pharmaceuticals Inc
Role
Principal Investigator
Start Date
September 01, 2014
End Date
August 31, 2017

Prostate Cancer Assessment and Treatment Guidance Via Integrated 3D ARFI Elasticity Imaging and Multi-Parametric MRI

Administered By
Biomedical Engineering
AwardedBy
Kitware Inc.
Role
Co Investigator
Start Date
April 01, 2015
End Date
September 30, 2016

Publications:

Assessing clinically significant prostate cancer: Diagnostic properties of multiparametric magnetic resonance imaging compared to three-dimensional transperineal template mapping histopathology.

To evaluate the diagnostic properties of multiparametric magnetic resonance imaging in the detection, localization and characterization of prostate cancer using three-dimensional transperineal template mapping biopsy histopathology as the comparator.A retrospective analysis of patients undergoing prostate multiparametric magnetic resonance imaging followed by three-dimensional transperineal template mapping biopsy was carried out. For imaging and pathology data, the prostate was divided in octants with the urethra being the midline. The index test properties were calculated using the biopsy histopathology as the reference test with the following end-points: any cancer, any Gleason ≥7, any Gleason ≥7 or cancer length of ≥4 mm and any Gleason ≥7 or 6 mm in any given core. The latter two definitions correspond to 0.2 and 0.5 mL of cancer volume, respectively. Diagnostic properties including sensitivity, specificity, positive and negative predictive values were calculated.A total of 50 patients were included in the study. A median of 55 (interquartile range 42-63) biopsy cores were obtained per patient. Of 400 prostate octants evaluated, 28.5% had prostate cancer on mapping biopsy, whereas 23% of octants were considered suspicious for cancer on imaging. Multiparametric magnetic resonance imaging negative predictive values for Gleason ≥7 and clinically significant cancers were 84-100%. Similarly, specificity ranged between 79% and 85%. Sensitivity and positive predictive value remained moderate for all the reference test definitions.Multiparametric magnetic resonance imaging is a useful minimally-invasive tool for detection, localization and characterization of prostate cancer. This imaging modality has high negative predictive value and specificity, and therefore it could be used to reliably rule out clinically significant cancer, obviating the multicore mapping biopsy.

Authors
Tsivian, M; Gupta, RT; Tsivian, E; Qi, P; Mendez, MH; Abern, MR; Tay, KJ; Polascik, TJ
MLA Citation
Tsivian, M, Gupta, RT, Tsivian, E, Qi, P, Mendez, MH, Abern, MR, Tay, KJ, and Polascik, TJ. "Assessing clinically significant prostate cancer: Diagnostic properties of multiparametric magnetic resonance imaging compared to three-dimensional transperineal template mapping histopathology." International journal of urology : official journal of the Japanese Urological Association 24.2 (February 2017): 137-143.
PMID
27859637
Source
epmc
Published In
International Journal of Urology
Volume
24
Issue
2
Publish Date
2017
Start Page
137
End Page
143
DOI
10.1111/iju.13251

Comparison between 3D ARFI imaging and mpMRI in detecting clinically-significant prostate cancer lesions

© 2016 IEEE.Current prostate cancer screening methods involve non-targeted needle biopsies and detection of clinically-insignificant lesions that receive excessive treatments, exposing patients to unnecessary adverse side effects and placing a burden on our health care systems. There is a strong clinical need for improved prostate imaging methods that are sensitive and specific for clinically-significant prostate cancer lesions to guide needle biopsies, target focal treatments, and improve overall patient outcomes. In this study, we compared 3D in vivo Acoustic Radiation Force Impulse (ARFI) imaging with 3 Tesla, endorectal coil, multi-parametric magnetic resonance imaging (mpMRI) to correlate the ability for each modality to identify clinically-significant prostate cancer lesions. We also correlated Apparent Diffusion Coefficient (ADC) values from Diffusion Weighted Imaging (DWI) MR sequences with ARFI indices of suspicion and MR Prostate Imaging - Reporting and Data Systems (PI-RADS) scores, testing the hypothesis that increased cellular density is associated with regions suspicious for prostate cancer in ARFI images. Overall, ARFI and mpMR imaging were well-correlated in identifying clinically-significant prostate cancer lesions. There were several cases where only one of the imaging modalities was able to identify the prostate cancer lesion, highlighting the potential to further improve prostate cancer lesion detection and localization with a fused ARFI:mpMRI imaging system. ADC values were decreased in all prostate cancer lesions identified with mpMRI, but there were no obvious trends between the absolute ADC values and the ARFI image indices of suspicion.

Authors
Palmeri, M; Glass, T; Gupta, R; McCormick, M; Brown, A; Polascik, T; Rosenzweig, S; Buck, A; Nightingale, K
MLA Citation
Palmeri, M, Glass, T, Gupta, R, McCormick, M, Brown, A, Polascik, T, Rosenzweig, S, Buck, A, and Nightingale, K. "Comparison between 3D ARFI imaging and mpMRI in detecting clinically-significant prostate cancer lesions." November 1, 2016.
Source
scopus
Published In
IEEE International Ultrasonics Symposium : [proceedings]. IEEE International Ultrasonics Symposium
Volume
2016-November
Publish Date
2016
DOI
10.1109/ULTSYM.2016.7728618

Integration of multiparametric MRI into active surveillance of prostate cancer.

Prostate cancer is the most common noncutaneous cancer in men though many men will not die of this disease and may not require definitive treatment. Active surveillance (AS) is an increasingly utilized potential solution to the issue of overtreatment of prostate cancer. Traditionally, prostate cancer patients have been stratified into risk groups based on clinical stage on digital rectal examination, prostate-specific antigen and biopsy Gleason score, though each of these variables has significant limitations. This review will discuss the potential role for prostate multiparametric MRI and targeted biopsy techniques incorporating MRI in the selection of candidates for AS, monitoring patients on AS and as triggers for definitive treatment.

Authors
Holtz, JN; Tay, KJ; Polascik, TJ; Gupta, RT
MLA Citation
Holtz, JN, Tay, KJ, Polascik, TJ, and Gupta, RT. "Integration of multiparametric MRI into active surveillance of prostate cancer." Future oncology (London, England) 12.21 (November 2016): 2513-2529.
PMID
27322161
Source
epmc
Published In
Future oncology (London, England)
Volume
12
Issue
21
Publish Date
2016
Start Page
2513
End Page
2529

Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project.

To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa).A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated.Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text.Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.

Authors
Postema, AW; De Reijke, TM; Ukimura, O; Van den Bos, W; Azzouzi, AR; Barret, E; Baumunk, D; Blana, A; Bossi, A; Brausi, M; Coleman, JA; Crouzet, S; Dominguez-Escrig, J; Eggener, S; Ganzer, R; Ghai, S; Gill, IS; Gupta, RT; Henkel, TO; Hohenfellner, M; Jones, JS; Kahmann, F; Kastner, C; Köhrmann, KU; Kovacs, G; Miano, R; van Moorselaar, RJ; Mottet, N; Osorio, L; Pieters, BR; Polascik, TJ; Rastinehad, AR; Salomon, G; Sanchez-Salas, R; Schostak, M; Sentker, L; Tay, KJ; Varkarakis, IM; Villers, A et al.
MLA Citation
Postema, AW, De Reijke, TM, Ukimura, O, Van den Bos, W, Azzouzi, AR, Barret, E, Baumunk, D, Blana, A, Bossi, A, Brausi, M, Coleman, JA, Crouzet, S, Dominguez-Escrig, J, Eggener, S, Ganzer, R, Ghai, S, Gill, IS, Gupta, RT, Henkel, TO, Hohenfellner, M, Jones, JS, Kahmann, F, Kastner, C, Köhrmann, KU, Kovacs, G, Miano, R, van Moorselaar, RJ, Mottet, N, Osorio, L, Pieters, BR, Polascik, TJ, Rastinehad, AR, Salomon, G, Sanchez-Salas, R, Schostak, M, Sentker, L, Tay, KJ, Varkarakis, IM, and Villers, A et al. "Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project." World journal of urology 34.10 (October 2016): 1373-1382.
PMID
26892160
Source
epmc
Published In
World Journal of Urology
Volume
34
Issue
10
Publish Date
2016
Start Page
1373
End Page
1382
DOI
10.1007/s00345-016-1782-x

Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project.

To codify the use of multiparametric magnetic resonance imaging (mpMRI) for the interrogation of prostate neoplasia (PCa) in clinical practice and focal therapy (FT).An international collaborative consensus project was undertaken using the Delphi method among experts in the field of PCa. An online questionnaire was presented in three consecutive rounds and modified each round based on the comments provided by the experts. Subsequently, a face-to-face meeting was held to discuss and finalize the consensus results.mpMRI should be performed in patients with prior negative biopsies if clinical suspicion remains, but not instead of the PSA test, nor as a stand-alone diagnostic tool or mpMRI-targeted biopsies only. It is not recommended to use a 1.5 Tesla MRI scanner without an endorectal or pelvic phased-array coil. mpMRI should be performed following standard biopsy-based PCa diagnosis in both the planning and follow-up of FT. If a lesion is seen, MRI-TRUS fusion biopsies should be performed for FT planning. Systematic biopsies are still required for FT planning in biopsy-naïve patients and for patients with residual PCa after FT. Standard repeat biopsies should be taken during the follow-up of FT. The final decision to perform FT should be based on histopathology. However, these consensus statements may differ for expert centers versus non-expert centers.The mpMRI is an important tool for characterizing and targeting PCa in clinical practice and FT. Standardization of acquisition and reading should be the main priority to guarantee consistent mpMRI quality throughout the urological community.

Authors
Scheltema, MJ; Tay, KJ; Postema, AW; de Bruin, DM; Feller, J; Futterer, JJ; George, AK; Gupta, RT; Kahmann, F; Kastner, C; Laguna, MP; Natarajan, S; Rais-Bahrami, S; Rastinehad, AR; de Reijke, TM; Salomon, G; Stone, N; van Velthoven, R; Villani, R; Villers, A; Walz, J; Polascik, TJ; de la Rosette, JJMCH
MLA Citation
Scheltema, MJ, Tay, KJ, Postema, AW, de Bruin, DM, Feller, J, Futterer, JJ, George, AK, Gupta, RT, Kahmann, F, Kastner, C, Laguna, MP, Natarajan, S, Rais-Bahrami, S, Rastinehad, AR, de Reijke, TM, Salomon, G, Stone, N, van Velthoven, R, Villani, R, Villers, A, Walz, J, Polascik, TJ, and de la Rosette, JJMCH. "Utilization of multiparametric prostate magnetic resonance imaging in clinical practice and focal therapy: report from a Delphi consensus project." World journal of urology (September 16, 2016).
PMID
27637908
Source
epmc
Published In
World Journal of Urology
Publish Date
2016

Interobserver Reproducibility of the PI-RADS Version 2 Lexicon: A Multicenter Study of Six Experienced Prostate Radiologists.

Purpose To determine the interobserver reproducibility of the Prostate Imaging Reporting and Data System (PI-RADS) version 2 lexicon. Materials and Methods This retrospective HIPAA-compliant study was institutional review board-approved. Six radiologists from six separate institutions, all experienced in prostate magnetic resonance (MR) imaging, assessed prostate MR imaging examinations performed at a single center by using the PI-RADS lexicon. Readers were provided screen captures that denoted the location of one specific lesion per case. Analysis entailed two sessions (40 and 80 examinations per session) and an intersession training period for individualized feedback and group discussion. Percent agreement (fraction of pairwise reader combinations with concordant readings) was compared between sessions. κ coefficients were computed. Results No substantial difference in interobserver agreement was observed between sessions, and the sessions were subsequently pooled. Agreement for PI-RADS score of 4 or greater was 0.593 in peripheral zone (PZ) and 0.509 in transition zone (TZ). In PZ, reproducibility was moderate to substantial for features related to diffusion-weighted imaging (κ = 0.535-0.619); fair to moderate for features related to dynamic contrast material-enhanced (DCE) imaging (κ = 0.266-0.439); and fair for definite extraprostatic extension on T2-weighted images (κ = 0.289). In TZ, reproducibility for features related to lesion texture and margins on T2-weighted images ranged from 0.136 (moderately hypointense) to 0.529 (encapsulation). Among 63 lesions that underwent targeted biopsy, classification as PI-RADS score of 4 or greater by a majority of readers yielded tumor with a Gleason score of 3+4 or greater in 45.9% (17 of 37), without missing any tumor with a Gleason score of 3+4 or greater. Conclusion Experienced radiologists achieved moderate reproducibility for PI-RADS version 2, and neither required nor benefitted from a training session. Agreement tended to be better in PZ than TZ, although was weak for DCE in PZ. The findings may help guide future PI-RADS lexicon updates. (©) RSNA, 2016 Online supplemental material is available for this article.

Authors
Rosenkrantz, AB; Ginocchio, LA; Cornfeld, D; Froemming, AT; Gupta, RT; Turkbey, B; Westphalen, AC; Babb, JS; Margolis, DJ
MLA Citation
Rosenkrantz, AB, Ginocchio, LA, Cornfeld, D, Froemming, AT, Gupta, RT, Turkbey, B, Westphalen, AC, Babb, JS, and Margolis, DJ. "Interobserver Reproducibility of the PI-RADS Version 2 Lexicon: A Multicenter Study of Six Experienced Prostate Radiologists." Radiology 280.3 (September 2016): 793-804.
PMID
27035179
Source
epmc
Published In
Radiology
Volume
280
Issue
3
Publish Date
2016
Start Page
793
End Page
804
DOI
10.1148/radiol.2016152542

Portrayal of radiology in a major medical television series: How does it influence the perception of radiology among patients and radiology professionals?

To assess how the portrayal of Radiology on medical TV shows is perceived by patients and radiology professionals.In this IRB-approved study with patient consent waived, surveys were conducted among adult patients scheduled for radiological examinations and radiology professionals. The questionnaire investigated medical TV watching habits including interest in medical TV shows, appearance of radiological examination/staff, radiology's role in diagnosis-making, and rating of the shows' accuracy in portraying radiology relative to reality.One hundred and twenty-six patients and 240 professionals (133 technologists, 107 radiologists) participated. 63.5 % patients and 63.2 % technologists rated interest in medical TV shows ≥5 (scale 1-10) versus 38.3 % of radiologists. All groups noted regular (every 2nd/3rd show) to >1/show appearance of radiological examinations in 58.5-88.2 % compared to 21.0-46.2 % for radiological staff appearance. Radiology played a role in diagnosis-making regularly to >1/show in 45.3-52.6 %. There is a positive correlation for interest in medical TV and the perception that radiology is accurately portrayed for patients (r = 0.49; P = 0.001) and technologists (r = 0.38; P = 0.001) but not for radiologists (r = 0.01).The majority of patients perceive the portrayed content as accurate. Radiologists should be aware of this cultivation effect to understand their patients' behaviour which may create false expectations towards radiological examinations and potential safety hazards.• Radiology in medical TV shows is conveyed as important in diagnosis making • Presence of radiological staff is less frequent compared to examinations shown • Positive correlation for interest in medical TV and radiology perceived as accurate • TV experience may create false expectations and potential safety hazards.

Authors
Heye, T; Merkle, EM; Leyendecker, JR; Boll, DT; Gupta, RT
MLA Citation
Heye, T, Merkle, EM, Leyendecker, JR, Boll, DT, and Gupta, RT. "Portrayal of radiology in a major medical television series: How does it influence the perception of radiology among patients and radiology professionals?." European radiology 26.8 (August 2016): 2863-2869.
PMID
26560733
Source
epmc
Published In
European Radiology
Volume
26
Issue
8
Publish Date
2016
Start Page
2863
End Page
2869
DOI
10.1007/s00330-015-4079-3

Defining the Incremental Utility of Prostate Multiparametric Magnetic Resonance Imaging at Standard and Specialized Read in Predicting Extracapsular Extension of Prostate Cancer.

Multiparametric magnetic resonance imaging (mpMRI) is increasingly used in staging early prostate cancer (PCa) but remains heavily reader-dependent. We aim to define the incremental utility of mpMRI over clinical parameters in determining the pathologic extracapsular extension (pECE) of PCa interpreted in a standard radiologic setting and when further over-read by a specialized reader. We retrospectively reviewed 120 men with clinically localized PCa undergoing mpMRI and radical prostatectomy. We obtained radiologic prediction of pECE from standard radiologic reports (standard read) and by a specialized reader blinded to clinical and pathologic findings (specialized read). We determined the incremental benefit of standard read and specialized read by sequential addition to a baseline clinical parameters-only logistic regression model predicting pECE. The sensitivity and specificity of standard read were 77% and 44%, respectively, whereas those of specialized read were 86% and 81%. The positive likelihood ratio was 1.7 at baseline, 1.7 adding standard read, and 6.5 adding specialized read. The negative likelihood ratio was 0.6 at baseline, 0.5 adding standard read, and 0.1 adding specialized read. Standard read modestly improved prediction of pECE, whereas specialized read improved it moderately.The incremental benefit of mpMRI over clinical information is small but increases to moderate with a specialized second opinion. This second opinion may be useful when considering active surveillance, nerve-sparing surgery, or focal therapy.

Authors
Tay, KJ; Gupta, RT; Brown, AF; Silverman, RK; Polascik, TJ
MLA Citation
Tay, KJ, Gupta, RT, Brown, AF, Silverman, RK, and Polascik, TJ. "Defining the Incremental Utility of Prostate Multiparametric Magnetic Resonance Imaging at Standard and Specialized Read in Predicting Extracapsular Extension of Prostate Cancer." European urology 70.2 (August 2016): 211-213.
PMID
26553331
Source
epmc
Published In
European Urology
Volume
70
Issue
2
Publish Date
2016
Start Page
211
End Page
213
DOI
10.1016/j.eururo.2015.10.041

Can Radiologic Staging With Multiparametric MRI Enhance the Accuracy of the Partin Tables in Predicting Organ-Confined Prostate Cancer?

The purpose of this study is to investigate the accuracy of multiparametric MRI with endorectal coil and Partin tables in predicting organ-confined (OC) prostate cancer in a contemporary cohort undergoing radical prostatectomy (RP) and to assess the possible added value of radiologic staging based on multiparametric MRI to the predictive accuracy of Partin tables.One hundred fifty-eight consecutive subjects underwent 3-T multiparametric MRI with endorectal coil before RP between November 2010 and November 2013. Data were randomly split 60% and 40% into derivation (n = 95) and validation (n = 62) datasets. Multiparametric MRI was used to assess the radiologic stage, and logistic regression models were created using the derivation dataset and were fit on the independent validation dataset using multiparametric MRI staging alone and with prostate-specific antigen (PSA) level as the covariate. The probability of each patient to harbor OC disease was calculated using an updated version of Partin tables, using either clinical staging from digital rectal examination (DRE) or radiologic staging (multiparametric MRI). The AUC was calculated to evaluate accuracy of these predictive methods.The accuracy of multiparametric MRI to predict OC disease on pathologic analysis was greater (AUC, 0.88) than that of Partin tables (AUC, 0.70) and improved when multiparametric MRI was combined with PSA level (AUC, 0.91). The accuracy of Partin nomograms to predict OC disease decreased (AUC, 0.63) when staging was based on multiparametric MRI versus DRE.The superior predictive accuracy of multiparametric MRI compared with Partin tables to predict OC disease validates the results of smaller previously published studies. Although there is no added benefit of substituting multiparametric MRI stage for clinical stage when using Partin tables, multiparametric MRI staging information is valuable as a stand-alone test.

Authors
Gupta, RT; Brown, AF; Silverman, RK; Tay, KJ; Madden, JF; George, DJ; Polascik, TJ
MLA Citation
Gupta, RT, Brown, AF, Silverman, RK, Tay, KJ, Madden, JF, George, DJ, and Polascik, TJ. "Can Radiologic Staging With Multiparametric MRI Enhance the Accuracy of the Partin Tables in Predicting Organ-Confined Prostate Cancer?." AJR. American journal of roentgenology 207.1 (July 2016): 87-95.
PMID
27064383
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
207
Issue
1
Publish Date
2016
Start Page
87
End Page
95
DOI
10.2214/ajr.15.15878

Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic Radiation Force Impulse Imaging with Whole-Mount Histology Validation.

Overly aggressive prostate cancer (PCa) treatment adversely affects patients and places an unnecessary burden on our health care system. The inability to identify and grade clinically significant PCa lesions is a factor contributing to excessively aggressive PCa treatment, such as radical prostatectomy, instead of more focal, prostate-sparing procedures such as cryotherapy and high-dose radiation therapy. We have performed 3-D in vivo B-mode and acoustic radiation force impulse (ARFI) imaging using a mechanically rotated, side-fire endorectal imaging array to identify regions suspicious for PCa in 29 patients being treated with radical prostatectomies for biopsy-confirmed PCa. Whole-mount histopathology analyses were performed to identify regions of clinically significant/insignificant PCa lesions, atrophy and benign prostatic hyperplasia. Regions of suspicion for PCa were reader-identified in ARFI images based on boundary delineation, contrast, texture and location. These regions of suspicion were compared with histopathology identified lesions using a nearest-neighbor regional localization approach. Of all clinically significant lesions identified on histopathology, 71.4% were also identified using ARFI imaging, including 79.3% of posterior and 33.3% of anterior lesions. Among the ARFI-identified lesions, 79.3% corresponded to clinically significant PCa lesions, with these lesions having higher indices of suspicion than clinically insignificant PCa. ARFI imaging had greater sensitivity for posterior versus anterior lesions because of greater displacement signal-to-noise ratio and finer spatial sampling. Atrophy and benign prostatic hyperplasia can cause appreciable prostate anatomy distortion and heterogeneity that confounds ARFI PCa lesion identification; however, in general, ARFI regions of suspicion did not coincide with these benign pathologies.

Authors
Palmeri, ML; Glass, TJ; Miller, ZA; Rosenzweig, SJ; Buck, A; Polascik, TJ; Gupta, RT; Brown, AF; Madden, J; Nightingale, KR
MLA Citation
Palmeri, ML, Glass, TJ, Miller, ZA, Rosenzweig, SJ, Buck, A, Polascik, TJ, Gupta, RT, Brown, AF, Madden, J, and Nightingale, KR. "Identifying Clinically Significant Prostate Cancers using 3-D In Vivo Acoustic Radiation Force Impulse Imaging with Whole-Mount Histology Validation." Ultrasound in medicine & biology 42.6 (June 2016): 1251-1262.
PMID
26947445
Source
epmc
Published In
Ultrasound in Medicine & Biology
Volume
42
Issue
6
Publish Date
2016
Start Page
1251
End Page
1262
DOI
10.1016/j.ultrasmedbio.2016.01.004

Massive gas gangrene secondary to occult colon carcinoma.

Gas gangrene is a rare but often fatal soft-tissue infection. Because it is uncommon and the classic symptom of crepitus does not appear until the infection is advanced, prompt diagnosis requires a high index of suspicion. We present a case report of a middle-aged man who presented with acute onset lower-extremity pain that was initially thought to be due to deep vein thrombosis. After undergoing workup for pulmonary embolism, he was found to have massive gas gangrene of the lower extremity secondary to an occult colon adenocarcinoma and died within hours of presentation from multisystem organ failure.

Authors
Griffin, AS; Crawford, MD; Gupta, RT
MLA Citation
Griffin, AS, Crawford, MD, and Gupta, RT. "Massive gas gangrene secondary to occult colon carcinoma." Radiology case reports 11.2 (June 2016): 67-69.
PMID
27257452
Source
epmc
Published In
Radiology Case Reports
Volume
11
Issue
2
Publish Date
2016
Start Page
67
End Page
69
DOI
10.1016/j.radcr.2016.02.006

How and why a generation of radiologists must be trained to accurately interpret prostate mpMRI.

Authors
Gupta, RT; Spilseth, B; Froemming, AT
MLA Citation
Gupta, RT, Spilseth, B, and Froemming, AT. "How and why a generation of radiologists must be trained to accurately interpret prostate mpMRI." Abdominal radiology (New York) 41.5 (May 2, 2016): 803-804.
PMID
27138433
Source
epmc
Published In
Abdominal radiology (New York)
Volume
41
Issue
5
Publish Date
2016
Start Page
803
End Page
804
DOI
10.1007/s00261-016-0745-4

Multiparametric prostate MRI: focus on T2-weighted imaging and role in staging of prostate cancer.

Multiparametric MRI (mpMRI) represents a growing modality for the non-invasive evaluation of prostate cancer (PCa) and is increasingly being used for patients with persistently elevated PSA and prior negative biopsies, for monitoring patients in active surveillance protocols, for preoperative characterization of cancer for surgical planning, and in planning for MRI-targeted biopsy. The focus of this work is twofold. First, we review the key role of T2-weighted imaging (T2WI) in mpMRI, specifically outlining how it is used for anatomic evaluation of the prostate, detection of clinically significant PCa, assessment of extraprostatic extension (EPE), and mimics of PCa on this sequence. We will also discuss optimal technical acquisition parameters for this sequence and recent technical advancements in T2WI. Second, we will delineate the role that mpMRI plays in the staging of PCa and describe the implications of the information that mpMRI can provide in determining the most appropriate management plan for the patient with PCa.

Authors
Gupta, RT; Spilseth, B; Patel, N; Brown, AF; Yu, J
MLA Citation
Gupta, RT, Spilseth, B, Patel, N, Brown, AF, and Yu, J. "Multiparametric prostate MRI: focus on T2-weighted imaging and role in staging of prostate cancer." Abdominal radiology (New York) 41.5 (May 2016): 831-843.
PMID
27193786
Source
epmc
Published In
Abdominal radiology (New York)
Volume
41
Issue
5
Publish Date
2016
Start Page
831
End Page
843
DOI
10.1007/s00261-015-0579-5

Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls.

Multi-parametric MRI (mpMRI) is widely used in the detection and characterization of clinically- significant prostate cancer. MRI-TRUS (trans-rectal ultrasound) fusion biopsy is an in-office procedure that promises to empower urologists to successfully target these MRI-visible lesions for histological confirmation. We describe the moving parts in the process and discuss methods to optimize biopsy outcomes. mpMRI is highly technical and reader-dependent. The acquisition of US images to generate a valid 3D US model and subsequent registration and fusion requires the urologist to attain equilibrium of probe position and pressure to achieve maximum registration accuracy. Environmental, medical and engineering measures can be undertaken to improve targeting accuracy. The art and skill of 'hitting' a visual target involves real-time recognition and adjustment for potential errors/ mis-registration in the fusion guide. A multi-disciplinary team effort is critical to improve all steps of the procedure.

Authors
Tay, KJ; Gupta, RT; Rastinehad, AR; Tsivian, E; Freedland, SJ; Moul, JW; Polascik, TJ
MLA Citation
Tay, KJ, Gupta, RT, Rastinehad, AR, Tsivian, E, Freedland, SJ, Moul, JW, and Polascik, TJ. "Navigating MRI-TRUS fusion biopsy: optimizing the process and avoiding technical pitfalls." Expert review of anticancer therapy 16.3 (January 2016): 303-311. (Review)
PMID
26653079
Source
epmc
Published In
Expert Review of Anticancer Therapy
Volume
16
Issue
3
Publish Date
2016
Start Page
303
End Page
311
DOI
10.1586/14737140.2016.1131155

How the radiologist can add value in the evaluation of the pre- and post-surgical pancreas.

Disease involving the pancreas can be a significant diagnostic challenge to the interpreting radiologist. Moreover, the majority of disease processes involving the pancreas carry high significant morbidity and mortality either due to their natural process or related to their treatment options. As such, it is critical for radiologists to not only provide accurate information from imaging to guide patient management, but also deliver that information in a clear manner so as to aid the referring physician. This is no better exemplified than in the case of pre-operative staging for pancreatic adenocarcinoma. Furthermore, with the changing healthcare landscape, it is now more important than ever to ensure that the value of radiology service to other providers is high. In this review, we will discuss how the radiologist can add value to the referring physician by employing novel imaging techniques in the pre-operative evaluation as well as how the information can be conveyed in the most meaningful manner through the use of structured reporting. We will also familiarize the radiologist with the imaging appearance of common complications that occur after pancreatic surgery.

Authors
Patel, BN; Gupta, RT; Zani, S; Jeffrey, RB; Paulson, EK; Nelson, RC
MLA Citation
Patel, BN, Gupta, RT, Zani, S, Jeffrey, RB, Paulson, EK, and Nelson, RC. "How the radiologist can add value in the evaluation of the pre- and post-surgical pancreas." Abdominal imaging 40.8 (October 19, 2015): 2932-2944. (Review)
PMID
26482048
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
8
Publish Date
2015
Start Page
2932
End Page
2944

Effect of radiologists' experience with an adaptive statistical iterative reconstruction algorithm on detection of hypervascular liver lesions and perception of image quality.

To prospectively evaluate whether clinical experience with an adaptive statistical iterative reconstruction algorithm (ASiR) has an effect on radiologists' diagnostic performance and confidence for the diagnosis of hypervascular liver tumors, as well as on their subjective perception of image quality.Forty patients, having 65 hypervascular liver tumors, underwent contrast-enhanced MDCT during the hepatic arterial phase. Image datasets were reconstructed with filtered backprojection algorithm and ASiR (20%, 40%, 60%, and 80% blending). During two reading sessions, performed before and after a three-year period of clinical experience with ASiR, three readers assessed datasets for lesion detection, likelihood of malignancy, and image quality.For all reconstruction algorithms, there was no significant change in readers' diagnostic accuracy and sensitivity for the detection of liver lesions, between the two reading sessions. However, a 60% ASiR dataset yielded a significant improvement in specificity, lesion conspicuity, and confidence for lesion likelihood of malignancy during the second reading session (P < 0.0001). The 60% ASiR dataset resulted in significant improvement in readers' perception of image quality during the second reading session (P < 0.0001).Clinical experience using an ASiR algorithm may improve radiologists' diagnostic performance for the diagnosis of hypervascular liver tumors, as well as their perception of image quality.

Authors
Marin, D; Mileto, A; Gupta, RT; Ho, LM; Allen, BC; Choudhury, KR; Nelson, RC
MLA Citation
Marin, D, Mileto, A, Gupta, RT, Ho, LM, Allen, BC, Choudhury, KR, and Nelson, RC. "Effect of radiologists' experience with an adaptive statistical iterative reconstruction algorithm on detection of hypervascular liver lesions and perception of image quality." Abdominal imaging 40.7 (October 2015): 2850-2860.
PMID
25783958
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
7
Publish Date
2015
Start Page
2850
End Page
2860
DOI
10.1007/s00261-015-0398-8

Apparent Diffusion Coefficient Values of the Benign Central Zone of the Prostate: Comparison With Low- and High-Grade Prostate Cancer.

The apparent diffusion coefficient (ADC) values for benign central zone (CZ) of the prostate were compared with ADC values of benign peripheral zone (PZ), benign transition zone (TZ), and prostate cancer, using histopathologic findings from radical prostatectomy as the reference standard.The study included 27 patients with prostate cancer (mean [± SD] age, 60.0 ± 7.6 years) who had 3-T endorectal coil MRI of the prostate performed before undergoing prostatectomy with whole-mount histopathologic assessment. Mean ADC values were recorded from the ROI within the index tumor and within benign CZ, PZ, and TZ, with the use of histopathologic findings as the reference standard. ADC values of the groups were compared using paired t tests and ROC curve analysis.The ADC of benign CZ in the right (1138 ± 123 × 10(-6) mm(2)/s) and left (1166 ± 141 × 10(-6) mm(2)/s) lobes was not significantly different (p = 0.217). However, the ADC of benign CZ (1154 ± 129 × 10(-6) mm(2)/s) was significantly lower (p < 0.001) than the ADCs of benign PZ (1579 ± 197 × 10(-6) mm(2)/s) and benign TZ (1429 ± 180 × 10(-6) mm(2)/s). Although the ADC of index tumors (1042 ± 134 × 10(-6) mm(2)/s) was significantly lower (p = 0.002) than the ADC of benign CZ there was no significant difference (p = 0.225) between benign CZ and tumors with a Gleason score of 6 (1119 ± 87 × 10(-6) mm(2)/s). In 22.2% of patients (6/27), including five patients who had tumors with a Gleason score greater than 6, the ADC was lower in benign CZ than in the index tumor. The AUC of ADC for the differentiation of benign CZ from index tumors was 72.4% (sensitivity, 70.4%; specificity, 51.9%), and the AUC of ADC for differentiation from tumors with a Gleason score greater than 6 was 76.7% (sensitivity, 75.0%; specificity, 65.0%).The ADC of benign CZ is lower than the ADC of other zones of the prostate and overlaps with the ADC of prostate cancer tissue, including high-grade tumors. Awareness of this potential diagnostic pitfall is important to avoid misinterpreting the normal CZ as suspicious for tumor.

Authors
Gupta, RT; Kauffman, CR; Garcia-Reyes, K; Palmeri, ML; Madden, JF; Polascik, TJ; Rosenkrantz, AB
MLA Citation
Gupta, RT, Kauffman, CR, Garcia-Reyes, K, Palmeri, ML, Madden, JF, Polascik, TJ, and Rosenkrantz, AB. "Apparent Diffusion Coefficient Values of the Benign Central Zone of the Prostate: Comparison With Low- and High-Grade Prostate Cancer." AJR. American journal of roentgenology 205.2 (August 2015): 331-336.
PMID
26204283
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
205
Issue
2
Publish Date
2015
Start Page
331
End Page
336
DOI
10.2214/ajr.14.14221

Computed high b-value diffusion-weighted imaging improves lesion contrast and conspicuity in prostate cancer.

To evaluate whether very high b-value computed diffusion-weighted imaging (cDWI) is able to provide better contrast between the foci of prostate cancer and background tissue than the standard apparent diffusion coefficient (ADC) map, and whether this improved contrast could be used to improve the tumor detection.Very high b-value cDWI series up to b4000 were created for 14 patients with high-grade prostate cancer. Contrast-to-noise ratios (CNRs) and CNR-to-ADC ratios were calculated. Three blinded readers also assessed the tumor conspicuity on a standard five-point scale.The tumor CNR increased with increasing b-values in all the patients up to a maximum average CNR of 75.1 for a b-value of 4000 (average CNR for the ADC maps: 10.0). CNR/ADC ratios were higher than 1 (indicating higher CNR than respective ADC) for cDWI of 1500 and higher, with a maximum of 6.5 for cDWI4000. The average subjective tumor conspicuity scores for cDWI2000, 3000 and 4000 were significantly higher than that of the ADC (4.0): 4.5 (P=0.018), 4.5 (P=0.017) and 4.6 (P=0.012).cDWI is able to provide better contrast between the foci of prostate cancer and background tissue compared with a standard ADC map. This resulted in improved subjective tumor conspicuity.

Authors
Feuerlein, S; Davenport, MS; Krishnaraj, A; Merkle, EM; Gupta, RT
MLA Citation
Feuerlein, S, Davenport, MS, Krishnaraj, A, Merkle, EM, and Gupta, RT. "Computed high b-value diffusion-weighted imaging improves lesion contrast and conspicuity in prostate cancer." Prostate cancer and prostatic diseases 18.2 (June 2015): 155-160.
PMID
25732928
Source
epmc
Published In
Prostate Cancer and Prostatic Diseases
Volume
18
Issue
2
Publish Date
2015
Start Page
155
End Page
160
DOI
10.1038/pcan.2015.5

Nephrogenic systemic fibrosis risk after liver magnetic resonance imaging with gadoxetate disodium in patients with moderate to severe renal impairment: results of a prospective, open-label, multicenter study.

The objective of this study was to assess the risk of gadoxetate disodium in liver imaging for the development of nephrogenic systemic fibrosis (NSF) in patients with moderate to severe renal impairment.We performed a prospective, multicenter, nonrandomized, open-label phase 4 study in 35 centers from May 2009 to July 2013. The study population consisted of patients with moderate to severe renal impairment scheduled for liver imaging with gadoxetate disodium. All patients received a single intravenous bolus injection of 0.025-mmol/kg body weight of liver-specific gadoxetate disodium. The primary target variable was the number of patients who develop NSF within a 2-year follow-up period.A total of 357 patients were included, with 85 patients with severe and 193 patients with moderate renal impairment, which were the clinically most relevant groups. The mean time period from diagnosis of renal disease to liver magnetic resonance imaging (MRI) was 1.53 and 5.46 years in the moderate and severe renal impairment cohort, respectively. Overall, 101 patients (28%) underwent additional contrast-enhanced MRI with other gadolinium-based MRI contrast agents within 12 months before the start of the study or in the follow-up. No patient developed symptoms conclusive of NSF within the 2-year follow-up.Gadoxetate disodium in patients with moderate to severe renal impairment did not raise any clinically significant safety concern. No NSF cases were observed.

Authors
Lauenstein, T; Ramirez-Garrido, F; Kim, YH; Rha, SE; Ricke, J; Phongkitkarun, S; Boettcher, J; Gupta, RT; Korpraphong, P; Tanomkiat, W; Furtner, J; Liu, PS; Henry, M; Endrikat, J
MLA Citation
Lauenstein, T, Ramirez-Garrido, F, Kim, YH, Rha, SE, Ricke, J, Phongkitkarun, S, Boettcher, J, Gupta, RT, Korpraphong, P, Tanomkiat, W, Furtner, J, Liu, PS, Henry, M, and Endrikat, J. "Nephrogenic systemic fibrosis risk after liver magnetic resonance imaging with gadoxetate disodium in patients with moderate to severe renal impairment: results of a prospective, open-label, multicenter study." Investigative radiology 50.6 (June 2015): 416-422.
PMID
25756684
Source
epmc
Published In
Investigative Radiology
Volume
50
Issue
6
Publish Date
2015
Start Page
416
End Page
422
DOI
10.1097/rli.0000000000000145

Current trends and new frontiers in focal therapy for localized prostate cancer.

Prostate cancer (PCa) care is an ever-evolving field. Research and technological developments continue to refine our definitions and management of this disease. Now, with a greater understanding of the natural history of PCa, the prevention of overtreatment has shaped a new era with the adoption of active surveillance (AS) and advancement of focal therapy (FT). Multiparametric magnetic resonance imaging (mpMRI) allows us to define, locate, and monitor cancers in a way never before possible. These capabilities combined with promising results from current prospective studies have changed the face of FT. This review presents the latest developments, current trends, and next steps in FT.

Authors
Mendez, MH; Joh, DY; Gupta, R; Polascik, TJ
MLA Citation
Mendez, MH, Joh, DY, Gupta, R, and Polascik, TJ. "Current trends and new frontiers in focal therapy for localized prostate cancer." Current urology reports 16.6 (June 2015): 35-. (Review)
PMID
25903803
Source
epmc
Published In
Current Urology Reports
Volume
16
Issue
6
Publish Date
2015
Start Page
35
DOI
10.1007/s11934-015-0513-y

Radiology reports for incidental thyroid nodules on CT and MRI: high variability across subspecialties.

Variability in radiologists' reporting styles and recommendations for incidental thyroid nodules can lead to confusion among clinicians and may contribute to inconsistent patient care. Our aim was to describe reporting practices of radiologists for incidental thyroid nodules seen on CT and MR imaging and to determine factors that influence reporting styles.This is a retrospective study of patients with incidental thyroid nodules reported on CT and MR imaging between January and December 2011, identified by text search for "thyroid nodule" in all CT and MR imaging reports. The studies included CT and MR imaging scans of the neck, spine, and chest. Radiology reports were divided into those that mentioned the incidental thyroid nodules only in the "Findings" section versus those that reported the incidental thyroid nodules in the "Impression" section as well, because this latter reporting style gives more emphasis to the finding. Univariate and multivariate analyses were performed to identify radiologist, patient, and nodule characteristics that influenced reporting styles.Three hundred seventy-five patients met the criterion of having incidental thyroid nodules. One hundred thirty-eight (37%) patients had incidental thyroid nodules reported in the "Impression" section. On multivariate analysis, only radiologists' divisions and nodule size were associated with reporting in "Impression." Chest radiologists and neuroradiologists were more likely to report incidental thyroid nodules in the "Impression" section than their abdominal imaging colleagues, and larger incidental thyroid nodules were more likely to be reported in "Impression" (P ≤ .03). Seventy-three percent of patients with incidental thyroid nodules of ≥20 mm were reported in the "Impression" section, but higher variability in reporting was seen for incidental thyroid nodules measuring 10-14 mm and 15-19 mm, which were reported in "Impression" for 61% and 50% of patients, respectively.Reporting practices for incidental thyroid nodules detected on CT and MR imaging are predominantly influenced by nodule size and the radiologist's subspecialty. Reporting was highly variable for nodules measuring 10-19 mm; this finding can be partially attributed to different reporting styles among radiology subspecialty divisions. The variability demonstrated in this study further underscores the need to develop CT and MR imaging practice guidelines with the goal of standardizing reporting of incidental thyroid nodules and thereby potentially improving the consistency and quality of patient care.

Authors
Grady, AT; Sosa, JA; Tanpitukpongse, TP; Choudhury, KR; Gupta, RT; Hoang, JK
MLA Citation
Grady, AT, Sosa, JA, Tanpitukpongse, TP, Choudhury, KR, Gupta, RT, and Hoang, JK. "Radiology reports for incidental thyroid nodules on CT and MRI: high variability across subspecialties." AJNR. American journal of neuroradiology 36.2 (February 2015): 397-402.
PMID
25147197
Source
epmc
Published In
American Journal of Neuroradiology
Volume
36
Issue
2
Publish Date
2015
Start Page
397
End Page
402
DOI
10.3174/ajnr.a4089

Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis.

To evaluate the impact of dedicated reader education on accuracy/confidence of peripheral zone index cancer and anterior prostate cancer (PCa) diagnosis with mpMRI; secondary aim was to assess the ability of readers to differentiate low-grade cancer (Gleason 6 or below) from high-grade cancer (Gleason 7+).Five blinded radiology fellows evaluated 31 total prostate mpMRIs in this IRB-approved, HIPAA-compliant, retrospective study for index lesion detection, confidence in lesion diagnosis (1-5 scale), and Gleason grade (Gleason 6 or lower vs. Gleason 7+). Following a dedicated education program, readers reinterpreted cases after a memory extinction period, blinded to initial reads. Reference standard was established combining whole mount histopathology with mpMRI findings by a board-certified radiologist with 5 years of prostate mpMRI experience.Index cancer detection: pre-education accuracy 74.2%; post-education accuracy 87.7% (p = 0.003). Confidence in index lesion diagnosis: pre-education 4.22 ± 1.04; post-education 3.75 ± 1.41 (p = 0.0004). Anterior PCa detection: pre-education accuracy 54.3%; post-education accuracy 94.3% (p = 0.001). Confidence in anterior PCa diagnosis: pre-education 3.22 ± 1.54; post-education 4.29 ± 0.83 (p = 0.0003). Gleason score accuracy: pre-education 54.8%; post-education 73.5% (p = 0.0005).A dedicated reader education program on PCa detection with mpMRI was associated with a statistically significant increase in diagnostic accuracy of index cancer and anterior cancer detection as well as Gleason grade identification as compared to pre-education values. This was also associated with a significant increase in reader diagnostic confidence. This suggests that substantial interobserver variability in mpMRI interpretation can potentially be reduced with a focus on education and that this can occur over a fellowship training year.

Authors
Garcia-Reyes, K; Passoni, NM; Palmeri, ML; Kauffman, CR; Choudhury, KR; Polascik, TJ; Gupta, RT
MLA Citation
Garcia-Reyes, K, Passoni, NM, Palmeri, ML, Kauffman, CR, Choudhury, KR, Polascik, TJ, and Gupta, RT. "Detection of prostate cancer with multiparametric MRI (mpMRI): effect of dedicated reader education on accuracy and confidence of index and anterior cancer diagnosis." Abdominal imaging 40.1 (January 2015): 134-142.
PMID
25034558
Source
epmc
Published In
Abdominal Imaging
Volume
40
Issue
1
Publish Date
2015
Start Page
134
End Page
142
DOI
10.1007/s00261-014-0197-7

B-mode and acoustic radiation force impulse (ARFI) imaging of prostate zonal anatomy: comparison with 3T T2-weighted MR imaging.

Prostate cancer (PCa) is the most common non-cutaneous malignancy among men in the United States and the second leading cause of cancer-related death. Multi-parametric magnetic resonance imaging (mpMRI) has gained recent popularity to characterize PCa. Acoustic Radiation Force Impulse (ARFI) imaging has the potential to aid PCa diagnosis and management by using tissue stiffness to evaluate prostate zonal anatomy and lesions. MR and B-mode/ARFI in vivo imaging datasets were compared with one another and with gross pathology measurements made immediately after radical prostatectomy. Images were manually segmented in 3D Slicer to delineate the central gland (CG) and prostate capsule, and 3D models were rendered to evaluate zonal anatomy dimensions and volumes. Both imaging modalities showed good correlation between estimated organ volume and gross pathologic weights. Ultrasound and MR total prostate volumes were well correlated (R(2) = 0.77), but B-mode images yielded prostate volumes that were larger (16.82% ± 22.45%) than MR images, due to overestimation of the lateral dimension (18.4% ± 13.9%), with less significant differences in the other dimensions (7.4% ± 17.6%, anterior-to-posterior, and -10.8% ± 13.9%, apex-to-base). ARFI and MR CG volumes were also well correlated (R(2) = 0.85). CG volume differences were attributed to ARFI underestimation of the apex-to-base axis (-28.8% ± 9.4%) and ARFI overestimation of the lateral dimension (21.5% ± 14.3%). B-mode/ARFI imaging yielded prostate volumes and dimensions that were well correlated with MR T2-weighted image (T2WI) estimates, with biases in the lateral dimension due to poor contrast caused by extraprostatic fat. B-mode combined with ARFI imaging is a promising low-cost, portable, real-time modality that can complement mpMRI for PCa diagnosis, treatment planning, and management.

Authors
Palmeri, ML; Miller, ZA; Glass, TJ; Garcia-Reyes, K; Gupta, RT; Rosenzweig, SJ; Kauffman, C; Polascik, TJ; Buck, A; Kulbacki, E; Madden, J; Lipman, SL; Rouze, NC; Nightingale, KR
MLA Citation
Palmeri, ML, Miller, ZA, Glass, TJ, Garcia-Reyes, K, Gupta, RT, Rosenzweig, SJ, Kauffman, C, Polascik, TJ, Buck, A, Kulbacki, E, Madden, J, Lipman, SL, Rouze, NC, and Nightingale, KR. "B-mode and acoustic radiation force impulse (ARFI) imaging of prostate zonal anatomy: comparison with 3T T2-weighted MR imaging." Ultrasonic imaging 37.1 (January 2015): 22-41.
PMID
25060914
Source
epmc
Published In
Ultrasonic Imaging
Volume
37
Issue
1
Publish Date
2015
Start Page
22
End Page
41
DOI
10.1177/0161734614542177

Practice and quality improvement: successful implementation of TeamSTEPPS tools into an academic interventional ultrasound practice.

OBJECTIVE: The goal of this study was to implement an evidence-based teamwork system to improve communication and teamwork skills among health care professionals (TeamSTEPPS) into an academic interventional ultrasound program and to assess safety and team-work climate across team members both before and after implementation. MATERIALS AND METHODS: Members of a change team (including master trainers) selected specific tools available within TeamSTEPPS to implement into an academic interventional ultrasound service. Tools selected were based on preimplementation survey data obtained from team members (n = 64: 11 attending faculty physicians, 12 clinical abdominal imaging fellows or residents, 17 sonographers, 19 nurses, and five technologist aides or administrative personnel). The survey included teamwork climate and safety climate domains from the Safety Attitudes Questionnaire. Four months after implementation, respondents were resurveyed and post-implementation data were collected. RESULTS: Teamwork climate scores improved from a mean of 67.9 (SD, 12.8) before implementation to a mean of 87.8 (SD, 14.1) after implementation (t = -7.6; p < 0.001). Safety climate scores improved from a mean of 76.5 (SD, 12.8) before implementation to a mean of 88.3 (SD, 13.4) after implementation (t = -4.6; p < 0.001). In particular, teamwork items about "input being well received" and "speaking up" were the most responsive to the intervention. CONCLUSION: The implementation of TeamSTEPPS tools was associated with statistically significant improvements in safety and teamwork metrics in an academic interventional ultrasound practice. The most notable improvements were seen in communication among team members and role clarification. We think that this model, which has been successfully implemented in many nonradiologic areas in medical care, is also applicable in imaging practice.

Authors
Gupta, RT; Sexton, JB; Milne, J; Frush, DP
MLA Citation
Gupta, RT, Sexton, JB, Milne, J, and Frush, DP. "Practice and quality improvement: successful implementation of TeamSTEPPS tools into an academic interventional ultrasound practice." AJR. American journal of roentgenology 204.1 (January 2015): 105-110.
PMID
25539244
Source
epmc
Published In
AJR. American journal of roentgenology
Volume
204
Issue
1
Publish Date
2015
Start Page
105
End Page
110
DOI
10.2214/ajr.14.12775

Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy.

OBJECTIVES: The purpose of our study was to test our hypothesis that multiparametric magnetic resonance imaging (mpMRI) may have a higher prognostic accuracy than the Partin tables in predicting organ-confined (OC) prostate cancer and extracapsular extension (ECE) after radical prostatectomy (RP). METHODS AND MATERIALS: After institutional review board approval, we retrospectively reviewed 60 patients who underwent 3-T mpMRI before RP. mpMRI was used to assess clinical stage and the updated version of the Partin tables was used to calculate the probability of each patient to harbor OC disease. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in detecting OC and ECE were calculated. Logistic regression models predicting OC pathology were created using either clinical stage at mpMRI or Partin tables probability. The area under the curve was used to calculate the predictive accuracy of each model. RESULTS: Median prostate-specific antigen level at diagnosis was 5 ng/ml (range: 4.1-6.7 ng/ml). Overall, 52 (86.7%) men had cT1 disease, 7 (11.7%) had cT2a/b, and 1 (1.6%) had cT3b at digital rectal examination. Biopsy Gleason score was 6, 3+4 = 7, 4+3 = 7, 8, and 9 to 10 in 28 (46.7%), 15 (25%), 3 (5%), 10 (16.7%), and 4 (6.6%) patients, respectively. At mpMRI, clinical stage was defined as cT2a/b, cT2c, cT3a, and cT3b in 11 (18.3%), 23 (38.3%), 21 (35%), and 5 (8.4%) patients, respectively. At final pathology, 38 men (63.3%) had OC disease, whereas 18 (30%) had ECE and 4 (6.7%) had seminal vesicle invasion. The sensitivity, specificity, PPV, and NPV of mpMRI in detecting OC disease were 81.6%, 86.4%, 91.2%, and 73.1%, respectively, whereas in detecting ECE were 77.8%, 83.4%, 66.7%, and 89.7%, respectively. At logistic regression, both the Partin tables-derived probability and the mpMRI clinical staging were significantly associated with OC disease (all P<0.01). The area under the curves of the model built using the Partin tables and that of the mpMRI model were 0.62 and 0.82, respectively (P = 0.04). CONCLUSIONS: The predictive accuracy of mpMRI in predicting OC disease on pathological analysis is significantly greater than that of the Partin tables. mpMRI had a high PPV (91.2%) when predicting OC disease and a high NPV (89.7%) with regard to ECE. mpMRI should be considered when planning prostate cancer treatment in addition to readily available clinical parameters.

Authors
Gupta, RT; Faridi, KF; Singh, AA; Passoni, NM; Garcia-Reyes, K; Madden, JF; Polascik, TJ
MLA Citation
Gupta, RT, Faridi, KF, Singh, AA, Passoni, NM, Garcia-Reyes, K, Madden, JF, and Polascik, TJ. "Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy." Urologic oncology 32.8 (November 2014): 1292-1299.
PMID
24863013
Source
epmc
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
32
Issue
8
Publish Date
2014
Start Page
1292
End Page
1299
DOI
10.1016/j.urolonc.2014.04.017

Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases.

PURPOSE: To compare abdominopelvic and lower extremity venous enhancement in contrast-enhanced magnetic resonance venography (ceMRV), using iron-based ferumoxytol and gadolinium-based gadofosveset. MATERIALS AND METHODS: This was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. Thirty-four patients were identified who had undergone ceMRV using either ferumoxtyol (Group A, all with chronic renal insufficiency) or gadofosveset (Group B). Two radiologists rated confidence for evaluation of the major abdominopelvic and lower extremity veins from 4 (excellent confidence) to 1 (nondiagnostic). A third radiologist measured signal intensity ratios (SIRs) of venous segments compared with adjacent muscles. Scores were compared using repeated-measures analysis of variance (ANOVA). The medical record was searched for contemporaneous imaging to confirm the ceMRV findings. RESULTS: In Group A, 14/225 venous segments were thrombosed, compared with 18/282 in Group B. There was no statistically significant difference between confidence scores (3.79 ± 0.44 vs. 3.85 ± 0.44, P = 0.34) or SIRs (2.40 ± 0.73 vs. 2.38 ± 0.51, P = 0.51) for patent segments in the two groups, nor were confidences scores (3.89 ± 0.29 vs. 3.72 ± 0.46, P = 0.31) or SIRs (0.90 ± 0.12 vs. 0.84 ± 0.19, P = 0.31) significantly different for thrombosed segments. Contemporaneous imaging confirmed ceMRV findings in 227 segments. CONCLUSION: ceMRV can be performed with ferumoxytol, yielding similar image quality to a blood pool gadolinium-based contrast agent.

Authors
Bashir, MR; Mody, R; Neville, A; Javan, R; Seaman, D; Kim, CY; Gupta, RT; Jaffe, TA
MLA Citation
Bashir, MR, Mody, R, Neville, A, Javan, R, Seaman, D, Kim, CY, Gupta, RT, and Jaffe, TA. "Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases." J Magn Reson Imaging 40.1 (July 2014): 113-118.
PMID
24130008
Source
pubmed
Published In
Journal of Magnetic Resonance Imaging
Volume
40
Issue
1
Publish Date
2014
Start Page
113
End Page
118
DOI
10.1002/jmri.24330

The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel.

OBJECTIVE: To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy. METHODS: Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors. Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of ≥0.5 mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy? RESULTS: Consensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist. Structured and standardised reporting of prostate MRI is paramount. State of the art mpMRI is capable of localising small tumours for focal therapy. State of the art mpMRI is the technique of choice for follow-up of focal ablation. CONCLUSIONS: The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumour aggressiveness. Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy.

Authors
Muller, BG; Fütterer, JJ; Gupta, RT; Katz, A; Kirkham, A; Kurhanewicz, J; Moul, JW; Pinto, PA; Rastinehad, AR; Robertson, C; de la Rosette, J; Sanchez-Salas, R; Jones, JS; Ukimura, O; Verma, S; Wijkstra, H; Marberger, M
MLA Citation
Muller, BG, Fütterer, JJ, Gupta, RT, Katz, A, Kirkham, A, Kurhanewicz, J, Moul, JW, Pinto, PA, Rastinehad, AR, Robertson, C, de la Rosette, J, Sanchez-Salas, R, Jones, JS, Ukimura, O, Verma, S, Wijkstra, H, and Marberger, M. "The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: recommendations from a consensus panel." BJU Int 113.2 (February 2014): 218-227.
PMID
24215670
Source
pubmed
Published In
Bju International
Volume
113
Issue
2
Publish Date
2014
Start Page
218
End Page
227
DOI
10.1111/bju.12243

The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: Recommendations from a consensus panel

Objective To establish a consensus on the utility of multiparametric magnetic resonance imaging (mpMRI) to identify patients for focal therapy. Methods Urological surgeons, radiologists, and basic researchers, from Europe and North America participated in a consensus meeting about the use of mpMRI in focal therapy of prostate cancer. The consensus process was face-to-face and specific clinical issues were raised and discussed with agreement sought when possible. All participants are listed among the authors. Topics specifically did not include staging of prostate cancer, but rather identifying the optimal requirements for performing MRI, and the current status of optimally performed mpMRI to (i) determine focality of prostate cancer (e.g. localising small target lesions of ≥0.5 mL), (ii) to monitor and assess the outcome of focal ablation therapies, and (iii) to identify the diagnostic advantages of new MRI methods. In addition, the need for transperineal template saturation biopsies in selecting patients for focal therapy was discussed, if a high quality mpMRI is available. In other words, can mpMRI replace the role of transperineal saturation biopsies in patient selection for focal therapy? Results Consensus was reached on most key aspects of the meeting; however, on definition of the optimal requirements for mpMRI, there was one dissenting voice. mpMRI is the optimum approach to achieve the objectives needed for focal therapy, if made on a high quality machine (3T with/without endorectal coil or 1.5T with endorectal coil) and judged by an experienced radiologist. Structured and standardised reporting of prostate MRI is paramount. State of the art mpMRI is capable of localising small tumours for focal therapy. State of the art mpMRI is the technique of choice for follow-up of focal ablation. Conclusions The present evidence for MRI in focal therapy is limited. mpMRI is not accurate enough to consistently grade tumour aggressiveness. Template-guided saturation biopsies are no longer necessary when a high quality state of the art mpMRI is available; however, suspicious lesions should always be confirmed by (targeted) biopsy. © 2013 The Authors. BJU International © 2013 BJU International.

Authors
Muller, BG; Fütterer, JJ; Gupta, RT; Katz, A; Kirkham, A; Kurhanewicz, J; Moul, JW; Pinto, PA; Rastinehad, AR; Robertson, C; De La Rosette, J; Sanchez-Salas, R; Jones, JS; Ukimura, O; Verma, S; Wijkstra, H; Marberger, M
MLA Citation
Muller, BG, Fütterer, JJ, Gupta, RT, Katz, A, Kirkham, A, Kurhanewicz, J, Moul, JW, Pinto, PA, Rastinehad, AR, Robertson, C, De La Rosette, J, Sanchez-Salas, R, Jones, JS, Ukimura, O, Verma, S, Wijkstra, H, and Marberger, M. "The role of magnetic resonance imaging (MRI) in focal therapy for prostate cancer: Recommendations from a consensus panel." BJU International 113.2 (January 1, 2014): 218-227.
Source
scopus
Published In
Bju International
Volume
113
Issue
2
Publish Date
2014
Start Page
218
End Page
227
DOI
10.1111/bju.12243

Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy

© 2014 Elsevier Inc.Objectives: The purpose of our study was to test our hypothesis that multiparametric magnetic resonance imaging (mpMRI) may have a higher prognostic accuracy than the Partin tables in predicting organ-confined (OC) prostate cancer and extracapsular extension (ECE) after radical prostatectomy (RP). Methods and materials: After institutional review board approval, we retrospectively reviewed 60 patients who underwent 3-T mpMRI before RP. mpMRI was used to assess clinical stage and the updated version of the Partin tables was used to calculate the probability of each patient to harbor OC disease. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in detecting OC and ECE were calculated. Logistic regression models predicting OC pathology were created using either clinical stage at mpMRI or Partin tables probability. The area under the curve was used to calculate the predictive accuracy of each model. Results: Median prostate-specific antigen level at diagnosis was 5. ng/ml (range: 4.1-6.7. ng/ml). Overall, 52 (86.7%) men had cT1 disease, 7 (11.7%) had cT2a/b, and 1 (1.6%) had cT3b at digital rectal examination. Biopsy Gleason score was 6, 3+4 = 7, 4+3 = 7, 8, and 9 to 10 in 28 (46.7%), 15 (25%), 3 (5%), 10 (16.7%), and 4 (6.6%) patients, respectively. At mpMRI, clinical stage was defined as cT2a/b, cT2c, cT3a, and cT3b in 11 (18.3%), 23 (38.3%), 21 (35%), and 5 (8.4%) patients, respectively. At final pathology, 38 men (63.3%) had OC disease, whereas 18 (30%) had ECE and 4 (6.7%) had seminal vesicle invasion. The sensitivity, specificity, PPV, and NPV of mpMRI in detecting OC disease were 81.6%, 86.4%, 91.2%, and 73.1%, respectively, whereas in detecting ECE were 77.8%, 83.4%, 66.7%, and 89.7%, respectively. At logistic regression, both the Partin tables-derived probability and the mpMRI clinical staging were significantly associated with OC disease (all P<0.01). The area under the curves of the model built using the Partin tables and that of the mpMRI model were 0.62 and 0.82, respectively (P = 0.04). Conclusions: The predictive accuracy of mpMRI in predicting OC disease on pathological analysis is significantly greater than that of the Partin tables. mpMRI had a high PPV (91.2%) when predicting OC disease and a high NPV (89.7%) with regard to ECE. mpMRI should be considered when planning prostate cancer treatment in addition to readily available clinical parameters.

Authors
Gupta, RT; Faridi, KF; Singh, AA; Passoni, NM; Garcia-Reyes, K; Madden, JF; Polascik, TJ
MLA Citation
Gupta, RT, Faridi, KF, Singh, AA, Passoni, NM, Garcia-Reyes, K, Madden, JF, and Polascik, TJ. "Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy." Urologic Oncology: Seminars and Original Investigations 32.8 (January 1, 2014): 1317-1326.
Source
scopus
Published In
Urologic Oncology: Seminars and Original Investigations
Volume
32
Issue
8
Publish Date
2014
Start Page
1317
End Page
1326
DOI
10.1016/j.urolonc.2014.04.017

Multimodality approach to detection and characterization of hepatic hemangiomas

© Springer Science+Business Media New York 2014.Hemangiomas are the most common benign hepatic tumor and represent a common incidental finding on routine imaging examinations of the liver. The majority of hemangiomas demonstrate classical imaging findings on grayscale ultrasound (US), multidetector-row computed tomography (MDCT), and magnetic resonance imaging (MRI). The classic appearance on contrast-enhanced cross-sectional imaging is that of centripetal nodular enhancement with progressive fill-in of the lesion over time with conventional extracellular CT and MR contrast agents. With the advent of new gadolinium-based MR contrast agents such as hepatocyte-specific contrast agents and blood pool contrast agents, some different appearances of hemangiomas are possible and familiarity with these appearances is critical in making the correct diagnosis. There are also variants of the typical hemangioma, including the flash-filling hemangioma, giant hemangioma, sclerosed or hyalinized hemangioma, as well as hemangiomas occurring on a background of hepatic steatosis and cirrhosis. Again, knowledge of these variant types of hemangiomas can prevent against misdiagnosis of these lesions in the clinical setting.

Authors
Gupta, RT; Marin, D
MLA Citation
Gupta, RT, and Marin, D. "Multimodality approach to detection and characterization of hepatic hemangiomas." Abdomen and Thoracic Imaging: An Engineering and Clinical Perspective. January 1, 2014. 123-144.
Source
scopus
Publish Date
2014
Start Page
123
End Page
144
DOI
10.1007/978-1-4614-8498-1_5

Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases

Purpose To compare abdominopelvic and lower extremity venous enhancement in contrast-enhanced magnetic resonance venography (ceMRV), using iron-based ferumoxytol and gadolinium-based gadofosveset. Materials and Methods This was a Health Insurance Portability and Accountability Act (HIPAA)-compliant retrospective study. Thirty-four patients were identified who had undergone ceMRV using either ferumoxtyol (Group A, all with chronic renal insufficiency) or gadofosveset (Group B). Two radiologists rated confidence for evaluation of the major abdominopelvic and lower extremity veins from 4 (excellent confidence) to 1 (nondiagnostic). A third radiologist measured signal intensity ratios (SIRs) of venous segments compared with adjacent muscles. Scores were compared using repeated-measures analysis of variance (ANOVA). The medical record was searched for contemporaneous imaging to confirm the ceMRV findings. Results In Group A, 14/225 venous segments were thrombosed, compared with 18/282 in Group B. There was no statistically significant difference between confidence scores (3.79 ± 0.44 vs. 3.85 ± 0.44, P = 0.34) or SIRs (2.40 ± 0.73 vs. 2.38 ± 0.51, P = 0.51) for patent segments in the two groups, nor were confidences scores (3.89 ± 0.29 vs. 3.72 ± 0.46, P = 0.31) or SIRs (0.90 ± 0.12 vs. 0.84 ± 0.19, P = 0.31) significantly different for thrombosed segments. Contemporaneous imaging confirmed ceMRV findings in 227 segments. Conclusion ceMRV can be performed with ferumoxytol, yielding similar image quality to a blood pool gadolinium-based contrast agent. © 2013 Wiley Periodicals, Inc. © 2013 Wiley Periodicals, Inc.

Authors
Bashir, MR; Mody, R; Neville, A; Javan, R; Seaman, D; Kim, CY; Gupta, RT; Jaffe, TA
MLA Citation
Bashir, MR, Mody, R, Neville, A, Javan, R, Seaman, D, Kim, CY, Gupta, RT, and Jaffe, TA. "Retrospective assessment of the utility of an iron-based agent for contrast-enhanced magnetic resonance venography in patients with endstage renal diseases." Journal of Magnetic Resonance Imaging 40.1 (2014): 113-118.
Source
scival
Published In
Journal of Magnetic Resonance Imaging
Volume
40
Issue
1
Publish Date
2014
Start Page
113
End Page
118
DOI
10.1002/jmri.24330

Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy

Copyright © 2014 Elsevier Inc. All rights reserved.OBJECTIVES: The purpose of our study was to test our hypothesis that multiparametric magnetic resonance imaging (mpMRI) may have a higher prognostic accuracy than the Partin tables in predicting organ-confined (OC) prostate cancer and extracapsular extension (ECE) after radical prostatectomy (RP).METHODS AND MATERIALS: After institutional review board approval, we retrospectively reviewed 60 patients who underwent 3-T mpMRI before RP. mpMRI was used to assess clinical stage and the updated version of the Partin tables was used to calculate the probability of each patient to harbor OC disease. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of mpMRI in detecting OC and ECE were calculated. Logistic regression models predicting OC pathology were created using either clinical stage at mpMRI or Partin tables probability. The area under the curve was used to calculate the predictive accuracy of each model.RESULTS: Median prostate-specific antigen level at diagnosis was 5 ng/ml (range: 4.1-6.7 ng/ml). Overall, 52 (86.7%) men had cT1 disease, 7 (11.7%) had cT2a/b, and 1 (1.6%) had cT3b at digital rectal examination. Biopsy Gleason score was 6, 3+4 = 7, 4+3 = 7, 8, and 9 to 10 in 28 (46.7%), 15 (25%), 3 (5%), 10 (16.7%), and 4 (6.6%) patients, respectively. At mpMRI, clinical stage was defined as cT2a/b, cT2c, cT3a, and cT3b in 11 (18.3%), 23 (38.3%), 21 (35%), and 5 (8.4%) patients, respectively. At final pathology, 38 men (63.3%) had OC disease, whereas 18 (30%) had ECE and 4 (6.7%) had seminal vesicle invasion. The sensitivity, specificity, PPV, and NPV of mpMRI in detecting OC disease were 81.6%, 86.4%, 91.2%, and 73.1%, respectively, whereas in detecting ECE were 77.8%, 83.4%, 66.7%, and 89.7%, respectively. At logistic regression, both the Partin tables-derived probability and the mpMRI clinical staging were significantly associated with OC disease (all P<0.01). The area under the curves of the model built using the Partin tables and that of the mpMRI model were 0.62 and 0.82, respectively (P = 0.04).CONCLUSIONS: The predictive accuracy of mpMRI in predicting OC disease on pathological analysis is significantly greater than that of the Partin tables. mpMRI had a high PPV (91.2%) when predicting OC disease and a high NPV (89.7%) with regard to ECE. mpMRI should be considered when planning prostate cancer treatment in addition to readily available clinical parameters.

Authors
Gupta, RT; Faridi, KF; Singh, AA; Passoni, NM; Garcia-Reyes, K; Madden, JF; Polascik, TJ
MLA Citation
Gupta, RT, Faridi, KF, Singh, AA, Passoni, NM, Garcia-Reyes, K, Madden, JF, and Polascik, TJ. "Comparing 3-T multiparametric MRI and the Partin tables to predict organ-confined prostate cancer after radical prostatectomy." Urologic oncology 32.8 (2014): 1292-1299.
Source
scival
Published In
Urologic Oncology: seminars and original investigations
Volume
32
Issue
8
Publish Date
2014
Start Page
1292
End Page
1299
DOI
10.1016/j.urolonc.2014.04.017

Clinical impact of an adaptive statistical iterative reconstruction algorithm for detection of hypervascular liver tumours using a low tube voltage, high tube current MDCT technique

Objectives: To investigate the impact of an adaptive statistical iterative reconstruction (ASiR) algorithm on diagnostic accuracy and confidence for the diagnosis of hypervascular liver tumours, as well as the reader's perception of image quality, using a low tube voltage (80 kVp), high tube current computed tomography (CT) technique. Methods: Forty patients (29 men, 11 women) with 65 hypervascular liver tumours underwent dual energy CT. The 80 kV set of the dual energy acquisition was reconstructed with standard filtered backprojection (FBP) and ASiR at different blending levels. Lesion contrast-to-noise ratio (CNR), reader's confidence for lesion detection and characterisation, and reader's evaluation of image quality were recorded. Results: ASiR yielded significantly higher CNR values compared with FBP (P < 0.0001 for all comparisons). Reader's perception of lesion conspicuity and confidence in the diagnosis of malignancy were also higher with 60 % and 80 % ASiR, compared with FBP (P = 0.01 and < 0.001, respectively). Compared with FBP, ASiR yielded nearly significantly lower specificity for lesion detection and a substantial decrease in the reader's perception of image quality. Conclusions: Compared with the standard FBP algorithm, ASiR significantly improves conspicuity of hypervascular liver lesions. This improvement may come at the cost of decreased specificity and reader's perception of image quality. Key Points: • Adaptive statistical iterative reconstruction algorithms (ASiRs) offer increasing potential in multidetector CT. • An ASiR algorithm significantly improves conspicuity of hypervascular liver lesions at MDCT. • Improved lesion conspicuity translates into increased reader's confidence for diagnosis of malignancy. • False positive findings may increase with ASiR, leading to potentially lower specificity. © 2013 European Society of Radiology.

Authors
Marin, D; Choudhury, KR; Gupta, RT; Ho, LM; Allen, BC; Schindera, ST; Colsher, JG; Samei, E; Nelson, RC
MLA Citation
Marin, D, Choudhury, KR, Gupta, RT, Ho, LM, Allen, BC, Schindera, ST, Colsher, JG, Samei, E, and Nelson, RC. "Clinical impact of an adaptive statistical iterative reconstruction algorithm for detection of hypervascular liver tumours using a low tube voltage, high tube current MDCT technique." European Radiology 23.12 (December 1, 2013): 3325-3335.
Source
scopus
Published In
European Radiology
Volume
23
Issue
12
Publish Date
2013
Start Page
3325
End Page
3335
DOI
10.1007/s00330-013-2964-1

Clinical impact of an adaptive statistical iterative reconstruction algorithm for detection of hypervascular liver tumours using a low tube voltage, high tube current MDCT technique.

OBJECTIVES: To investigate the impact of an adaptive statistical iterative reconstruction (ASiR) algorithm on diagnostic accuracy and confidence for the diagnosis of hypervascular liver tumours, as well as the reader's perception of image quality, using a low tube voltage (80 kVp), high tube current computed tomography (CT) technique. METHODS: Forty patients (29 men, 11 women) with 65 hypervascular liver tumours underwent dual energy CT. The 80 kV set of the dual energy acquisition was reconstructed with standard filtered backprojection (FBP) and ASiR at different blending levels. Lesion contrast-to-noise ratio (CNR), reader's confidence for lesion detection and characterisation, and reader's evaluation of image quality were recorded. RESULTS: ASiR yielded significantly higher CNR values compared with FBP (P < 0.0001 for all comparisons). Reader's perception of lesion conspicuity and confidence in the diagnosis of malignancy were also higher with 60 % and 80 % ASiR, compared with FBP (P = 0.01 and < 0.001, respectively). Compared with FBP, ASiR yielded nearly significantly lower specificity for lesion detection and a substantial decrease in the reader's perception of image quality. CONCLUSIONS: Compared with the standard FBP algorithm, ASiR significantly improves conspicuity of hypervascular liver lesions. This improvement may come at the cost of decreased specificity and reader's perception of image quality.

Authors
Marin, D; Choudhury, KR; Gupta, RT; Ho, LM; Allen, BC; Schindera, ST; Colsher, JG; Samei, E; Nelson, RC
MLA Citation
Marin, D, Choudhury, KR, Gupta, RT, Ho, LM, Allen, BC, Schindera, ST, Colsher, JG, Samei, E, and Nelson, RC. "Clinical impact of an adaptive statistical iterative reconstruction algorithm for detection of hypervascular liver tumours using a low tube voltage, high tube current MDCT technique." Eur Radiol 23.12 (December 2013): 3325-3335.
PMID
23832320
Source
pubmed
Published In
European Radiology
Volume
23
Issue
12
Publish Date
2013
Start Page
3325
End Page
3335
DOI
10.1007/s00330-013-2964-1

Automated patient-tailored screening of the liver for diffuse steatosis and iron overload using MRI.

OBJECTIVE: The purpose of this article is to validate an automated screening method for evaluation of hepatic steatosis or siderosis. MATERIALS AND METHODS: This was a two-part study, with retrospective and prospective portions. First, 130 consecutive abdominal MRI examinations, including both the automated algorithm and reference standard fat and iron quantification, were retrospectively identified. The algorithm's performance was validated against the reference standard and was compared with the performance of three expert readers. Subsequently, 39 subjects undergoing liver MRI were prospectively identified and enrolled. These subjects were scanned with a protocol where quantification sequences were either performed or not performed on the basis of the recommendation of the algorithm. Total examination time in these subjects was compared with examination times in the 90 subjects from the retrospective cohort who had undergone a similar liver MRI protocol with complete quantification. RESULTS: The automated algorithm was accurate in determining the presence of deposition disease (93.1%), with no significant difference between its conclusions and those of any of the readers (p=0.48-1.0). Use of the algorithm resulted in a small but statistically significant time savings compared with performing quantification in all subjects (28 minutes 56 seconds vs 31 minutes 20 seconds; p<0.05). CONCLUSION: Automated screening for hepatic steatosis and siderosis can be performed in real time during abdominal MRI examinations, can save total scan time compared with always performing quantification, and could serve as a gatekeeper for dedicated quantification sequences.

Authors
Bashir, MR; Zhong, X; Dale, BM; Gupta, RT; Boll, DT; Merkle, EM
MLA Citation
Bashir, MR, Zhong, X, Dale, BM, Gupta, RT, Boll, DT, and Merkle, EM. "Automated patient-tailored screening of the liver for diffuse steatosis and iron overload using MRI." AJR Am J Roentgenol 201.3 (September 2013): 583-588.
PMID
23971450
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
201
Issue
3
Publish Date
2013
Start Page
583
End Page
588
DOI
10.2214/AJR.12.10051

Abdominopelvic and lower extremity deep venous thrombosis: evaluation with contrast-enhanced MR venography with a blood-pool agent.

OBJECTIVE: The purpose of this article is to evaluate contrast-enhanced (CE) MR venography (MRV) with a blood-pool agent for detection of abdominopelvic and lower extremity deep venous thrombosis (DVT) compared with a conventional unenhanced gradient-recalled echo (GRE) MRV technique. MATERIALS AND METHODS: This retrospective study was performed on 30 patients (mean age, 52.7 years; 15 men and 15 women) referred for MRV between March 2010 and November 2010 for evaluation of lower extremity or abdominopelvic DVT. All patients underwent a GRE sequence followed by a CE T1-weighted sequence with gadofosveset, a blood-pool agent. The abdominopelvic and lower extremity venous system was divided into 13 segments. The presence of acute or chronic DVT was assessed by six radiologists, as well as qualitative and quantitative assessments of each venous segment. Image acquisition and interpretation times were also tabulated. RESULTS: The sensitivity and specificity for acute DVT were 91.0% and 99.8%, respectively, on CE MRV compared with 80.8% and 95.8%, respectively, on GRE MRV (p = 0.077 and p < 0.001). The sensitivity and specificity for chronic DVT were 84.4% and 98.4%, respectively, on CE MRV and 64.5% and 95.6%, respectively, on GRE MRV (p < 0.001 for both). Subjective ratings of vein visualization, signal homogeneity, and confidence pertaining to DVT diagnosis were significantly higher with the CE images (p < 0.001). The contrast-to-noise ratio for CE images was similar or significantly higher for all venous segments. Image acquisition and radiologist interpretation times on the CE studies were decreased (p < 0.001). CONCLUSION: Gadofosveset-enhanced MRV had equal or higher sensitivity and specificity for detection of DVT than did GRE MRV, with decreased time for image acquisition and interpretation.

Authors
Huang, SY; Kim, CY; Miller, MJ; Gupta, RT; Lessne, ML; Horvath, JJ; Boll, DT; Evans, PD; Befera, NT; Krishnan, P; Chan, JL; Merkle, EM
MLA Citation
Huang, SY, Kim, CY, Miller, MJ, Gupta, RT, Lessne, ML, Horvath, JJ, Boll, DT, Evans, PD, Befera, NT, Krishnan, P, Chan, JL, and Merkle, EM. "Abdominopelvic and lower extremity deep venous thrombosis: evaluation with contrast-enhanced MR venography with a blood-pool agent." AJR Am J Roentgenol 201.1 (July 2013): 208-214.
PMID
23789677
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
201
Issue
1
Publish Date
2013
Start Page
208
End Page
214
DOI
10.2214/AJR.12.9611

MRI assessment of biliary ductal obstruction: is there added value of T1-weighted gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MR cholangiography?

OBJECTIVE: The goal of the present study was to determine the added value of gadolium-ethoxybenzyl-diethylenetriamine pentaacetic acid (gadoxetate disodium)-enhanced magnetic resonance cholangiography (MRC) to standard liver MRI including T2-weighted MRCP in assessment of biliary ductal obstruction. MATERIALS AND METHODS: Thirty-eight patients (mean age, 48.1 ± 16.7 years) (40 total examinations) who underwent liver MRI (including T2-weighted MRCP and gadoxetate disodium-enhanced MRC) for suspicion of biliary disease were included in this institutional review board-approved, HIPAA-compliant retrospective study. Three blinded radiologists first evaluated MR images without gadoxetate disodium-enhanced MRC for presence and significance of biliary obstruction, underlying cause for obstruction, and confidence in final diagnosis. After inclusion of gadoxetate disodium-enhanced MRC, readers again determined presence and significance of biliary obstruction and confidence in final diagnosis. Reference standard was established using MRI along with ERCP, percutaneous transhepatic cholangiography, intraoperative cholangiography, or a combination thereof. RESULTS: Overall sensitivity across all readers in diagnosing significance of obstruction was 60% without gadoxetate disodium-enhanced MRC and 91% with gadoxetate disodium- enhanced MRC (p < 0.001). Across all readers, assessment of significance of obstruction was changed when adding gadoxetate disodium-enhanced MRC in 40 of 120 cases (33%); significance of obstruction was correctly changed in 35 of 40 cases (87.5%). Biliary obstruction was graded of unknown significance in 27 of 120 cases (22.5%) across all readers when gadoxetate disodium-enhanced MRC was not reviewed. Significance of biliary obstruction was classified correctly after adding gadoxetate disodium-enhanced MRC in 25 of these 27 cases (93%). Confidence in final diagnosis was significantly higher with addition of gadoxetate di-sodium-enhanced MRC for two of three readers (p < 0.003). CONCLUSION: Addition of gadoxetate disodium-enhanced MRC to liver MRI significantly improves sensitivity in assessing significance of biliary obstruction and can improve reader confidence in establishing a final diagnosis. This added information could have a substantial impact in the determination of the most appropriate therapeutic options.

Authors
Reiner, CS; Merkle, EM; Bashir, MR; Walle, NL; Nazeer, HK; Gupta, RT
MLA Citation
Reiner, CS, Merkle, EM, Bashir, MR, Walle, NL, Nazeer, HK, and Gupta, RT. "MRI assessment of biliary ductal obstruction: is there added value of T1-weighted gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced MR cholangiography?." AJR Am J Roentgenol 201.1 (July 2013): W49-W56.
PMID
23789696
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
201
Issue
1
Publish Date
2013
Start Page
W49
End Page
W56
DOI
10.2214/AJR.12.9332

Bone marrow enhancement during time-resolved magnetic resonance angiography of the pelvis.

OBJECTIVE: This study aimed to determine whether visible bone marrow enhancement (BME) at pelvic magnetic resonance angiography (MRA) correlates with anemia. METHODS: This is an institutional review board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study. Seventy-five female patients with a hemoglobin (Hb) test within 10 days of an MRA examination of the pelvis are included, mean age of 46 years (range, 18-81 years). The BME was graded using a 4-point scale. Fifteen subjects had sufficient imaging data for calculation of quantitative perfusion parameters. Receiver operating characteristic and analysis of covariance were performed for 2 levels of anemia. RESULTS: Enhancement was visually present in 44% (33/75) of cases; 66% (19/29) of anemic subjects (Hb < 12 g/dL), and 30% (14/46) of nonanemic subjects (P = 0.002). Enhancement had a sensitivity of 87.5% and a specificity of 92.5% for the diagnosis of severe anemia (Hb < 10 g/dL); 88% (7/8) of these subjects had moderate to marked enhancement. A high extraction coefficient (Kep) in the iliac crest was associated with anemia, with an area under the curve of the receiver operating characteristic of 0.85 for mild anemia and 0.92 for severe anemia. CONCLUSIONS: Visible BME during time-resolved MRA is common and may be related to anemia.

Authors
Allen, BC; Bashir, MR; Dale, BM; Heye, TJ; Gupta, RT; Merkle, EM
MLA Citation
Allen, BC, Bashir, MR, Dale, BM, Heye, TJ, Gupta, RT, and Merkle, EM. "Bone marrow enhancement during time-resolved magnetic resonance angiography of the pelvis." Journal of computer assisted tomography 37.3 (May 2013): 458-462.
PMID
23674021
Source
epmc
Published In
Journal of Computer Assisted Tomography
Volume
37
Issue
3
Publish Date
2013
Start Page
458
End Page
462
DOI
10.1097/rct.0b013e318283d549

The State of Prostate MRI in 2013

Authors
Gupta, RT; Kauffman, CR; Polascik, TJ; Taneja, SS; Rosenkrantz, AB
MLA Citation
Gupta, RT, Kauffman, CR, Polascik, TJ, Taneja, SS, and Rosenkrantz, AB. "The State of Prostate MRI in 2013." ONCOLOGY-NEW YORK 27.4 (April 2013): 262-270.
PMID
23781689
Source
wos-lite
Published In
Oncology
Volume
27
Issue
4
Publish Date
2013
Start Page
262
End Page
270

Lesion detection and assessment of extrahepatic findings in abdominal MRI using hepatocyte specific contrast agents--comparison of Gd-EOB-DTPA and Gd-BOPTA.

BACKGROUND: To evaluate the contrast agent performance of Gd-EOB-DTPA and Gd-BOPTA for detection and assessment of extrahepatic findings, semi-quantitatively and qualitatively. METHODS: 13 patients with 19 extrahepatic lesions underwent liver MRI with Gd-EOB-DTPA and Gd-BOPTA. Quantitative and relative SNR measurements were performed in each dataset in the arterial and portalvenous phase within the extrahepatic lesion, aorta, inferior vena cava, portal vein, spleen, pancreas and renal cortex. Further, relative CNR measurements were performed. Three readers assessed contrast quality using a five-point scale and choosing the preferred image dataset. Statistical analysis consisted of a Student's t-test with p < 0.05 deemed significant, a weighted kappa statistic for assessment of interobserver variability and an ROC analysis. RESULTS: Mean SNR after injection of Gd-BOPTA was significantly higher compared with Gd-EOB-DTPA for all measurements (p < 0.05). Mean relative SNR was also higher for Gd-BOPTA, but without being statistically significant. There was no significant difference in relative CNR. Interobserver agreement for selection of image preference was moderate (mean weighted kappa 0.485). The area under the curve for the ROC-analysis regarding contrast agent performance was 0.464. CONCLUSION: Even though mean SNR is significantly higher after injection of Gd-BOPTA compared with Gd-EOB-DTPA, there is no significant difference in relative CNR with extrahepatic lesions being assessed equally well. Visual impression may differ after injection of Gd-EOB-DTPA, but does not influence image interpretation. Extrahepatic findings can be assessed similarly to MRI after injection of Gd-BOPTA.

Authors
Ringe, KI; Boll, DT; Husarik, DB; Bashir, MR; Gupta, RT; Merkle, EM
MLA Citation
Ringe, KI, Boll, DT, Husarik, DB, Bashir, MR, Gupta, RT, and Merkle, EM. "Lesion detection and assessment of extrahepatic findings in abdominal MRI using hepatocyte specific contrast agents--comparison of Gd-EOB-DTPA and Gd-BOPTA. (Published online)" BMC Med Imaging 13 (March 18, 2013): 10-.
PMID
23506523
Source
pubmed
Published In
BMC Medical Imaging
Volume
13
Publish Date
2013
Start Page
10
DOI
10.1186/1471-2342-13-10

Evaluation of the biliary tree and gallbladder with hepatocellular MR contrast agents.

Newer hepatobiliary magnetic resonance (MR) contrast agents allow the ability to combine the anatomical information from T2-weighted magnetic resonance cholangiopancreatography with functional information derived from contrast-enhanced T1-weighted magnetic resonance cholangiography for off-label biliary imaging. Potential applications include determination of biliary anatomy, functional assessment of biliary obstruction, and evaluation for acute cholecystitis. Through MR protocol optimization, it is also possible to achieve this within the standard 30-minute imaging window of liver MR.

Authors
Gupta, RT
MLA Citation
Gupta, RT. "Evaluation of the biliary tree and gallbladder with hepatocellular MR contrast agents." Curr Probl Diagn Radiol 42.2 (March 2013): 67-76.
PMID
23332139
Source
pubmed
Published In
Current Problems in Diagnostic Radiology
Volume
42
Issue
2
Publish Date
2013
Start Page
67
End Page
76
DOI
10.1067/j.cpradiol.2012.08.004

Quantitative dynamic contrast-enhanced MRI of pelvic and lumbar bone marrow: effect of age and marrow fat content on pharmacokinetic parameter values.

OBJECTIVE: The purpose of this study was to determine the effects of age and fat content on quantitative dynamic contrast-enhanced MRI (DCE-MRI) parameters in the bone marrow of the lumbar spine and pelvis. The interreader reproducibility of this technique will also be assessed. MATERIALS AND METHODS: Forty-three DCE-MRI studies of the female pelvis defined the study group. Quantitative pharmacokinetic perfusion parameters of lumbar and pelvic marrow were analyzed by three readers on a DCE-MRI postprocessing platform. Linear regression analysis was performed to determine the effect of age and marrow fat fraction on the parameters of transfer constant (K(trans)), efflux rate constant (K(ep)), extravascular extracellular space (V(e)), and initial area under the gadolinium curve at 60 seconds (iAUGC(60)). Interreader agreement was assessed by means of intraclass correlation coefficient calculation. RESULTS: A weak but statistically significant correlation was established between both age and fat fraction and the parameters K(trans) (R(2) = 0.14) and K(ep) (R(2) = 0.09). There was also a weak but statistically significant correlation between fat fraction and V(e) (R(2) = 0.116) and iAUGC(60) (R(2) = 0.108), but no correlation between age and these parameters. Intraclass correlation coefficients of parameter measurements by different readers were all greater than 0.7 at the p < 0.05 level. CONCLUSION: Age and fat fraction have small measurable effects on quantitative DCE-MRI parameters in bone marrow. However, given the wide interindividual variation of these parameters, these effects are unlikely to confound changes related to malignancy or treatment. Also of note, there was strong interreader reproducibility of parameter measurements among a range of experience levels, suggesting that the reader-reader experience level may not represent a significant source of variability in bone marrow DCE-MRI.

Authors
Breault, SR; Heye, T; Bashir, MR; Dale, BM; Merkle, EM; Reiner, CS; Faridi, KF; Gupta, RT
MLA Citation
Breault, SR, Heye, T, Bashir, MR, Dale, BM, Merkle, EM, Reiner, CS, Faridi, KF, and Gupta, RT. "Quantitative dynamic contrast-enhanced MRI of pelvic and lumbar bone marrow: effect of age and marrow fat content on pharmacokinetic parameter values." AJR Am J Roentgenol 200.3 (March 2013): W297-W303.
PMID
23436875
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
200
Issue
3
Publish Date
2013
Start Page
W297
End Page
W303
DOI
10.2214/AJR.12.9080

Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis?

PURPOSE: To evaluate the value of hepatobiliary phase imaging for detection and characterization of hepatocellular carcinoma (HCC) in liver MRI with Gd-EOB-DTPA, in a North American population. MATERIALS AND METHODS: One hundred MRI examinations performed with the intravenous injection of Gd-EOB-DTPA in patients with cirrhosis were reviewed retrospectively. Nodules were classified as HCC (n = 70), indeterminate (n = 33), or benign (n = 22). Five readers independently reviewed each examination with and without hepatobiliary phase images (HBP). Lesion conspicuity scores were compared between the two readings. Lesion detection, confidence scores, and receiver operating characteristic (ROC) analysis were compared. RESULTS: Lesion detection was slightly improved for all lesion types with the inclusion of the HBP, and was substantially higher for small HCCs (96.0% versus 85.3%). Mean confidence scores for the diagnosis of HCC increased for HCCs overall and each size category (P < 0.001). Diagnostic performance improved with the addition of the HBP (aggregate AROC 87.7% versus 80.0%, P < 0.01), and sensitivity for characterization improved (90.9% versus 78.3%, P < 0.01) while specificity was unchanged. CONCLUSION: Hepatobiliary phase imaging may improve small lesion detection (<1 cm) and characterization of lesions in general, in MRI of the cirrhotic liver with Gd-EOB-DTPA.

Authors
Bashir, MR; Gupta, RT; Davenport, MS; Allen, BC; Jaffe, TA; Ho, LM; Boll, DT; Merkle, EM
MLA Citation
Bashir, MR, Gupta, RT, Davenport, MS, Allen, BC, Jaffe, TA, Ho, LM, Boll, DT, and Merkle, EM. "Hepatocellular carcinoma in a North American population: does hepatobiliary MR imaging with Gd-EOB-DTPA improve sensitivity and confidence for diagnosis?." J Magn Reson Imaging 37.2 (February 2013): 398-406.
PMID
23011874
Source
pubmed
Published In
Journal of Magnetic Resonance Imaging
Volume
37
Issue
2
Publish Date
2013
Start Page
398
End Page
406
DOI
10.1002/jmri.23818

Dichorionic, diamnionic twin pregnancy discordant for anencephaly: Report of two cases and literature review.

Anencephaly is a lethal diagnosis. In the unique situation of a twin pregnancy discordant for anencephaly, early ultrasound diagnosis based on the discrepancy in the appearance of the heads can facilitate management and potentially decrease morbidity and mortality for the unaffected twin. We report two such cases of dichorionic, diamniotic twin pregnancies and provide a review of the literature.

Authors
Lee Langman, E; Hertzberg, BS; Boyd, BK; Gupta, RT
MLA Citation
Lee Langman, E, Hertzberg, BS, Boyd, BK, and Gupta, RT. "Dichorionic, diamnionic twin pregnancy discordant for anencephaly: Report of two cases and literature review." Radiology case reports 8.2 (January 2013): 843-.
PMID
27330630
Source
epmc
Published In
Radiology Case Reports
Volume
8
Issue
2
Publish Date
2013
Start Page
843
DOI
10.2484/rcr.v8i2.843

The state of prostate MRI in 2013.

Compared with earlier prostate MRI techniques that suffered from relatively poor sensitivity and specificity for detecting prostate cancer because of their reliance predominantly on morphology, multiparametric prostate MRI (mpMRI) in 2013 provides a wealth of functional information that has made possible vastly improved detection and characterization of prostate cancer. Our aims in this article are to describe the various imaging sequences that comprise the mpMRI exam, as well as to review current literature on the strengths/weaknesses of these sequences; to delineate strategies for standardizing interpretation and reporting of MRI results; and finally, to expound on the role that prostate MRI currently does and potentially can play in clinical practice.

Authors
Gupta, RT; Kauffman, CR; Polascik, TJ; Taneja, SS; Rosenkrantz, AB
MLA Citation
Gupta, RT, Kauffman, CR, Polascik, TJ, Taneja, SS, and Rosenkrantz, AB. "The state of prostate MRI in 2013." Oncology (Williston Park, N.Y.) 27.4 (2013): 262-270.
Source
scival
Published In
Oncology
Volume
27
Issue
4
Publish Date
2013
Start Page
262
End Page
270

Radiologic-Pathologic Correlation of Uncommon Mesenchymal Liver Tumors

Mesenchymal liver tumors are rarely encountered in clinical practice. We review the spectrum of mesenchymal liver tumors with radiologic-pathologic correlation. There is an overlap of cross-sectional imaging findings of mesenchymal liver tumors with that of the more common malignant epithelial tumors. Familiarity with the radiologic findings and its pathologic basis would help radiologists to include these uncommon liver tumors in their differential diagnosis. © 2013.

Authors
Bhargava, P; Iyer, RS; Moshiri, M; Yeh, MM; Upton, MP; Foo, W-C; Mannelli, L; Gupta, RT
MLA Citation
Bhargava, P, Iyer, RS, Moshiri, M, Yeh, MM, Upton, MP, Foo, W-C, Mannelli, L, and Gupta, RT. "Radiologic-Pathologic Correlation of Uncommon Mesenchymal Liver Tumors." Current Problems in Diagnostic Radiology 42.5 (2013): 183-190.
PMID
24070712
Source
scival
Published In
Current Problems in Diagnostic Radiology
Volume
42
Issue
5
Publish Date
2013
Start Page
183
End Page
190
DOI
10.1067/j.cpradiol.2013.05.002

Hepatic hemangiomas: difference in enhancement pattern on 3T MR imaging with gadobenate dimeglumine versus gadoxetate disodium.

PURPOSE: To compare intraindividual differences in enhancement pattern of hepatic hemangiomas between gadobenate dimeglumine (Gd-BOPTA) and gadoxetate disodium (Gd-EOB-DTPA)-enhanced 3T MR imaging. MATERIALS AND METHODS: This is a HIPAA-compliant, IRB-approved retrospective study with waiver for informed consent granted. From 10/07 to 5/09, 10 patients (2 males, 8 females; mean age, 57.3 years) with 15 hepatic hemangiomas (mean diameter, 4.4 ± 5.6 cm) underwent both Gd-BOPTA- and Gd-EOB-DTPA-enhanced 3T MR imaging (mean interval, 266 days; range, 38-462 days). Diagnosis of hemangioma was based on strict imaging criteria. MR imaging was obtained during three arterial, portal venous, and up to four delayed phases. During each phase, hemangioma-to-liver contrast-to-noise ratio (CNR) was measured for each lesion on both examinations. Statistical analysis was performed using paired Student's t-test. RESULTS: Hemangioma-to-liver CNR peaked during the portal venous phase (Gd-BOPTA: 48.9 ± 65.8, Gd-EOB-DTPA: 0.7 ± 3.8). During all imaging phases except the first arterial phase, hemangioma-to-liver CNR was significantly lower on Gd-EOB-DTPA-enhanced compared to Gd-BOPTA-enhanced MR images (p<0.05). Notably, Gd-EOB-DTPA yielded negative hemangioma-to-liver CNR (-2.5 ± 2.4) compared to Gd-BOPTA (40.7 ± 56.4) during the first delayed phase (7-8 min after contrast administration), remaining negative for the rest of the delayed phases (up to 26 min after contrast administration). CONCLUSION: The enhancement patterns of hepatic hemangiomas differs significantly between Gd-BOPTA and Gd-EOB-DTPA-enhanced 3T MR imaging. The smaller dose, shorter plasma half-life, and increased hepatobiliary uptake of Gd-EOB-DTPA leads to a negative CNR of hemangioma-to-liver on delayed phases and could create an imaging pitfall with this agent.

Authors
Gupta, RT; Marin, D; Boll, DT; Husarik, DB; Davis, DE; Feuerlein, S; Merkle, EM
MLA Citation
Gupta, RT, Marin, D, Boll, DT, Husarik, DB, Davis, DE, Feuerlein, S, and Merkle, EM. "Hepatic hemangiomas: difference in enhancement pattern on 3T MR imaging with gadobenate dimeglumine versus gadoxetate disodium." Eur J Radiol 81.10 (October 2012): 2457-2462.
PMID
22138122
Source
pubmed
Published In
European Journal of Radiology
Volume
81
Issue
10
Publish Date
2012
Start Page
2457
End Page
2462
DOI
10.1016/j.ejrad.2011.10.014

Hepatocellular MR contrast agents: enhancement characteristics of liver parenchyma and portal vein after administration of gadoxetic acid in comparison to gadobenate dimeglumine.

PURPOSE: To investigate the enhancement characteristics of liver parenchyma and portal vein as well as the portal vein-to liver contrast in Gd-EOB-DTPA- and Gd-BOPTA-enhanced abdominal MRI. MATERIALS AND METHODS: The local institutional review board approved this retrospective study. A total of 70 patients (30 female, 40 male) without relevant liver disease underwent either Gd-EOB-DTPA-enhanced (35 patients, dose 0.025 mmol/kg) or Gd-BOPTA-enhanced (35 patients, dose 0.1 mmol/kg) abdominal MRI. Signal-to-noise ratios (SNR) for the portal vein and the liver as well as portal vein-to-liver contrast-to-noise ratios (CNR) were calculated for three consecutive arterial phases, one portal venous phase and one delayed imaging phase. RESULTS: The liver SNR showed higher values for the Gd-BOPTA group in the arterial and portal venous phases (statistically significant for the second and third arterial phase), while the liver SNR in the delayed phase was higher for the Gd-EOB-DTPA group. The portal venous SNR as well as the portal vein-to-liver CNR was higher in the Gd-BOPTA group in all imaging phases (statistically significant in all phases except for the first arterial phase). CONCLUSION: The enhancement of liver parenchyma and portal vein as well as the portal vein-to-liver contrast in the arterial and portal venous imaging phases were higher for patients receiving Gd-BOPTA compared with Gd-EOB-DTPA at the respective recommended doses. Gd-BOPTA might therefore enable better evaluation of the portal vein.

Authors
Feuerlein, S; Gupta, RT; Boll, DT; Merkle, EM
MLA Citation
Feuerlein, S, Gupta, RT, Boll, DT, and Merkle, EM. "Hepatocellular MR contrast agents: enhancement characteristics of liver parenchyma and portal vein after administration of gadoxetic acid in comparison to gadobenate dimeglumine." Eur J Radiol 81.9 (September 2012): 2037-2041.
PMID
21719224
Source
pubmed
Published In
European Journal of Radiology
Volume
81
Issue
9
Publish Date
2012
Start Page
2037
End Page
2041
DOI
10.1016/j.ejrad.2011.06.014

Gradient shimming during magnetic resonance imaging of the liver: comparison of a standard protocol versus a novel reduced protocol.

PURPOSE: The aim of this study was to examine the effect of minimizing prescan adjustments on table time and image quality in magnetic resonance imaging (MRI) of the liver. MATERIALS AND METHODS: This prospective Health Insurance Portability and Accountability Act-compliant study was approved by the institutional review board, and written informed consent was obtained. Ten volunteers were imaged twice using a noncontrast liver MRI protocol consisting of a total of 10 pulse sequences, once with a standard protocol and once with a fixed table position/minimized prescan adjustment protocol (in random order). Total examination time was evaluated according to a Lean Six Sigma framework. Quantitative sequences, including diffusion-weighted imaging with apparent diffusion coefficient, multi-echo Dixon fat percentage, and the transverse relaxation time, were evaluated and compared between the two protocols. Two experienced readers, blinded to the protocol used, compared image quality between the two protocols. RESULTS: The average number of prescan adjustment steps per examination was reduced from 58.0 to 22.1 using the minimal shimming protocol compared with the normal shimming protocol (P < 0.001). Mean business value added time (scan preparatory time) was reduced by 58% (3 minutes 3 seconds vs 7 minutes 13 seconds), whereas mean total examination time was 20% lower (18 minutes 13 seconds vs 22 minutes 48 seconds, P < 0.001). Quantitative measures obtained using the two protocols were equivalent, and neither reader detected a significant difference in subjective image quality. CONCLUSION: Fixing table position minimizes prescan adjustments and reduces total table time in liver MRI without adversely affecting image quality.

Authors
Bashir, MR; Dale, BM; Gupta, RT; Horvath, JJ; Boll, DT; Merkle, EM
MLA Citation
Bashir, MR, Dale, BM, Gupta, RT, Horvath, JJ, Boll, DT, and Merkle, EM. "Gradient shimming during magnetic resonance imaging of the liver: comparison of a standard protocol versus a novel reduced protocol." Invest Radiol 47.9 (September 2012): 524-529.
PMID
22864376
Source
pubmed
Published In
Investigative Radiology
Volume
47
Issue
9
Publish Date
2012
Start Page
524
End Page
529
DOI
10.1097/RLI.0b013e31825a8e5b

Diagnosis of focal nodular hyperplasia with MRI: multicenter retrospective study comparing gadobenate dimeglumine to gadoxetate disodium.

OBJECTIVE: The purpose of this article is to report the results from a multicenter retrospective MRI study comparing gadobenate dimeglumine and gadoxetate disodium for diagnosis of hepatic focal nodular hyperplasia (FNH). MATERIALS AND METHODS: Thirty patients (28 women and two men; mean age, 37.1 years) with hepatic FNH who underwent both gadobenate dimeglumine- and gadoxetate disodium-enhanced MRI at 1.5 T were assessed. MRI was performed during the arterial, portal venous, late venous, and hepatobiliary contrast-enhanced phases (10 and 20 minutes or 1-3 hours after contrast administration, respectively, for gadoxetate disodium and gadobenate dimeglumine). Qualitative (lesion conspicuity score) and quantitative (lesion signal intensity [SI] ratio and lesion contrast ratio) assessments were performed. RESULTS: In 30 patients, 51 FNHs were assessed (mean size 3.1 ± 1.5 cm). There was equivalent qualitative lesion conspicuity in the arterial phase between the two contrast agents and higher qualitative lesion conspicuity and SI ratio in the hepatobiliary phase with gadoxetate disodium (p < 0.002). Lesion contrast ratio was significantly higher in the arterial and late venous phases with gadobenate dimeglumine (p < 0.009), with no difference in the portal venous and hepatobiliary phases between the two contrast agents (p > 0.22). CONCLUSION: These results indicate an advantage for gadobenate dimeglumine for detection of FNH at the dynamic phase and for gadoxetate disodium at the hepatobiliary phase. However, the equivalent or better qualitative lesion conspicuity coupled with the ability to obtain a comprehensive evaluation of the liver within a standard 30-minute imaging window suggests that gadoxetate disodium may be a better choice for diagnosis of FNH.

Authors
Gupta, RT; Iseman, CM; Leyendecker, JR; Shyknevsky, I; Merkle, EM; Taouli, B
MLA Citation
Gupta, RT, Iseman, CM, Leyendecker, JR, Shyknevsky, I, Merkle, EM, and Taouli, B. "Diagnosis of focal nodular hyperplasia with MRI: multicenter retrospective study comparing gadobenate dimeglumine to gadoxetate disodium." AJR Am J Roentgenol 199.1 (July 2012): 35-43.
PMID
22733891
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
199
Issue
1
Publish Date
2012
Start Page
35
End Page
43
DOI
10.2214/AJR.11.7757

Functional evaluation of cystic duct patency with Gd-EOB-DTPA MR imaging: an alternative to hepatobiliary scintigraphy for diagnosis of acute cholecystitis?

PURPOSE: To determine if MR cholangiography with Gd-EOB-DTPA can be used to assess cystic duct patency and to establish normal time range for reflux of contrast material into the cystic duct/gallbladder. MATERIALS AND METHODS: This retrospective study is HIPAA-compliant and IRB-approved with waiver for informed consent granted. From September 2008 to June 2009, 300 patients who underwent Gd-EOB-DTPA-enhanced MR imaging for various clinical indications, not specifically limited to evaluation for acute cholecystitis, were identified. 112 patients were excluded: prior cholecystectomy (n = 93), severe technical limitations (n = 9), or absence of appropriate clinical follow-up (n = 10). 188 total patients (82 male, 106 female, mean age 51.0 years) were included in the final dataset. Time between contrast administration and contrast reflux into the cystic duct/gallbladder on delayed phase imaging was measured. RESULTS: Reflux of contrast into the gallbladder was identified in 130/188 patients (69.1%) on delayed phase imaging. Average time to gallbladder reflux was 15:24 ± 5:51 minutes (range: 6:01-41:05 min). 58/188 patients (30.9%) demonstrated no reflux of contrast into the gallbladder at time of final delayed phase images. Of 58 patients who demonstrated no reflux into cystic duct/gallbladder, 15 patients demonstrated no extrahepatic biliary excretion, limiting evaluation of cystic duct patency. A total of 173 patients demonstrated biliary excretion of contrast with 76% overall sensitivity of detection of cystic duct patency. CONCLUSION: MR cholangiography with hepatobiliary MR contrast agents such as Gd-EOB-DTPA can demonstrate cystic duct patency with high sensitivity. MR protocols can be designed within a clinically feasible timeframe to optimize diagnosis of acute cholecystitis.

Authors
Krishnan, P; Gupta, RT; Boll, DT; Brady, CM; Husarik, DB; Merkle, EM
MLA Citation
Krishnan, P, Gupta, RT, Boll, DT, Brady, CM, Husarik, DB, and Merkle, EM. "Functional evaluation of cystic duct patency with Gd-EOB-DTPA MR imaging: an alternative to hepatobiliary scintigraphy for diagnosis of acute cholecystitis?." Abdom Imaging 37.3 (June 2012): 457-464.
PMID
21870116
Source
pubmed
Published In
Abdominal Imaging
Volume
37
Issue
3
Publish Date
2012
Start Page
457
End Page
464
DOI
10.1007/s00261-011-9785-y

MDCT evaluation of the pancreas: nuts and bolts.

Multidetector-row CT (MDCT) imaging of the pancreas has important roles in diagnosis, staging, and treatment monitoring of a vast array of pancreatic diseases. Optimizing MDCT protocols not only requires an understanding of expected pathologies but also must take into account cumulative radiation dose considerations.

Authors
Bashir, MR; Gupta, RT
MLA Citation
Bashir, MR, and Gupta, RT. "MDCT evaluation of the pancreas: nuts and bolts." Radiol Clin North Am 50.3 (May 2012): 365-377. (Review)
PMID
22560686
Source
pubmed
Published In
Radiologic Clinics of North America
Volume
50
Issue
3
Publish Date
2012
Start Page
365
End Page
377
DOI
10.1016/j.rcl.2012.03.012

Characterization of adrenal nodules with dual-energy CT: can virtual unenhanced attenuation values replace true unenhanced attenuation values?

OBJECTIVE: The purpose of our study was to investigate whether virtual unenhanced adrenal nodule attenuation values can replace true noncontrast attenuation values. MATERIALS AND METHODS: Twenty-three incidentally discovered adrenal nodules (19 adenomas and four metastases) were identified in 19 patients (11 men and eight women; mean age, 65 years; age range, 38-84 years) who underwent unenhanced single-energy CT followed by contrast-enhanced dual-energy CT on the same scanner. A virtual unenhanced imaging dataset was generated from each dual-energy CT dataset. CT attenuation of each adrenal nodule was measured at the same location on virtual unenhanced images and true unenhanced images by three radiologists and mean values compared using the Student t test. Correlation between virtual unenhanced and true unenhanced values was determined using linear regression analysis. The mean difference and percentage of diagnostic agreement were also determined. Interreader variability was assessed using the intraclass correlation coefficient (ICC). RESULTS: The mean ± SD attenuation values for virtual unenhanced images and true unenhanced images were 14.7 ± 15.1 HU and 12.9 ± 13.4 HU, respectively (p = 0.2). Strong positive correlation was observed between virtual unenhanced images and true unenhanced images (R = 0.83-0.87). The mean difference between virtual unenhanced images and true unenhanced images was 1.8 ± 1.7 HU. Diagnostic agreement between virtual unenhanced images and true unenhanced images was 83-91% for three radiologists. No malignant nodules were misclassified as benign on virtual unenhanced images. The ICC was 0.88 and 0.96 for virtual unenhanced images and true unenhanced images, respectively, indicating high interreader agreement. CONCLUSION: Virtual unenhanced and true unenhanced attenuation measurements of adrenal nodules were not significantly different and showed strongly positive linear correlation. This finding resulted in substantial diagnostic agreement between virtual unenhanced images and true unenhanced images for distinguishing benign from malignant nodules.

Authors
Ho, LM; Marin, D; Neville, AM; Barnhart, HX; Gupta, RT; Paulson, EK; Boll, DT
MLA Citation
Ho, LM, Marin, D, Neville, AM, Barnhart, HX, Gupta, RT, Paulson, EK, and Boll, DT. "Characterization of adrenal nodules with dual-energy CT: can virtual unenhanced attenuation values replace true unenhanced attenuation values?." AJR Am J Roentgenol 198.4 (April 2012): 840-845.
PMID
22451549
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
198
Issue
4
Publish Date
2012
Start Page
840
End Page
845
DOI
10.2214/AJR.11.7316

Liver MRI in the hepatocyte phase with gadolinium-EOB-DTPA: does increasing the flip angle improve conspicuity and detection rate of hypointense lesions?

PURPOSE: To compare conspicuity and detection rate of hypointense lesions on T1-weighted (T1w) gradient echo (GRE) sequences with low and high flip angles (FA) in hepatocyte phase magnetic resonance imaging (MRI) using gadoxetate disodium. MATERIALS AND METHODS: This Health Insurance Portability and Accountability Act (HIPAA)-compliant study was Institutional Review Board (IRB)-approved. The study population consisted of patients with hypointense liver lesions undergoing MRI with gadoxetate disodium, with hepatocyte-phase fat suppressed 3D T1w GRE sequences at both low (10-12°) and high (30-35°) FA. Contrast-to-noise ratios (CNRs) were calculated for liver parenchyma vs. large lesions and common bile duct (CBD) vs. liver. Three radiologists each assigned a conspicuity score (CS) for each lesion detected at low or high FA. Paired Student's t-tests compared the lesion detection (LD) rate using only the hepatocyte phase data set compared with the entire MRI examination, and CS for low and high FA. RESULTS: In all, 57 large and 70 small lesions were identified in 18 patients. Average LD and CS were significantly greater at high FA versus low FA overall (LD 89.0% vs. 79.5%; CS 2.8 vs. 2.2; P < 0.05) and for small lesions (81.4% vs. 65.7%; 2.5 vs. 1.8; P < 0.05). Average liver-to-lesion CNR for large lesions and CBD-to-liver CNR was significantly greater at high FA (P < 0.05). CONCLUSION: Increasing the FA in hepatocyte phase MRI with gadoxetate disodium improves hypointense lesion detection and conspicuity, particularly for small lesions.

Authors
Bashir, MR; Husarik, DB; Ziemlewicz, TJ; Gupta, RT; Boll, DT; Merkle, EM
MLA Citation
Bashir, MR, Husarik, DB, Ziemlewicz, TJ, Gupta, RT, Boll, DT, and Merkle, EM. "Liver MRI in the hepatocyte phase with gadolinium-EOB-DTPA: does increasing the flip angle improve conspicuity and detection rate of hypointense lesions?." J Magn Reson Imaging 35.3 (March 2012): 611-616.
PMID
22034383
Source
pubmed
Published In
Journal of Magnetic Resonance Imaging
Volume
35
Issue
3
Publish Date
2012
Start Page
611
End Page
616
DOI
10.1002/jmri.22850

Nodular regenerative hyperplasia in the setting of Budd-Chiari syndrome: Application of MR with hepatobiliary contrast agents and histologic confirmation

Overview: Nodular regenerative hyperplasia in the setting of Budd-Chiari syndrome is an uncommon benign finding but critical to diagnose accurately. Its imaging appearance of hyperenhancing lesions on arterial phase imaging on a background of chronic liver disease can raise concern for neoplastic etiologies such as hepatocellular carcinoma. However, the imaging appearance of these lesions on delayed hepatobiliary phase imaging with hepatobiliary MR contrast agents can be extremely useful in excluding hepatocellular carcinoma from the differential diagnosis and confirming nodular regenerative hyperplasia. The findings on histologic examination can also be helpful in understanding the reason for the hyperintensity of these lesions on delayed phase imaging with these hepatobiliary MR contrast agents.

Authors
Davis, EE; Lagoo, AS; Gupta, RT
MLA Citation
Davis, EE, Lagoo, AS, and Gupta, RT. "Nodular regenerative hyperplasia in the setting of Budd-Chiari syndrome: Application of MR with hepatobiliary contrast agents and histologic confirmation." Journal of Surgical Radiology 3.4 (2012): 224-229.
Source
scival
Published In
Journal of Surgical Radiology
Volume
3
Issue
4
Publish Date
2012
Start Page
224
End Page
229

Contrast enhanced liver MRI in patients with primary sclerosing cholangitis: inverse appearance of focal confluent fibrosis on delayed phase MR images with hepatocyte specific versus extracellular gadolinium based contrast agents.

RATIONALE AND OBJECTIVES: To assess the enhancement pattern of focal confluent fibrosis (FCF) on contrast-enhanced hepatic magnetic resonance imaging (MRI) using hepatocyte-specific (Gd-EOB-DTPA) and extracellular (ECA) gadolinium-based contrast agents in patients with primary sclerosing cholangitis (PSC). MATERIALS AND METHODS: After institutional review board approval, 10 patients with PSC (6 male, 4 female; 33-61 years) with 13 FCF were included in this retrospective study. All patients had a Gd-EOB-DTPA-enhanced liver MRI exam, and a comparison ECA-enhanced MRI. On each T1-weighted dynamic dataset, the signal intensity (SI) of FCF and the surrounding liver as well as the paraspinal muscle (M) were measured. In the Gd-EOB-DTPA group, hepatocyte phase images were also included. SI FCF/SI M, SI liver/SI M, and [(SI liver - SI FCF)/SI liver] were compared between the different contrast agents for each dynamic phase using the paired Student's t-test. RESULTS: There was no significant difference in SI FCF/SI M in all imaging phases. SI liver/SI M was significantly higher for the Gd-EOB-DTPA group in the delayed phase (P < .001), whereas there was no significant difference in all other imaging phases. In the Gd-EOB-DTPA group, mean [(SI liver - SI FCF)/SI liver] were as follows (values for ECA group in parentheses): unenhanced phase: 0.26 (0.26); arterial phase: 0.01 (-0.31); portal venous phase (PVP): -0.05 (-0.26); delayed phase (DP): 0.14 (-0.54); and hepatocyte phase: 0.26. Differences were significant for the DP (P < .001). CONCLUSIONS: On delayed phase MR images the FCF-to-liver contrast is reversed with the lesions appearing hyperintense on ECA enhanced images and hypointense on Gd-EOB-DTPA-enhanced images.

Authors
Husarik, DB; Gupta, RT; Ringe, KI; Boll, DT; Merkle, EM
MLA Citation
Husarik, DB, Gupta, RT, Ringe, KI, Boll, DT, and Merkle, EM. "Contrast enhanced liver MRI in patients with primary sclerosing cholangitis: inverse appearance of focal confluent fibrosis on delayed phase MR images with hepatocyte specific versus extracellular gadolinium based contrast agents." Acad Radiol 18.12 (December 2011): 1549-1554.
PMID
21958599
Source
pubmed
Published In
Academic Radiology
Volume
18
Issue
12
Publish Date
2011
Start Page
1549
End Page
1554
DOI
10.1016/j.acra.2011.08.007

PET appearance of tuberculous empyema necessitans.

Authors
Lungren, MP; Christensen, JD; Coleman, RE; Gupta, RT
MLA Citation
Lungren, MP, Christensen, JD, Coleman, RE, and Gupta, RT. "PET appearance of tuberculous empyema necessitans." Clin Nucl Med 36.10 (October 2011): 939-941.
PMID
21892055
Source
pubmed
Published In
Clinical Nuclear Medicine
Volume
36
Issue
10
Publish Date
2011
Start Page
939
End Page
941
DOI
10.1097/RLU.0b013e3182291bfd

Hepatobiliary transit times of gadoxetate disodium (Primovist®) for protocol optimization of comprehensive MR imaging of the biliary system--what is normal?

OBJECTIVE: The purpose of this study was to determine transit times for excretion of Gd-EOB-DTPA into different segments of the hepatobiliary system in patients with normal liver function. METHODS: This retrospective study was IRB approved with a waiver of consent granted. 61 patients (39 female, 22 male, mean age 52.5 years) with normal liver and renal function who underwent contrast enhanced hepatic MRI after injection of 10 mL Gd-EOB-DTPA at 1.5T and 3T were included. Two readers evaluated all delayed images (3-20 min post contrast) for the presence of contrast agent in the intrahepatic bile ducts (IBD), the common bile duct (CBD), the gallbladder and the duodenum. A two-tailed, unpaired Student's t-test with p<0.05 deemed significant was used to determine whether transit times were affected by patient gender, age or body mass index. RESULTS: 20 min after contrast initiation, Gd-EOB-DTPA could be detected in the IBD and the CBD in all patients (100%); gallbladder reflux was visible in 53 (86.9%), duodenal excretion in 40 patients (65.5%), respectively. Mean transit times for contrast appearance in the various segments were as follows: IBD 12 min 13s; CBD 12 min 27 s; gallbladder 13 min 32s. Transit times were not significantly affected by patient gender, age or BMI. CONCLUSION: Within 20 min post contrast initiation, Gd-EOB-DTPA can be expected in the IBD and the CBD in patients with normal liver function. However, functional information about the sphincter Oddi complex can be ascertained only in about two thirds of these patients within this timeframe.

Authors
Ringe, KI; Husarik, DB; Gupta, RT; Boll, DT; Merkle, EM
MLA Citation
Ringe, KI, Husarik, DB, Gupta, RT, Boll, DT, and Merkle, EM. "Hepatobiliary transit times of gadoxetate disodium (Primovist®) for protocol optimization of comprehensive MR imaging of the biliary system--what is normal?." Eur J Radiol 79.2 (August 2011): 201-205.
PMID
20347540
Source
pubmed
Published In
European Journal of Radiology
Volume
79
Issue
2
Publish Date
2011
Start Page
201
End Page
205
DOI
10.1016/j.ejrad.2010.03.008

Effect of organ enhancement and habitus on estimation of unenhanced attenuation at contrast-enhanced dual-energy MDCT: concepts for individualized and organ-specific spectral iodine subtraction strategies.

OBJECTIVE: The purpose of this study was to assess whether habitus and organ enhancement influence iodine subtraction and should be incorporated into spectral subtraction algorithms. SUBJECTS AND METHODS: This study included 171 patients. In the unenhanced phase, MDCT was performed with single-energy acquisition (120 kVp, 250 mAs) and in the parenchymal phase with dual-energy acquisitions (80 kVp, 499 mAs; 140 kVp, 126 mAs). Habitus was determined by measuring trunk diameters and calculating circumference. Iodine subtraction was performed with input parameters individualized to muscle, fat, and blood ratio. Attenuation of the liver, pancreas, spleen, kidneys, and aorta was assessed in truly and virtually unenhanced image series. Pearson analysis was performed to correlate habitus with the input parameters. Analysis of truly unenhanced and virtually unenhanced images was performed with the Student t test; magnitude of variation was evaluated with Bland-Altman plots. Correction strategies were derived from organ-specific regression analysis of scatterplots of truly unenhanced and virtually unenhanced attenuation and implemented in a pixel-by-pixel approach. Analysis of individual organ correction and truly unenhanced attenuation was performed with the Student t test. RESULTS: The correlations between habitus and blood ratio (r = 0.694) and attenuation variation of fat at 80 kVp (r = -0.468) and 140 kV (r = -0.454) were confirmed. Although overall mean attenuation differed by no more than 10 HU between truly and virtually unenhanced scans overall, these differences varied by organ and were large in individual patients. Paired comparisons of truly and virtually unenhanced measurements differed significantly for liver, spleen, pancreas, kidneys, and aortic blood pool (p < 0.001 for all comparisons), but paired comparisons of truly unenhanced and individually organ-corrected measurements did not differ when organ- and habitus-based correction strategies were applied (p > 0.38 for all comparisons). CONCLUSION: Habitus and organ enhancement influence virtually unenhanced imaging and should be incorporated into spectral subtraction algorithms.

Authors
Miller, CM; Gupta, RT; Paulson, EK; Neville, AM; Bashir, MR; Merkle, EM; Boll, DT
MLA Citation
Miller, CM, Gupta, RT, Paulson, EK, Neville, AM, Bashir, MR, Merkle, EM, and Boll, DT. "Effect of organ enhancement and habitus on estimation of unenhanced attenuation at contrast-enhanced dual-energy MDCT: concepts for individualized and organ-specific spectral iodine subtraction strategies." AJR Am J Roentgenol 196.5 (May 2011): W558-W564.
PMID
21512045
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
196
Issue
5
Publish Date
2011
Start Page
W558
End Page
W564
DOI
10.2214/AJR.10.4858

Detection of renal lesion enhancement with dual-energy multidetector CT.

PURPOSE: To determine whether dual-energy multidetector CT enables detection of renal lesion enhancement by using calculated nonenhanced images with spectral-based extraction in a non-body weight-restricted patient population. MATERIALS AND METHODS: Between January 2008 and December 2009, 139 patients were enrolled in this prospective HIPAA-compliant, institutional review board-approved study. Written informed consent was obtained from all patients. After single-energy nonenhanced 120-kVp CT images were acquired, contrast material-enhanced dual-energy multidetector CT images were acquired at 80 and 140 kVp. Calculated nonenhanced images were generated by using spectral-based iodine extraction. Lesion attenuation was measured on the acquired nonenhanced, calculated nonenhanced, and 140-kVp contrast-enhanced nephrographic images. Enhancement, defined as a 15-HU or greater increase in attenuation on the nephrographic images, was assessed by using the baseline attenuation on the acquired and calculated nonenhanced images. Acquired nonenhanced versus calculated nonenhanced image attenuation, as well as enhancement values, were compared by using paired Student t tests and Bland-Altman plots. RESULTS: Hypoattenuating (n = 66) and hyperattenuating (n = 28) cysts, angiomyolipomas (n = 18), and solid enhancing lesions (n = 27) were detected. Mean attenuation values for hypoattenuating cysts on the acquired and calculated nonenhanced CT images were 6.5 HU ± 5.8 (standard deviation) and 8.1 HU ± 3.1 (P = .13), respectively, with corresponding enhancement values of 1.1 HU ± 5.2 and -0.5 HU ± 6.2 (P = .12), respectively. Mean values for hyperattenuating cysts were 29.4 HU ± 5.6 on acquired images and 31.7 HU ± 5.1 on calculated images (P = .39) (corresponding enhancement, 4.7 HU ± 3.3 and 2.3 HU ± 4.1, respectively; P = .09). Mean values for fat-containing enhancing lesions were -90.6 HU ± 24.7 on acquired images and -85.9 HU ± 23.7 on calculated images (P = .57) (corresponding enhancement, 18.2 HU ± 10.1 and 13.6 HU ± 10.7, respectively; P = .19). Mean attenuation values for solid enhancing lesions were 26.0 HU ± 15.0 on acquired images and 27.7 HU ± 14.9 on calculated images (P = .45) (corresponding enhancement, 60.3 HU ± 13.1 and 58.3 HU ± 15.5, respectively; P = .38). CONCLUSION: Dual-energy CT acquisitions with spectral-based postprocessing enabled accurate detection of renal lesion enhancement across the attenuation spectrum of frequently encountered renal lesions in a non-body habitus-restricted patient population.

Authors
Neville, AM; Gupta, RT; Miller, CM; Merkle, EM; Paulson, EK; Boll, DT
MLA Citation
Neville, AM, Gupta, RT, Miller, CM, Merkle, EM, Paulson, EK, and Boll, DT. "Detection of renal lesion enhancement with dual-energy multidetector CT." Radiology 259.1 (April 2011): 173-183.
PMID
21292866
Source
pubmed
Published In
Radiology
Volume
259
Issue
1
Publish Date
2011
Start Page
173
End Page
183
DOI
10.1148/radiol.10101170

Gadoxetate disodium-enhanced hepatic MRI: dose-dependent contrast dynamics of hepatic parenchyma and portal vein.

OBJECTIVE: The purpose of this study was to investigate the relative enhancement characteristics of the hepatic parenchyma and portal vein during gadoxetate disodium-enhanced abdominal MRI and to assess whether contrast between the portal vein and the hepatic parenchyma can be improved with higher doses of gadoxetate disodium. MATERIALS AND METHODS: A total of 102 patients (61 women, 41 men) underwent gadoxetate disodium-enhanced abdominal MRI. They received a weight-independent dose of 10 mL of gadoxetate disodium, corresponding to a dose spectrum of 0.02-0.06 mmol/kg body weight. The patients were assigned to one of three dose groups: recommended dose (0.02-0.03 mmol/kg), intermediate dose (0.03-0.045 mmol/kg), or high dose (0.045-0.06 mmol/kg). The signal-to-noise ratios for the portal vein, liver, and the portal vein-to-liver contrast-to-noise ratio were calculated for three consecutive arterial phases, one portal venous phase, and four delayed imaging phases. RESULTS: The delayed phase images of the liver showed statistically significant dose dependency and greater enhancement in the intermediate- and high-dose groups (p < 0.01). Analogously, the portal vein also exhibited greater enhancement in the two higher-dose groups, but the difference was not statistically significant (p > 0.05). Regarding portal vein-to-liver contrast, all three groups had a dose-independent fast parallel increase from baseline toward maximum contrast followed by a steady decline in contrast with no statistically significant differences between dose groups (p > 0.05). CONCLUSION: Portal vein-to-liver contrast during gadoxetate disodium-enhanced hepatic MRI cannot be improved within a dose spectrum of 0.025-0.06 mmol/kg body weight.

Authors
Feuerlein, S; Boll, DT; Gupta, RT; Ringe, KI; Marin, D; Merkle, EM
MLA Citation
Feuerlein, S, Boll, DT, Gupta, RT, Ringe, KI, Marin, D, and Merkle, EM. "Gadoxetate disodium-enhanced hepatic MRI: dose-dependent contrast dynamics of hepatic parenchyma and portal vein." AJR Am J Roentgenol 196.1 (January 2011): W18-W24.
PMID
21178026
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
196
Issue
1
Publish Date
2011
Start Page
W18
End Page
W24
DOI
10.2214/AJR.10.4387

Methodology to register prostate B-mode and ARFI images to MR and histology

Acoustic Radiation Force Impulse (ARFI) imaging is being developed for guiding needle biopsy and focal therapy of Prostate cancer (PCa). In vivo ARFI images portray internal structures in the prostate with higher contrast than matched B-mode images. Given the heterogeneity of the prostate and the poor visualization provided by B-mode, another gold standard for determining what is being visualized in ARFI images is necessary. In this study, we present image registration techniques that facilitate correlation of in vivo ARFI, B-mode ultrasound (US), and Magnetic Resonance (MR) images obtained prior to radical prostatectomy with whole mount histology data. Pathology and structures were identified and segmented in the different datasets. The segmented datasets were used to form 3D mesh models of the prostate and the node and element information was extrapolated into a 3D image matrix of equivalent size for all modalities. Non-rigid registration of the different models was performed and the registered images were evaluated for co-localization of confirmed pathology. The methodology was validated using simulated prostate anatomy and finite-element techniques and found to improve the average displacement of registration markers by 76% in the MR simulation and 58% in the US simulation. When implemented on the patient data, the registration methodology was found to simplify multi-modality image comparison and analysis. Confirmed pathology was found to align with similarly suspicious regions in both ARFI and MR images. With its improved anatomical visualization over traditional B-mode imaging, ARFI holds promise for providing targeted image guidance of prostate focal therapy and needle biopsy. © 2011 IEEE.

Authors
Hsu, CML; Polascik, TJ; Davenport, MS; Kauffman, C; Gupta, RT; Kulbacki, E; Madden, J; Lipman, SL; Palmeri, ML; Nightingale, KR
MLA Citation
Hsu, CML, Polascik, TJ, Davenport, MS, Kauffman, C, Gupta, RT, Kulbacki, E, Madden, J, Lipman, SL, Palmeri, ML, and Nightingale, KR. "Methodology to register prostate B-mode and ARFI images to MR and histology." 2011.
Source
scival
Published In
IEEE International Ultrasonics Symposium : [proceedings]. IEEE International Ultrasonics Symposium
Publish Date
2011
Start Page
1866
End Page
1869
DOI
10.1109/ULTSYM.2011.0466

Successful endovascular management of a transected horseshoe kidney

Overview: The horseshoe kidney is more prone to blunt abdominal trauma because of its low position and the presence of the isthmus across the midline. This is a rare case of complete transection of a horseshoe kidney at the isthmus due to blunt abdominal trauma with two sites of active extravasation on initial CT imaging. This extravasation was successfully treated by embolization with coils. Superselective embolization may be used for eff ective, minimally invasive control of active extravasation due to blunt renal trauma, even in kidneys with congenital malformations such as the horseshoe kidney.

Authors
Paxton, BE; Kim, CY; Miller, MJ; Gupta, RT
MLA Citation
Paxton, BE, Kim, CY, Miller, MJ, and Gupta, RT. "Successful endovascular management of a transected horseshoe kidney." Journal of Surgical Radiology 2.1 (2011): 80-85.
Source
scival
Published In
Journal of Surgical Radiology
Volume
2
Issue
1
Publish Date
2011
Start Page
80
End Page
85

Dynamic MR imaging of the biliary system using hepatocyte-specific contrast agents.

OBJECTIVE: The objective of our study was to illustrate how the properties of hepatocyte-specific MR contrast agents can be used in the dynamic evaluation of the biliary system. CONCLUSION: Because of their dual route of excretion through the kidneys and the liver, gadolinium-based, hepatocyte-specific MR contrast agents can be used to evaluate the biliary tract as an off-label use. Images are obtained during the hepatocyte phase, which usually occurs within 20-40 minutes after injection depending on the specific contrast agent selected. Potential uses include showing variant biliary anatomy and choledocholithiasis. Evaluation for acute cholecystitis is possible by assessing for reflux of contrast material across the cystic duct. Additionally, these agents have value in both presurgical and postsurgical imaging for showing anatomy and complications. Finally, these agents are useful in the evaluation of choledochal cysts.

Authors
Gupta, RT; Brady, CM; Lotz, J; Boll, DT; Merkle, EM
MLA Citation
Gupta, RT, Brady, CM, Lotz, J, Boll, DT, and Merkle, EM. "Dynamic MR imaging of the biliary system using hepatocyte-specific contrast agents." AJR Am J Roentgenol 195.2 (August 2010): 405-413.
PMID
20651197
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
195
Issue
2
Publish Date
2010
Start Page
405
End Page
413
DOI
10.2214/AJR.09.3641

Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging?

Dual-energy CT provides information about how substances behave at different energies, the ability to generate virtual unenhanced datasets, and improved detection of iodine-containing substances on low-energy images. Knowing how a substance behaves at two different energies can provide information about tissue composition beyond that obtainable with single-energy techniques. The term K edge refers to the spike in attenuation that occurs at energy levels just greater than that of the K-shell binding because of the increased photoelectric absorption at these energy levels. K-edge values vary for each element, and they increase as the atomic number increases. The energy dependence of the photoelectric effect and the variability of K edges form the basis of dual-energy techniques, which may be used to detect substances such as iodine, calcium, and uric acid crystals. The closer the energy level used in imaging is to the K edge of a substance such as iodine, the more the substance attenuates. In the abdomen and pelvis, dual-energy CT may be used in the liver to increase conspicuity of hypervascular lesions; in the kidneys, to distinguish hyperattenuating cysts from enhancing renal masses and to characterize renal stone composition; in the adrenal glands, to characterize adrenal nodules; and in the pancreas, to differentiate between normal and abnormal parenchyma.

Authors
Coursey, CA; Nelson, RC; Boll, DT; Paulson, EK; Ho, LM; Neville, AM; Marin, D; Gupta, RT; Schindera, ST
MLA Citation
Coursey, CA, Nelson, RC, Boll, DT, Paulson, EK, Ho, LM, Neville, AM, Marin, D, Gupta, RT, and Schindera, ST. "Dual-energy multidetector CT: how does it work, what can it tell us, and when can we use it in abdominopelvic imaging?." Radiographics 30.4 (July 2010): 1037-1055.
PMID
20631367
Source
pubmed
Published In
Radiographics : a review publication of the Radiological Society of North America, Inc
Volume
30
Issue
4
Publish Date
2010
Start Page
1037
End Page
1055
DOI
10.1148/rg.304095175

Dual-energy CT for characterization of adrenal nodules: initial experience.

OBJECTIVE: The purpose of this study was to determine whether use of dual-energy technique can improve the diagnostic performance of CT in the differential diagnosis of adrenal adenomas and metastatic lesions. SUBJECTS AND METHODS: Thirty-one adrenal nodules were prospectively identified in 17 patients who underwent dual-energy CT at 140 and 80 kVp. Attenuation measurements were performed for each nodule at both tube voltages. The mean attenuation change (increase or decrease) between 140 kVp and 80 kVp was determined for each adrenal nodule. RESULTS: Twenty-six adrenal nodules were benign adenomas (attenuation less than +10 HU or stability for at least 1 year). Five adrenal nodules were classified as metastatic (rapid growth in 1 year and history of extraadrenal malignancy). The mean attenuation change between 140 kVp and 80 kVp was 0.4 +/- 7.1 HU for adenomas and 9.2 +/- 4.3 HU for metastatic lesions (p < 0.003). Fifty percent of adenomas had an attenuation decrease at 80 kVp. All metastatic lesions had an attenuation increase at 80 kVp. With a decrease in attenuation at 80 kVp as an indicator of intracellular lipid within an adenoma, dual-energy CT has 50% sensitivity, 100% specificity, 100% positive predictive value, and 28% negative predictive value in the diagnosis of adenoma. CONCLUSION: A decrease in attenuation of an adrenal lesion between 140 kVp and 80 kVp is a highly specific sign of adrenal adenoma. However, because an increase in attenuation at 80 kVp is seen with metastatic lesions and some adenomas, the sensitivity of this test is low. These data suggest that dual-energy CT can be used to help differentiate some lipid-poor adrenal adenomas from metastatic lesions.

Authors
Gupta, RT; Ho, LM; Marin, D; Boll, DT; Barnhart, HX; Nelson, RC
MLA Citation
Gupta, RT, Ho, LM, Marin, D, Boll, DT, Barnhart, HX, and Nelson, RC. "Dual-energy CT for characterization of adrenal nodules: initial experience." AJR Am J Roentgenol 194.6 (June 2010): 1479-1483.
PMID
20489086
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
194
Issue
6
Publish Date
2010
Start Page
1479
End Page
1483
DOI
10.2214/AJR.09.3476

Respiratory-triggered three-dimensional T2-weighted MR cholangiography after injection of gadoxetate disodium: is it still reliable?

PURPOSE: To test the null hypothesis that there is no quantitative or qualitative difference between respiratory-triggered three-dimensional (3D) T2-weighted magnetic resonance (MR) cholangiography performed before or after administration of gadoxetate disodium. MATERIALS AND METHODS: For this retrospective HIPAA-compliant dual-center study, institutional review board approval was obtained, and a waiver of informed consent was granted. Between July and December 2008, 60 patients (age range, 18-82 years) who were referred for liver MR imaging with gadoxetate disodium underwent respiratory-triggered 3D MR cholangiography before and immediately after completion of portal venous phase contrast material-enhanced T1-weighted MR imaging. Quantitative signal-to-noise ratio (SNR) measurements were obtained in the extrahepatic biliary tract in both MR cholangiographic data sets in each patient. Qualitative assessment was performed by four readers with a four-point scale to assess the depiction of extra- and intrahepatic ducts up to the third order. Statistical analysis consisted of a one-sided Wilcoxon signed rank test, with a P value of less than .05 indicating a significant difference. RESULTS: There was a significant decrease in mean SNR in the MR cholangiographic data set after injection of gadoxetate disodium. SNR was 96 + or - 50 [standard deviation] and 78 + or - 47 before and after contrast media administration, respectively (P < .0001). For all readers, qualitative differences were most obvious in the depiction of the common bile duct and second- and third-order biliary branches, with the precontrast MR cholangiographic data sets being preferred (P < .0001). Precontrast data sets were also significantly preferred in the assessment of the right and left hepatic ducts by all readers. CONCLUSION: Gadoxetate disodium adversely affects respiratory-triggered 3D MR cholangiography, both qualitatively and quantitatively. We recommend that such a sequence be performed before injection of gadoxetate disodium.

Authors
Ringe, KI; Gupta, RT; Brady, CM; Massey, CM; Hahn, A; Galanski, M; Merkle, EM; Lotz, J
MLA Citation
Ringe, KI, Gupta, RT, Brady, CM, Massey, CM, Hahn, A, Galanski, M, Merkle, EM, and Lotz, J. "Respiratory-triggered three-dimensional T2-weighted MR cholangiography after injection of gadoxetate disodium: is it still reliable?." Radiology 255.2 (May 2010): 451-458.
PMID
20413758
Source
pubmed
Published In
Radiology
Volume
255
Issue
2
Publish Date
2010
Start Page
451
End Page
458
DOI
10.1148/radiol.10091130

D-dimers and efficacy of clinical risk estimation algorithms: sensitivity in evaluation of acute pulmonary embolism.

OBJECTIVE: The goal of this study was to test the efficacy of clinical risk algorithms and a quantitative immunoturbidimetric D-dimer assay in the evaluation of patients undergoing pulmonary CT angiography for suspected acute pulmonary embolism. SUBJECTS AND METHODS: From April 1, 2007, to March 31, 2008, emergency department evaluations for clinically suspected pulmonary embolism were performed with the revised Geneva score, a quantitative D-dimer assay, and pulmonary CT angiography. RESULTS: Evaluations for pulmonary embolism were performed for 745 consecutively registered patients, 627 of whom were included in the study. The other 118 patients were excluded because a d-dimer assay was not performed. According to the revised Geneva score, 281 patients had low clinical probability of having pulmonary embolism; 330, intermediate probability; and 16, high probability. CT angiography showed that 28 patients had pulmonary embolism (six in the low-probability group, 17 in the intermediate-probability group, and five in the high-probability group). The sensitivity, negative predictive value, and specificity of the D-dimer assay were 100%, 100%, and 25% (low-clinical-probability group); 100%, 100%, and 33% (intermediate-probability group); and 80%, 80%, and 37% (high-probability group). CONCLUSION: The data appear to support the use of a quantitative D-dimer assay as a first-line test in evaluation for pulmonary embolism when the clinical probability of the presence of pulmonary embolism is low or intermediate. The sensitivity and negative predictive value were 100% for these cases. More than 26% of CT angiographic examinations might have been avoided if the D-dimer assay had been used as a first-line test in the care of patients at low or intermediate risk. Because of the small sample size, the D-dimer assay is not recommended as a first-line test in the evaluation of patients at high risk.

Authors
Gupta, RT; Kakarla, RK; Kirshenbaum, KJ; Tapson, VF
MLA Citation
Gupta, RT, Kakarla, RK, Kirshenbaum, KJ, and Tapson, VF. "D-dimers and efficacy of clinical risk estimation algorithms: sensitivity in evaluation of acute pulmonary embolism." AJR Am J Roentgenol 193.2 (August 2009): 425-430.
PMID
19620439
Source
pubmed
Published In
AJR. American journal of roentgenology
Volume
193
Issue
2
Publish Date
2009
Start Page
425
End Page
430
DOI
10.2214/AJR.08.2186

Lisfranc injury: imaging findings for this important but often-missed diagnosis.

The Lisfranc injury is a popular topic in the radiology, orthopedic surgery, and emergency medicine literature, primarily due to the subtleties of the radiographic findings and potentially dire consequences of missed diagnoses. The purpose of this article is to help readers understand the anatomy of the tarsometatarsal joint, identify a systematic approach for the evaluation of the joint, and demonstrate how a multimodality approach can be used in both straightforward and more complex cases. Specifically, the utility of lateral and weight-bearing radiographs as well as computed tomography and magnetic resonance will be addressed. The dorsoplantar radiograph is often the first radiological examination performed, after initial history and physical examination. An understanding of the anatomy of the normal Lisfranc joint and subtle findings in the abnormal joint is essential in making an accurate diagnosis. Lateral and weight-bearing radiographs can be very useful in evaluating for subtle dislocation and minimizing the effects of overlapping structures at the tarsometatarsal joint. Computed tomography is particularly helpful in the delineation of anatomy and identification of small fractures. The strength of magnetic resonance lies in its ability to show isolated ligamentous injury and bone marrow edema. At the end of the article, the reader should be able to describe the normal anatomy of the tarsometatarsal joint, identify findings of Lisfranc injury on all three modalities, and understand the specific indications for the use of each modality.

Authors
Gupta, RT; Wadhwa, RP; Learch, TJ; Herwick, SM
MLA Citation
Gupta, RT, Wadhwa, RP, Learch, TJ, and Herwick, SM. "Lisfranc injury: imaging findings for this important but often-missed diagnosis." Curr Probl Diagn Radiol 37.3 (May 2008): 115-126. (Review)
PMID
18436111
Source
pubmed
Published In
Current Problems in Diagnostic Radiology
Volume
37
Issue
3
Publish Date
2008
Start Page
115
End Page
126
DOI
10.1067/j.cpradiol.2007.08.012

Trunk kinematics and the influence on valgus knee stress in persons with high sacral level myelomeningocele.

Historically, trunk movement has been thought to be reactionary to lower body motions. The excessive trunk movement in patients with myelomeningocele may be a primary mechanism during ambulation. The purpose of this study was to quantify three-dimensional trunk movement in patients with myelomeningocele. Patients walked with ankle-foot orthoses (AFOs), both with and without crutches. Data were collected in reference to global and pelvic coordinates. Patients who walked with AFOs and crutches showed less trunk dynamic range of motion than patients without crutches. Between the two patient groups, there was a significant difference in trunk obliquity but not in trunk tilt or rotation. There is a good correlation between maximum trunk obliquity and coronal plane valgus knee stress. Overall, coronal plane valgus knee stress is multifactorial and trunk motion and external tibial torsion are major contributors. However, when using trunk kinematics to describe dynamic motion, both global and pelvic coordinate systems are important reference frames.

Authors
Gupta, RT; Vankoski, S; Novak, RA; Dias, LS
MLA Citation
Gupta, RT, Vankoski, S, Novak, RA, and Dias, LS. "Trunk kinematics and the influence on valgus knee stress in persons with high sacral level myelomeningocele." J Pediatr Orthop 25.1 (January 2005): 89-94.
PMID
15614067
Source
pubmed
Published In
Journal of Pediatric Orthopaedics
Volume
25
Issue
1
Publish Date
2005
Start Page
89
End Page
94
Show More