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Patel L, Bridgham K, Ciriello J, Almardawi R, Leon J, Hostetter J, Yazbek S, Raghavan P. PET/MR Imaging in Evaluating Treatment Failure of Head and Neck Malignancies: A Neck Imaging Reporting and Data System-Based Study. AJNR Am J Neuroradiol 2022; 43:435-441. [PMID: 35177543 PMCID: PMC8910793 DOI: 10.3174/ajnr.a7427] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/19/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE PET/MR imaging is a relatively new hybrid technology that holds great promise for the evaluation of head and neck cancer. The aim of this study was to assess the performance of simultaneous PET/MR imaging versus MR imaging in the evaluation of posttreatment head and neck malignancies, as determined by its ability to predict locoregional recurrence or progression after imaging. MATERIALS AND METHODS The electronic medical records of patients who had posttreatment PET/MR imaging studies were reviewed, and after applying the exclusion criteria, we retrospectively included 46 studies. PET/MR imaging studies were independently reviewed by 2 neuroradiologists, who recorded scores based on the Neck Imaging Reporting and Data System (using CT/PET-CT criteria) for the diagnostic MR imaging sequences alone and the combined PET/MR imaging. Treatment failure was determined with either biopsy pathology or initiation of new treatment. Statistical analyses including univariate association, interobserver agreement, and receiver operating characteristic analysis were performed. RESULTS There was substantial interreader agreement among PET/MR imaging scores (κ = 0.634; 95% CI, 0.605-0.663). PET/MR imaging scores showed a strong association with treatment failure by univariate association analysis, with P < .001 for the primary site, neck lymph nodes, and combined sites. Receiver operating characteristic curves of PET/MR imaging scores versus treatment failure indicated statistically significant diagnostic accuracy (area under curve range, 0.864-0.987; P < .001). CONCLUSIONS Simultaneous PET/MR imaging has excellent discriminatory performance for treatment outcomes of head and neck malignancy when the Neck Imaging Reporting and Data System is applied. PET/MR imaging could play an important role in surveillance imaging for head and neck cancer.
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Affiliation(s)
- L.D. Patel
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - K. Bridgham
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Ciriello
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - R. Almardawi
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Leon
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - J. Hostetter
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - S. Yazbek
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
| | - P. Raghavan
- From the Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine Ringgold Standard Institution, Baltimore, Maryland
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Elsholtz FHJ, Erxleben C, Bauknecht HC, Dinkelborg P, Kreutzer K, Hamm B, Niehues SM. Reliability of NI-RADS criteria in the interpretation of contrast-enhanced magnetic resonance imaging considering the potential role of diffusion-weighted imaging. Eur Radiol 2021; 31:6295-6304. [PMID: 33533989 PMCID: PMC8270833 DOI: 10.1007/s00330-021-07693-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 12/17/2020] [Accepted: 01/18/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVES To assess inter- and intrareader agreement of the Neck Imaging Reporting and Data System (NI-RADS) used in contrast-enhanced magnetic resonance imaging (MRI) including analysis of diffusion-weighted imaging (DWI), which is currently not part of the NI-RADS criteria. METHODS This retrospective study included anonymized surveillance contrast-enhanced MRI datasets of 104 patients treated for different head and neck cancers. Three radiologists experienced in head and neck imaging reported findings for the primary site and the neck using NI-RADS criteria in a first step and evaluated DWI sequences for the primary site in a second step. Thirty randomly selected imaging datasets were again presented to the readers. Kappa statistics and observed agreement (Ao) were calculated. RESULTS Interreader agreement across all MRI datasets was moderate (κFleiss = 0.53) for NI-RADS categories assigned to the primary site, substantial for NI-RADS categories of the neck (κFleiss = 0.67), and almost perfect for DWI of the primary site (κFleiss = 0.83). Interreader agreement for the primary site was particularly low in cases of cancer recurrence (κFleiss = 0.35) and when categories 2a, 2b, and 3 were combined (κFleiss = 0.30). Intrareader agreement was considerably lower for NI-RADS categories of the primary site (range Ao = 53.3-70.0%) than for NI-RADS categories of the neck (range Ao = 83.3-90.0%) and DWI of the primary site (range Ao = 93.3-100.0%). CONCLUSION Interreader agreement of NI-RADS for reporting contrast-enhanced MRI findings is acceptable for the neck but limited for the primary site. Here, DWI has the potential to serve as a reliable additional criterion. KEY POINTS • NI-RADS was originally designed for contrast-enhanced computed tomography with or without positron emission tomography but can also be used for contrast-enhanced magnetic resonance imaging alone. • Overall interreader agreement was acceptable for NI-RADS categories assigned to the neck but should be improved for the primary site, where it was inferior to DWI; similar tendencies were found for intrareader agreement. • DWI is currently no criterion of NI-RADS, but has shown potential to improve its reliability, especially for categories 2a, 2b, and 3 of the primary site.
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Affiliation(s)
- Fabian Henry Jürgen Elsholtz
- Department of Radiology, Campus Benjamin Franklin, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany.
| | - Christoph Erxleben
- Department of Radiology, Campus Benjamin Franklin, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Hans-Christian Bauknecht
- Department of Neuroradiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin and Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Patrick Dinkelborg
- Department of Oral and Maxillofacial Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Kilian Kreutzer
- Department of Oral and Maxillofacial Surgery, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Campus Benjamin Franklin, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Stefan Markus Niehues
- Department of Radiology, Campus Benjamin Franklin, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Hindenburgdamm 30, 12203, Berlin, Germany
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Juliano AF, Aiken AH. NI-RADS for head and neck cancer surveillance imaging: What, why, and how. Cancer Cytopathol 2019; 128:166-170. [PMID: 31750995 DOI: 10.1002/cncy.22214] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/29/2019] [Indexed: 11/06/2022]
Abstract
The Neck Imaging Reporting and Data System (NI-RADS) was conceived in 2016 with the objective of standardizing assessment and reporting in surveillance imaging for patients with head and neck squamous cell carcinomas and their subsequent management. The goals are to simplify radiology reports while increasing the consistency and accuracy of the interpretation of cancer surveillance imaging; enable better communication among clinicians and between clinicians and patients; facilitate outcomes research; and ultimately improve patient survival, morbidity, and mortality. The objective of the current study was to provide the background as to why and how NI-RADS was conceived and what it entails in radiology reporting.
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Affiliation(s)
- Amy F Juliano
- Department of Radiology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - Ashley H Aiken
- Department of Radiology, Emory University Hospital, Emory University School of Medicine, Atlanta, Georgia
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Hsu D, Chokshi FH, Hudgins PA, Kundu S, Beitler JJ, Patel MR, Aiken AH. Predictive Value of First Posttreatment Imaging Using Standardized Reporting in Head and Neck Cancer. Otolaryngol Head Neck Surg 2019; 161:978-985. [PMID: 31331239 DOI: 10.1177/0194599819865235] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE The Neck Imaging Reporting and Data System (NI-RADS) is a standardized numerical reporting template for surveillance of head and neck squamous cell carcinoma (HNSCC). Our aim was to analyze the accuracy of NI-RADS on the first posttreatment fluorodeoxyglucose positron emission tomography/contrast-enhanced computed tomography (PET/CECT). STUDY DESIGN Retrospective cohort study. SETTING Academic tertiary hospital. SUBJECT AND METHODS Patients with HNSCC with a 12-week posttreatment PET/CECT interpreted using the NI-RADS template and 9 months of clinical and radiologic follow-up starting from treatment completion between June 2014 and July 2016 were included. Treatment failure was defined as positive tumor confirmed by biopsy or Response Evaluation Criteria in Solid Tumors criteria. Cox proportional hazards models were performed. RESULTS This study comprised 199 patients followed for a median of 15.5 months after treatment completion (25% quartile, 11.8 months; 75% quartile, 20.2 months). The rates of treatment failure increased with each incremental increase in NI-RADS category from 1 to 3 (4.3%, 9.1%, and 42.1%, respectively). A Cox proportional hazards model demonstrated a strong association between NI-RADS categories and treatment failure at both primary and neck sites (hazard ratio [HR], 2.60 and 5.22, respectively; P < .001). In the smaller treatment subgroup analysis, increasing NI-RADS category at the primary site in surgically treated patients and treatment failure did not achieve statistically significant association (HR, 0.88; P = .82). CONCLUSION Increasing NI-RADS category at the baseline posttreatment PET/CECT is strongly associated with increased risk of treatment failure in patients with HNSCC.
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Affiliation(s)
- Derek Hsu
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Falgun H Chokshi
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Patricia A Hudgins
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Suprateek Kundu
- Department of Biostatistics and Bioinformatics, Emory School of Public Health, Atlanta, Georgia, USA
| | - Jonathan J Beitler
- Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.,Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mihir R Patel
- Department of Otolaryngology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Ashley H Aiken
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
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Jazmati T, Chandra V, Contractor S, Abujudeh H. Quality Assurance in Interventional Radiology: Preprocedural Care. Curr Radiol Rep 2019; 7:2. [DOI: 10.1007/s40134-019-0309-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Mohan SK, Hudgins PA, Patel MR, Stapleton J, Duszak R, Aiken AH. Making Time for Patients: Positive Impact of Direct Patient Reporting. AJR Am J Roentgenol 2018; 210:W12-7. [DOI: 10.2214/ajr.17.18327] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Krieger DA, Hudgins PA, Nayak GK, Baugnon KL, Corey AS, Patel MR, Beitler JJ, Saba NF, Liu Y, Aiken AH. Initial Performance of NI-RADS to Predict Residual or Recurrent Head and Neck Squamous Cell Carcinoma. AJNR Am J Neuroradiol 2017; 38:1193-1199. [PMID: 28364010 DOI: 10.3174/ajnr.a5157] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 01/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The Head and Neck Imaging Reporting and Data System (NI-RADS) surveillance template for head and neck cancer includes a numeric assessment of suspicion for recurrence (1-4) for the primary site and neck. Category 1 indicates no evidence of recurrence; category 2, low suspicion of recurrence; category 3, high suspicion of recurrence; and category 4, known recurrence. Our purpose was to evaluate the performance of the NI-RADS scoring system to predict local and regional disease recurrence or persistence. MATERIALS AND METHODS This study was classified as a quality-improvement project by the institutional review board. A retrospective database search yielded 500 consecutive cases interpreted using the NI-RADS template. Cases without a numeric score, non-squamous cell carcinoma primary tumors, and primary squamous cell carcinoma outside the head and neck were excluded. The electronic medical record was reviewed to determine the subsequent management, pathology results, and outcome of clinical and radiologic follow-up. RESULTS A total of 318 scans and 618 targets (314 primary targets and 304 nodal targets) met the inclusion criteria. Among the 618 targets, 85.4% were scored NI-RADS 1; 9.4% were scored NI-RADS 2; and 5.2% were scored NI-RADS 3. The rates of positive disease were 3.79%, 17.2%, and 59.4% for each NI-RADS category, respectively. Univariate association analysis demonstrated a strong association between the NI-RADS score and ultimate disease recurrence, with P < .001 for primary and regional sites. CONCLUSIONS The baseline performance of NI-RADS was good, demonstrating significant discrimination among the categories 1-3 for predicting disease.
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Affiliation(s)
- D A Krieger
- From the Department of Radiology, Hackensack University Medical Center (D.A.K.), Hackensack, New Jersey
| | - P A Hudgins
- Departments of Radiology and Imaging Sciences (P.A.H., A.H.A., K.L.B., A.S.C.)
| | - G K Nayak
- Department of Radiology (G.K.N.), New York University School of Medicine, New York, New York
| | - K L Baugnon
- Departments of Radiology and Imaging Sciences (P.A.H., A.H.A., K.L.B., A.S.C.)
| | - A S Corey
- Departments of Radiology and Imaging Sciences (P.A.H., A.H.A., K.L.B., A.S.C.)
| | - M R Patel
- Otolaryngology Head and Neck Surgery (M.R.P., J.J.B.), Emory University School of Medicine, Atlanta, Georgia
| | - J J Beitler
- Otolaryngology Head and Neck Surgery (M.R.P., J.J.B.), Emory University School of Medicine, Atlanta, Georgia.,Departments of Radiation Oncology (J.J.B.).,Hematology and Medical Oncology (J.J.B., N.F.S.)
| | - N F Saba
- Hematology and Medical Oncology (J.J.B., N.F.S.)
| | - Y Liu
- Biostatistics (Y.L.), Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - A H Aiken
- Departments of Radiology and Imaging Sciences (P.A.H., A.H.A., K.L.B., A.S.C.)
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Abujudeh HM, Danielson A, Bruno MA. A Patient-Centered Radiology Quality Process Map: Opportunities and Solutions. AJR Am J Roentgenol 2016; 207:940-6. [DOI: 10.2214/ajr.16.16803] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Aiken AH, Farley A, Baugnon KL, Corey A, El-Deiry M, Duszak R, Beitler J, Hudgins PA. Implementation of a Novel Surveillance Template for Head and Neck Cancer: Neck Imaging Reporting and Data System (NI-RADS). J Am Coll Radiol 2016; 13:743-746.e1. [DOI: 10.1016/j.jacr.2015.09.032] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 09/21/2015] [Indexed: 10/22/2022]
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Gupta D, Karst I, Mendelson EB. Value-Based Reimbursement: Impact of Curtailing Physician Autonomy in Medical Decision Making. AJR Am J Roentgenol 2016; 206:276-9. [PMID: 26797353 DOI: 10.2214/AJR.15.15370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In this article, we define value in the context of reimbursement and explore the effect of shifting reimbursement paradigms on the decision-making autonomy of a women's imaging radiologist. CONCLUSION The current metrics used for value-based reimbursement such as report turnaround time are surrogate measures that do not measure value directly. The true measure of a physician's value in medicine is accomplishment of better health outcomes, which, in breast imaging, are best achieved with a physician-patient relationship. Complying with evidence-based medicine, which includes data-driven best clinical practices, a physician's clinical expertise, and the patient's values, will improve our science and preserve the art of medicine.
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