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Flory M, Elsayes KM, Kielar A, Harmath C, Dillman JR, Shehata M, Horvat N, Minervini M, Marks R, Kamaya A, Borhani AA. Congestive Hepatopathy: Pathophysiology, Workup, and Imaging Findings with Pathologic Correlation. Radiographics 2024; 44:e230121. [PMID: 38602867 DOI: 10.1148/rg.230121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
Liver congestion is increasingly encountered in clinical practice and presents diagnostic pitfalls of which radiologists must be aware. The complex altered hemodynamics associated with liver congestion leads to diffuse parenchymal changes and the development of benign and malignant nodules. Distinguishing commonly encountered benign hypervascular lesions, such as focal nodular hyperplasia (FNH)-like nodules, from hepatocellular carcinoma (HCC) can be challenging due to overlapping imaging features. FNH-like lesions enhance during the hepatic arterial phase and remain isoenhancing relative to the background liver parenchyma but infrequently appear to wash out at delayed phase imaging, similar to what might be seen with HCC. Heterogeneity, presence of an enhancing capsule, washout during the portal venous phase, intermediate signal intensity at T2-weighted imaging, restricted diffusion, and lack of uptake at hepatobiliary phase imaging point toward the diagnosis of HCC, although these features are not sensitive individually. It is important to emphasize that the Liver Imaging Reporting and Data System (LI-RADS) algorithm cannot be applied in congested livers since major LI-RADS features lack specificity in distinguishing HCC from benign hypervascular lesions in this population. Also, the morphologic changes and increased liver stiffness caused by congestion make the imaging diagnosis of cirrhosis difficult. The authors discuss the complex liver macro- and microhemodynamics underlying liver congestion; propose a more inclusive approach to and conceptualization of liver congestion; describe the pathophysiology of liver congestion, hepatocellular injury, and the development of benign and malignant nodules; review the imaging findings and mimics of liver congestion and hypervascular lesions; and present a diagnostic algorithm for approaching hypervascular liver lesions. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Marta Flory
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Khaled M Elsayes
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Ania Kielar
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Carla Harmath
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Jonathan R Dillman
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Mostafa Shehata
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Natally Horvat
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Marta Minervini
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Robert Marks
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Aya Kamaya
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
| | - Amir A Borhani
- From the Department of Radiology, Division of Body Imaging, Stanford University School of Medicine, 300 Pasteur Dr, H1307, Stanford, CA 94305 (M.F., A. Kamaya); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.E.); Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A. Kielar, M.S.); Department of Radiology, University of Chicago, Chicago, Ill (C.H.); Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio (J.R.D.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (N.H.); Department of Pathology, University of Pittsburgh Medical Center, Pittsburgh, Pa (M.M.); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.); and Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.A.B.)
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Kamaya A. Editorial Comment: Validating Usage of the Society of Radiologists in Ultrasound Consensus Conference Recommendations for Management of Incidental Gallbladder Polyps. AJR Am J Roentgenol 2024. [PMID: 38415579 DOI: 10.2214/ajr.24.31062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Aya Kamaya
- Department of Radiology, Stanford University, Stanford CA
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Knight J, Kamaya A, Fetzer D, Dahiya N, Gabriel H, Rodgers SK, Tublin M, Walsh A, Bingham D, Middleton W, Fung C. Management of incidentally detected gallbladder polyps: a review of clinical scenarios using the 2022 SRU gallbladder polyp consensus guidelines. Abdom Radiol (NY) 2024:10.1007/s00261-024-04197-9. [PMID: 38411693 DOI: 10.1007/s00261-024-04197-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 10/15/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/28/2024]
Abstract
Gallbladder (GB) polyps are a common incidental finding on sonography, but only a small fraction of polyps become GB cancer. The Society of Radiologists in Ultrasound (SRU) consensus committee recently performed an extensive literature review and published guidelines for GB polyp follow-up/management to provide clarity among the many heterogeneous recommendations that are available to clinicians. As these guidelines have become adopted into clinical practice, challenging clinical scenarios have arisen including GB polyps in primary sclerosing cholangitis (PSC), high risk geographic/genetic patient populations, shrinking polyps, pedunculated vs sessile polyps, thin vs thick stalked polyps, vascular polyps and multiple polyps. According to the SRU guidelines, clinicians should refer to gastroenterology guidelines when managing GB polyps in patients with known PSC. If patients at high geographic/genetic risk develop GB polyps, 'extremely low risk' polyps may be managed as 'low risk' and 10-14 mm 'extremely low risk' or '7-14 mm' low risk polyps that decrease in size by ≥ 4 mm require no follow-up. Thin-stalked or pedunculated polyps are 'extremely low risk' and thick-stalked pedunculated polyps are 'low risk'. Sessile polyps are 'low risk' but should receive immediate specialist referral if features suggestive of GB cancer are present. Neither polyp multiplicity nor vascularity impact risk of GB cancer and follow up should be based on morphology alone.
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Affiliation(s)
- Jessica Knight
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - David Fetzer
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Scottsdale, Phoenix, AZ, 85259, USA
| | - Helena Gabriel
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Mitchell Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Andrew Walsh
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
| | - David Bingham
- Department of Pathology, Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA, 94305, USA
| | - William Middleton
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Christopher Fung
- Department of Radiology and Diagnostic Imaging, Walter C. Mackenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, AB, T6G 2B7, Canada
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4
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Lyshchik A, Wessner CE, Bradigan K, Eisenbrey JR, Forsberg F, Yi M, Keith SW, Kono Y, Wilson SR, Medellin A, Rodgers SK, Planz V, Kamaya A, Finch L, Fetzer DT, Berzigotti A, Sidhu PS, Piscaglia F. Contrast-enhanced ultrasound liver imaging reporting and data system: clinical validation in a prospective multinational study in North America and Europe. Hepatology 2024; 79:380-391. [PMID: 37548928 DOI: 10.1097/hep.0000000000000558] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/28/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND AND AIMS The objective of this study is to determine the diagnostic accuracy of the American College of Radiology Contrast-Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System LR-5 characterization for HCC diagnosis in North American or European patients. APPROACH AND RESULTS A prospective multinational cohort study was performed from January 2018 through November 2022 at 11 academic and nonacademic centers in North America and Europe. Patients at risk for HCC with at least 1 liver observation not previously treated, identified on ultrasound (US), or multiphase CT or MRI performed as a part of standard clinical care were eligible for the study. All participants were examined with CEUS of the liver within 4 weeks of CT/MRI or tissue diagnosis to characterize up to 2 liver nodules per participant using ACR CEUS Liver Imaging Reporting and Data System. Definite HCC diagnosis on the initial CT/MRI, imaging follow-up, or histology for CT/MRI-indeterminate nodules were used as reference standards. A total of 545 nodules had confirmed reference standards in 480 patients, 73.8% were HCC, 5.5% were other malignancies, and 20.7% were nonmalignant. The specificity of CEUS LR-5 for HCC was 95.1% (95% CI 90.1%-97.7%), sensitivity 62.9% (95% CI 57.9%-67.7%), positive predictive value 97.3% (95% CI 94.5%-98.7%), and negative predictive value 47.7% (95% CI 41.7%-53.8%). In addition, benign CEUS characterization (LR-1 or LR-2) had 100% specificity and 100% positive predictive value for nonmalignant liver nodules. CONCLUSIONS CEUS Liver Imaging Reporting and Data System provides an accurate categorization of liver nodules in participants at risk for HCC.
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Affiliation(s)
- Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Kristen Bradigan
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Misung Yi
- Department of Pharmacology, Physiology, and Cancer Biology, Division of Biostatistics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Scott W Keith
- Department of Pharmacology, Physiology, and Cancer Biology, Division of Biostatistics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Cancer Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yuko Kono
- University of California, San Diego, San Diego, California, USA
| | | | | | - Shuchi K Rodgers
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
- Einstein Medical Center, Philadelphia, Pennsylvania, USA
| | | | - Aya Kamaya
- Stanford University, Stanford, California, USA
| | - Lisa Finch
- Swedish Medical Center, Seattle, Washington, USA
| | | | - Annalisa Berzigotti
- Department of Visceral Surgery and Medicine, Bern, University Hospital, University of Bern, Bern Switzerland
| | - Paul S Sidhu
- Department of Imaging Sciences, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Department of Radiology, King's College Hospital, London, UK
| | - Fabio Piscaglia
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Italy
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Shen L, Lobo VE, Cordova D, Larson DB, Kamaya A. Establishing a Point-of-Care Ultrasound Program: An Institutional Approach for Developing a Point-of-Care Ultrasound Program Infrastructure. J Am Coll Radiol 2023:S1546-1440(23)00941-9. [PMID: 37984768 DOI: 10.1016/j.jacr.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 05/15/2023] [Revised: 08/31/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Point-of-care ultrasound (POCUS) is rapidly accelerating in adoption and applications outside the traditional realm of diagnostic radiology departments. Although the use of this imaging technology in a distributed fashion has great potential, there are many associated challenges. To address these challenges, the authors developed an enterprise-wide POCUS program at their institution (Stanford Health Care). Here, the authors share their experience, the governance organization, and their approaches to device and information security, training, and quality assurance. The authors also share the basic principles they use to guide their approach to manage these challenges. Through their work, the authors have learned that a foundational framework of defining POCUS and the different levels of POCUS use and delineating program management elements are critical. The authors hope that their experience will be helpful to others who are also interested in POCUS or in the process of creating POCUS programs at their institutions. With a clearly established framework, patient safety and quality of care are improved for everyone.
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Affiliation(s)
- Luyao Shen
- Codirector of Point-of-Care Ultrasound, Department of Radiology, Stanford University School of Medicine, Stanford, California.
| | - Viveta E Lobo
- Codirector of Point-of-Care Ultrasound, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California
| | - Dorothy Cordova
- Program Manager of Point-of-Care Ultrasound, Imaging Services, Stanford Health Care, Stanford, California
| | - David B Larson
- Senior Vice Chair for Strategy and Clinical Operations, Department of Radiology, Stanford University School of Medicine, Stanford, California
| | - Aya Kamaya
- Chief of Body Imaging, Director of Ultrasound, Department of Radiology, Stanford University School of Medicine, Stanford, California
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Cao JJ, Kamaya A, Tse JR. Reply to "Improving Accuracy in ChatGPT". AJR Am J Roentgenol 2023; 221:705-706. [PMID: 37703485 DOI: 10.2214/ajr.23.29949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Affiliation(s)
- Jennie J Cao
- Stanford University School of Medicine, Stanford, CA
| | - Aya Kamaya
- Stanford University School of Medicine, Stanford, CA
| | - Justin R Tse
- Stanford University School of Medicine, Stanford, CA,
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Cao JJ, Kwon DH, Ghaziani TT, Kwo P, Tse G, Kesselman A, Kamaya A, Tse JR. Accuracy of Information Provided by ChatGPT Regarding Liver Cancer Surveillance and Diagnosis. AJR Am J Roentgenol 2023; 221:556-559. [PMID: 37222278 DOI: 10.2214/ajr.23.29493] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- Jennie J Cao
- Stanford University School of Medicine, Stanford, CA
| | - Daniel H Kwon
- University of California, San Francisco School of Medicine, San Francisco, CA
| | | | - Paul Kwo
- Stanford University School of Medicine, Stanford, CA
| | - Gary Tse
- University of California, Los Angeles David Geffen School of Medicine, Los Angeles, CA
| | | | - Aya Kamaya
- Stanford University School of Medicine, Stanford, CA
| | - Justin R Tse
- Stanford University School of Medicine, Stanford, CA,
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Lemieux S, Shen L, Liang T, Lo E, Chu Y, Kamaya A, Tse JR. External Validation of a Five-Tiered CT Algorithm for the Diagnosis of Clear Cell Renal Cell Carcinoma: A Retrospective Five-Reader Study. AJR Am J Roentgenol 2023; 221:334-343. [PMID: 37162037 DOI: 10.2214/ajr.23.29151] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND. In 2022, a five-tiered CT algorithm was proposed for predicting whether a small (cT1a) solid renal mass represents clear cell renal cell carcinoma (ccRCC). OBJECTIVE. The purpose of this external validation study was to evaluate the proposed CT algorithm for diagnosis of ccRCC among small solid renal masses. METHODS. This retrospective study included 93 patients (median age, 62 years; 42 women, 51 men) with 97 small solid renal masses that were seen on corticomedullary phase contrast-enhanced CT performed between January 2012 and July 2022 and subsequently underwent surgical resection. Five readers (three attending radiologists, two clinical fellows) independently evaluated masses for the mass-to-cortex corticomedullary attenuation ratio and heterogeneity score; these scores were used to derive the CT score by use of the previously proposed CT algorithm. The CT score's sensitivity, specificity, and PPV for ccRCC were calculated at threshold of 4 or greater, and the NPV for ccRCC was calculated at a threshold of 3 or greater (consistent with thresholds in studies of the MRI-based clear cell likelihood score and the CT algorithm's initial study). The CT score's sensitivity and specificity for papillary RCC were calculated at a threshold of 2 or less. Interreader agreement was assessed using the Gwet agreement coefficient (AC1). RESULTS. Overall, 61 of 97 masses (63%) were malignant and 43 of 97 (44%) were ccRCC. Across readers, CT score had sensitivity ranging from 47% to 95% (pooled sensitivity, 74% [95% CI, 68-80%]), specificity ranging from 19% to 83% (pooled specificity, 59% [95% CI, 52-67%]), PPV ranging from 48% to 76% (pooled PPV, 59% [95% CI, 49-71%]), and NPV ranging from 83% to 100% (pooled NPV, 90% [95% CI, 84-95%]), for ccRCC. A CT score of 2 or less had sensitivity ranging from 44% to 100% and specificity ranging from 77% to 98% for papillary RCC (representing nine of 97 masses). Interreader agreement was substantial for attenuation score (AC1 = 0.70), poor for heterogeneity score (AC1 = 0.17), fair for five-tiered CT score (AC1 = 0.32), and fair for dichotomous CT score at a threshold of 4 or greater (AC1 = 0.24 [95% CI, 0.14-0.33]). CONCLUSION. The five-tiered CT algorithm for evaluation of small solid renal masses was tested in an external sample and showed high NPV for ccRCC. CLINICAL IMPACT. The CT algorithm may be used for risk stratification and patient selection for active surveillance by identifying patients unlikely to have ccRCC.
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Affiliation(s)
- Simon Lemieux
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - Luyao Shen
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - Tie Liang
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - Edward Lo
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - Youngmin Chu
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
| | - Justin R Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Rm H-1307, Stanford, CA 94305
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9
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Greben S, Kamaya A. Patient-Friendly Summary of the ACR Appropriateness Criteria®: Management of Liver Cancer. J Am Coll Radiol 2023; 20:e41. [PMID: 36997104 DOI: 10.1016/j.jacr.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/24/2023] [Indexed: 03/31/2023]
Affiliation(s)
| | - Aya Kamaya
- Professor, Department of Radiology, Stanford University School of Medicine, Palo Alto, California
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Chernyak V, Fowler KJ, Do RKG, Kamaya A, Kono Y, Tang A, Mitchell DG, Weinreb J, Santillan CS, Sirlin CB. LI-RADS: Looking Back, Looking Forward. Radiology 2023; 307:e222801. [PMID: 36853182 PMCID: PMC10068888 DOI: 10.1148/radiol.222801] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/09/2023] [Accepted: 01/23/2023] [Indexed: 03/01/2023]
Abstract
Since its initial release in 2011, the Liver Imaging Reporting and Data System (LI-RADS) has evolved and expanded in scope. It started as a single algorithm for hepatocellular carcinoma (HCC) diagnosis with CT or MRI with extracellular contrast agents and has grown into a multialgorithm network covering all major liver imaging modalities and contexts of use. Furthermore, it has developed its own lexicon, report templates, and supplementary materials. This article highlights the major achievements of LI-RADS in the past 11 years, including adoption in clinical care and research across the globe, and complete unification of HCC diagnostic systems in the United States. Additionally, the authors discuss current gaps in knowledge, which include challenges in surveillance, diagnostic population definition, perceived complexity, limited sensitivity of LR-5 (definite HCC) category, management implications of indeterminate observations, challenges in reporting, and treatment response assessment following radiation-based therapies and systemic treatments. Finally, the authors discuss future directions, which will focus on mitigating the current challenges and incorporating advanced technologies. Tha authors envision that LI-RADS will ultimately transform into a probability-based system for diagnosis and prognostication of liver cancers that will integrate patient characteristics and quantitative imaging features, while accounting for imaging modality and contrast agent.
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Affiliation(s)
- Victoria Chernyak
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Kathryn J. Fowler
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Richard K. G. Do
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Aya Kamaya
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Yuko Kono
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - An Tang
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Donald G. Mitchell
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Jeffrey Weinreb
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Cynthia S. Santillan
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
| | - Claude B. Sirlin
- From the Department of Radiology, Memorial Sloan-Kettering Cancer
Center, New York, NY (V.C., R.K.G.D.); Liver Imaging Group, Department of
Radiology, University of California, San Diego, San Diego, Calif (K.J.F.,
C.S.S., C.B.S.); Department of Radiology, Stanford University Medical Center,
Stanford, Calif (A.K.); Department of Medicine and Radiology, University of
California, San Diego, San Diego, Calif (Y.K.); Department of Radiology,
Radiation Oncology and Nuclear Medicine, Université de Montréal,
Montréal, Canada (A.T.); Department of Radiology, Thomas Jefferson
University Hospital, Philadelphia, Pa (D.G.M.); and Department of Radiology,
Yale Medical School, New Haven, Conn (J.W.)
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Shen L, Nawaz R, Tse JR, Negrete LM, Lubner MG, Toia GV, Liang T, Wentland AL, Kamaya A. Diagnostic performance of the "drooping" sign in CT diagnosis of exophytic renal angiomyolipoma. Abdom Radiol (NY) 2023; 48:2091-2101. [PMID: 36947205 DOI: 10.1007/s00261-023-03880-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE To evaluate the prevalence of angular interface and the "drooping" sign in exophytic renal angiomyolipomas (AMLs) and the diagnostic performance in differentiating exophytic lipid-poor AMLs from other solid renal masses. METHODS This IRB-approved, two-center study included 185 patients with 188 exophytic solid renal masses < 4 cm with histopathology and pre-operative CT within 30 days of surgical resection or biopsy. Images were reviewed for the presence of angular interface and the "drooping" sign qualitatively by three readers blinded to the final diagnosis, with majority rules applied. Both features were assessed quantitatively by cohort creators (who are not readers) independently. Free-marginal kappa was used to assess inter-reader agreement and agreement between two methods assessing each feature. Fisher's exact test, Mann-Whitney test, and multivariable logistic regression with two-tailed p < 0.05 were used to determine statistical significance. Diagnostic performance was assessed. RESULTS Ninety-four patients had 96 AMLs, and 91 patients had 92 non-AMLs. Seventy-four (77%) of AMLs were lipid-poor based on quantitative assessment on CT. The presence of angular interface and the "drooping" sign by both qualitative and quantitative assessment were statistically significantly associated with AMLs (39% (qualitative) and 45% (quantitative) vs 15% (qualitative) and 13% (quantitative), and 48% (qualitative) and 43% (quantitative) vs 4% (qualitative) and 1% (quantitative), respectively, all p < 0.001) in univariable analysis. In multivariable analysis, only the "drooping" sign in either qualitative or quantitative assessment was a statistically significant predictor of AMLs (both p < 0.001). Inter-reader agreement for the "drooping" sign was moderate (k = 0.55) and for angular interface was fair (k = 0.33). Agreement between the two methods of assessing the "drooping" sign was substantial (k = 0.84) and of assessing the angular interface was moderate (k = 0.59). The "drooping" sign both qualitatively and quantitatively, alone or in combination of angular interface, had very high specificity (96-100%) and positive predictive value (PPV) (89-100%), moderate negative predictive value (62-68%), but limited sensitivity (23-49%) for lipid-poor AMLs. CONCLUSION The "drooping" sign by both qualitative and quantitative assessment is highly specific for lipid-rich and lipid-poor AMLs. This feature alone or in combination with angular interface can aid in CT diagnosis of lipid-poor AMLs with very high specificity and PPV.
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Affiliation(s)
- Luyao Shen
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA.
| | - Rasheed Nawaz
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Justin R Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Lindsey M Negrete
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Meghan G Lubner
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Giuseppe V Toia
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, 600 Highland Ave, Madison, WI, 53792, USA
| | - Tie Liang
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Andrew L Wentland
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, 1111 Highland Ave, Room 2425, Madison, WI, 53705, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
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Tse JR, Felker ER, Naini BV, Shen L, Shen J, Lu DSK, Kamaya A, Raman SS. Hepatocellular Adenomas: Molecular Basis and Multimodality Imaging Update. Radiographics 2023; 43:e220134. [PMID: 36821508 DOI: 10.1148/rg.220134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Hepatocellular adenomas (HCAs) are a family of liver tumors that are associated with variable prognoses. Since the initial description of these tumors, the classification of HCAs has expanded and now includes eight distinct genotypic subtypes based on molecular analysis findings. These genotypic subtypes have unique derangements in their cellular biologic makeup that determine their clinical course and may allow noninvasive identification of certain subtypes. Multiphasic MRI performed with hepatobiliary contrast agents remains the best method to noninvasively detect, characterize, and monitor HCAs. HCAs are generally hypointense during the hepatobiliary phase; the β-catenin-mutated exon 3 subtype and up to a third of inflammatory HCAs are the exception to this characterization. It is important to understand the appearances of HCAs beyond their depictions at MRI, as these tumors are typically identified with other imaging modalities first. The two most feared related complications are bleeding and malignant transformation to hepatocellular carcinoma, although the risk of these complications depends on tumor size, subtype, and clinical factors. Elective surgical resection is recommended for HCAs that are persistently larger than 5 cm, adenomas of any size in men, and all β-catenin-mutated exon 3 HCAs. Thermal ablation and transarterial embolization are potential alternatives to surgical resection. In the acute setting of a ruptured HCA, patients typically undergo transarterial embolization with or without delayed surgical resection. This update on HCAs includes a review of radiologic-pathologic correlations by subtype and imaging modality, related complications, and management recommendations. © RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Justin R Tse
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Ely R Felker
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Bita V Naini
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Luyao Shen
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Jody Shen
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - David S K Lu
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Aya Kamaya
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Steven S Raman
- From the Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr, Room H-1307, Stanford, CA 94305 (J.R.T., L.S., J.S., A.K.); and Departments of Radiological Sciences (E.R.F., D.S.K.L., S.S.R.) and Pathology (B.V.N.), University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
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Cao JJ, Shen L, Visser BC, Yoon L, Kamaya A, Tse JR. Growth Kinetics of Pancreatic Neuroendocrine Neoplasms by Histopathologic Grade. Pancreas 2023; 52:e135-e143. [PMID: 37523605 DOI: 10.1097/mpa.0000000000002221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
OBJECTIVES The aims of the study are to describe the growth kinetics of pathologically proven, treatment-naive pancreatic neuroendocrine neoplasms (panNENs) at imaging surveillance and to determine their association with histopathologic grade and Ki-67. METHODS This study included 100 panNENs from 95 patients who received pancreas protocol computed tomography or magnetic resonance imaging from January 2005 to July 2022. All masses were treatment-naive, had histopathologic correlation, and were imaged with at least 2 computed tomography or magnetic resonance imaging at least 90 days apart. Growth kinetics was assessed using linear and specific growth rate, stratified by grade and Ki-67. Masses were also assessed qualitatively to determine other possible imaging predictors of grade. RESULTS There were 76 grade 1 masses, 17 grade 2 masses, and 7 grade 3 masses. Median (interquartile range) linear growth rates were 0.06 cm/y (0-0.20), 0.40 cm/y (0.22-1.06), and 2.70 cm/y (0.41-3.89) for grade 1, 2, and 3 masses, respectively (P < 0.001). Linear growth rate correlated with Ki-67 with r2 of 0.623 (P < 0.001). At multivariate analyses, linear growth rate was the only imaging feature significantly associated with grade (P = 0.009). CONCLUSIONS Growth kinetics correlate with Ki-67 and grade. Grade 1 panNENs grow slowly versus grade 2-3 panNENs.
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Fowler KJ, Bashir MR, Fetzer DT, Kitao A, Lee JM, Jiang H, Kielar AZ, Ronot M, Kamaya A, Marks RM, Elsayes KM, Tang A, Sirlin CB, Chernyak V. Universal Liver Imaging Lexicon: Imaging Atlas for Research and Clinical Practice. Radiographics 2023; 43:e239001. [PMID: 36701248 DOI: 10.1148/rg.239001] [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: 01/27/2023]
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Fowler KJ, Bashir MR, Fetzer DT, Kitao A, Lee JM, Jiang H, Kielar AZ, Ronot M, Kamaya A, Marks RM, Elsayes KM, Tang A, Sirlin CB, Chernyak V. Universal Liver Imaging Lexicon: Imaging Atlas for Research and Clinical Practice. Radiographics 2023; 43:e220066. [PMID: 36427260 DOI: 10.1148/rg.220066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of standardized terms in assessing and reporting disease processes has well-established benefits, such as clear communication between radiologists and other health care providers, improved diagnostic accuracy and reproducibility, and the enhancement and facilitation of research. Recently, the Liver Imaging Reporting and Data System (LI-RADS) Steering Committee released a universal liver imaging lexicon. The current version of the lexicon includes 81 vetted and precisely defined terms that are relevant to acquisition of images using all major liver imaging modalities and contrast agents, as well as lesion- and organ-level features. Most terms in the lexicon are applicable to all patients undergoing imaging of the liver, and only a minority of the terms are strictly intended to be used for patients with high risk factors for hepatocellular carcinoma. This pictorial atlas familiarizes readers with the liver imaging lexicon and includes discussion of general concepts, providing sample definitions, schematics, and clinical examples for a subset of the terms in the liver imaging lexicon. The authors discuss general, technical, and imaging feature terms used commonly in liver imaging, with the goal of illustrating their use for clinical and research applications. Work of the U.S. Government published under an exclusive license with the RSNA. Online supplemental material is available for this article.
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Affiliation(s)
- Kathryn J Fowler
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Mustafa R Bashir
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - David T Fetzer
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Azusa Kitao
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Jeong Min Lee
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Hanyu Jiang
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Ania Z Kielar
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Maxime Ronot
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Aya Kamaya
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Robert M Marks
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Khaled M Elsayes
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - An Tang
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Claude B Sirlin
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
| | - Victoria Chernyak
- From the Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, Calif (K.J.F., C.B.S.); Department of Radiology, Duke University Health System, Durham, NC (M.R.B.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan (A.Kitao); Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea (J.M.L.); Department of Radiology, West China Hospital, Sichuan University, Chengdu, China (H.J.); Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada (A.Z.K.); Department of Radiology, Université Paris Cité, Paris, France, and Department of Radiology, Hôpital Beaujon, APHP.Nord, Clichy, France (M.R.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.Kamaya); Department of Radiology, Naval Medical Center San Diego, San Diego, Calif (R.M.M.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (R.M.M.); Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (K.M.E.); Department of Radiology, Radiation Oncology and Nuclear Medicine, Université de Montréal, Montréal, Quebec, Canada (A.T.); and Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065 (V.C.)
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Shen L, Tse JR, Negrete LM, Lo E, Yoon L, Kamaya A. Predictive value and prevalence of refractive edge shadow in diagnosis of ovarian dermoids. Abdom Radiol (NY) 2022; 47:4227-4236. [PMID: 36098759 DOI: 10.1007/s00261-022-03666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of refractive edge shadow in evaluation of ovarian dermoids compared to other benign adnexal masses. METHODS Ultrasound images of 139 patients with 154 dermoids, endometriomas, and hemorrhagic cysts were retrospectively reviewed by 3 radiologists blinded to final diagnosis. Ultrasound and clinical features were compared to pathology or follow-up ultrasound results as reference standard. Inter-reader agreements with free-marginal kappa and diagnostic performance were evaluated. The former was compared using Fisher's exact test or Mann-Whitney test with p < 0.05 to determine statistical significance. RESULTS The study sample consisted of 154 lesions: 50 dermoids, 50 endometriomas, and 54 hemorrhagic cysts. Refractive edge shadow, homogeneous echogenic appearance, tip of the iceberg sign, mural echogenic nodule, echogenic shadowing focus, and dot-dash sign all were statistically significant across all readers for the diagnosis of dermoid. Prevalence of each feature in dermoids compared to other entities were as follows: refractive edge shadow (70% vs 8%; p < 0.001), homogeneously echogenic appearance (34% vs 2%; p < 0.001), tip of the iceberg sign (16% vs 1%; p < 0.001), mural echogenic nodule (38% vs 2%; p < 0.001), echogenic shadowing focus (13% vs 1%; p < 0.001), and dot-dash sign (44% vs 1%; p < 0.001). Refractive edge shadow had the highest sensitivity, negative predictive value, and accuracy among all ultrasound features associated with dermoids (70%, 86%, and 85%, respectively). CONCLUSION Refractive edge shadow is a promising ultrasound feature for diagnosis of dermoids, with the highest diagnostic accuracy and prevalence compared to other previously described features associated with dermoids.
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Affiliation(s)
- Luyao Shen
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA.
| | - Justin R Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Lindsey M Negrete
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Edward Lo
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Luke Yoon
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
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Liang E, Kamaya A. Patient-Friendly Summary of the ACR Appropriateness Criteria Acute Pyelonephritis: 2022 Update. J Am Coll Radiol 2022; 20:e11. [PMID: 36529607 DOI: 10.1016/j.jacr.2022.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 12/23/2022]
Affiliation(s)
| | - Aya Kamaya
- Stanford University, Stanford, California.
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Tiyarattanachai T, Turco S, Eisenbrey JR, Wessner CE, Medellin-Kowalewski A, Wilson S, Lyshchik A, Kamaya A, Kaffas AE. A Comprehensive Motion Compensation Method for In-Plane and Out-of-Plane Motion in Dynamic Contrast-Enhanced Ultrasound of Focal Liver Lesions. Ultrasound Med Biol 2022; 48:2217-2228. [PMID: 35970658 PMCID: PMC9529818 DOI: 10.1016/j.ultrasmedbio.2022.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 05/23/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
Contrast-enhanced ultrasound (CEUS) acquisitions of focal liver lesions are affected by motion, which has an impact on contrast signal quantification. We therefore developed and tested, in a large patient cohort, a motion compensation algorithm called the Iterative Local Search Algorithm (ILSA), which can correct for both periodic and non-periodic in-plane motion and can reject frames with out-of-plane motion. CEUS cines of 183 focal liver lesions in 155 patients from three hospitals were used to develop and test ILSA. Performance was evaluated through quantitative metrics, including the root mean square error and R2 in fitting time-intensity curves and standard deviation value of B-mode intensities, computed across cine frames), and qualitative evaluation, including B-mode mean intensity projection images and parametric perfusion imaging. The median root mean square error significantly decreased from 0.032 to 0.024 (p < 0.001). Median R2 significantly increased from 0.88 to 0.93 (p < 0.001). The median standard deviation value of B-mode intensities significantly decreased from 6.2 to 5.0 (p < 0.001). B-Mode mean intensity projection images revealed improved spatial resolution. Parametric perfusion imaging also exhibited improved spatial detail and better differentiation between lesion and background liver parenchyma. ILSA can compensate for all types of motion encountered during liver CEUS, potentially improving contrast signal quantification of focal liver lesions.
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Affiliation(s)
- Thodsawit Tiyarattanachai
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA; Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Simona Turco
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Corinne E Wessner
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Stephanie Wilson
- Department of Radiology, University of Calgary, Calgary, Alberta, Canada; Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Ahmed El Kaffas
- Department of Radiology, Stanford University School of Medicine, Stanford, California, USA.
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Sanabria SJ, Pirmoazen AM, Dahl J, Kamaya A, El Kaffas A. Comparative Study of Raw Ultrasound Data Representations in Deep Learning to Classify Hepatic Steatosis. Ultrasound Med Biol 2022; 48:2060-2078. [PMID: 35914993 DOI: 10.1016/j.ultrasmedbio.2022.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
Adiposity accumulation in the liver is an early-stage indicator of non-alcoholic fatty liver disease. Analysis of ultrasound (US) backscatter echoes from liver parenchyma with deep learning (DL) may offer an affordable alternative for hepatic steatosis staging. The aim of this work was to compare DL classification scores for liver steatosis using different data representations constructed from raw US data. Steatosis in N = 31 patients with confirmed or suspected non-alcoholic fatty liver disease was stratified based on fat-fraction cutoff values using magnetic resonance imaging as a reference standard. US radiofrequency (RF) frames (raw data) and clinical B-mode images were acquired. Intermediate image formation stages were modeled from RF data. Power spectrum representations and phase representations were also calculated. Co-registered patches were used to independently train 1-, 2- and 3-D convolutional neural networks (CNNs), and classifications scores were compared with cross-validation. There were 67,800 patches available for 2-D/3-D classification and 1,830,600 patches for 1-D classification. The results were also compared with radiologist B-mode annotations and quantitative ultrasound (QUS) metrics. Patch classification scores (area under the receiver operating characteristic curve [AUROC]) revealed significant reductions along successive stages of the image formation process (p < 0.001). Patient AUROCs were 0.994 for RF data and 0.938 for clinical B-mode images. For all image formation stages, 2-D CNNs revealed higher patch and patient AUROCs than 1-D CNNs. CNNs trained with power spectrum representations converged faster than those trained with RF data. Phase information, which is usually discarded in the image formation process, provided a patient AUROC of 0.988. DL models trained with RF and power spectrum data (AUROC = 0.998) provided higher scores than conventional QUS metrics and multiparametric combinations thereof (AUROC = 0.986). Radiologist annotations indicated lower hepatic steatosis classification accuracies (Acc = 0.914) with respect to magnetic resonance imaging proton density fat fraction that DL models (Acc = 0.989). Access to raw ultrasound data combined with artificial intelligence techniques may offer superior opportunities for quantitative tissue diagnostics than conventional sonographic images.
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Affiliation(s)
- Sergio J Sanabria
- Department of Radiology, Stanford University, Stanford, California, USA; Deusto Institute of Technology, University of Deusto/Ikerbasque, Basque Foundation for Science, Bilbao, Spain.
| | - Amir M Pirmoazen
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Jeremy Dahl
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Ahmed El Kaffas
- Department of Radiology, Stanford University, Stanford, California, USA
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Shen L, Tse JR, Negrete LM, Flory MN, Yoon L, Kamaya A. Clinical and ultrasound features of dermoid-associated adnexal torsion. Abdom Radiol (NY) 2022; 47:3583-3593. [PMID: 35809127 DOI: 10.1007/s00261-022-03601-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To determine the clinical and ultrasound features of dermoid-associated adnexal torsion. METHODS Forty-four patients with at least one dermoid and ultrasound ≤ 30 days of surgery were retrospectively reviewed by three radiologists. Ultrasound and clinical findings were compared to intra-operative findings using Fisher's exact test or Mann-Whitney test with p < 0.05 to determine statistical significance.Please check and confirm that the authors and their respective affiliations have been correctly identified and amend if necessary.Correct. No edit RESULTS: Twenty patients had torsion, while 24 patients did not. Patients with dermoid-associated torsion were more likely to present to emergency department (ED) (100% vs 13%; p < 0.001) and have acute unilateral pelvic pain (100% vs 42%; p < 0.001). On ultrasound, patients with torsion had larger dermoids (median largest dimension 9.0 cm (IQR 7.7-11.1) vs 6.0 cm (IQR 4.4-7.5); p < 0.001), displaced dermoid anterior or superior to the uterus (59% vs 21%; p = 0.016), and ipsilateral adnexal fluid (41% vs 4%; p = 0.003). Displaced dermoid and ipsilateral adnexal fluid had substantial (kappa = 0.72) and moderate inter-rater agreement (kappa = 0.49), respectively. The combination of ED presentation and each statistically significant ultrasound feature (dermoid size ≥ 5.0 cm, displaced dermoid, and ipsilateral adnexal fluid) yielded high specificity and positive predictive value (ranging from 93-100% to 92-100%, respectively). The combination of ED presentation and dermoid size ≥ 5.0 cm yielded the highest sensitivity, negative predicative value, and accuracy (100%, 100%, and 96%, respectively).Please check and confirm whether the edit made to the article title is in order.Looks great. No edits. Thank you! CONCLUSION Although the diagnosis of adnexal torsion in the presence of an ovarian dermoid is traditionally challenging, the combination of ED presentation and ultrasound features increase diagnostic confidence of dermoid-associated adnexal torsion.
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Affiliation(s)
- Luyao Shen
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA.
| | - Justin R Tse
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Lindsey M Negrete
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Marta N Flory
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Luke Yoon
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Drive, H1307, Stanford, CA, 94305, USA
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Foiret J, Cai X, Bendjador H, Park EY, Kamaya A, Ferrara KW. Improving plane wave ultrasound imaging through real-time beamformation across multiple arrays. Sci Rep 2022; 12:13386. [PMID: 35927389 PMCID: PMC9352764 DOI: 10.1038/s41598-022-16961-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 07/19/2022] [Indexed: 11/09/2022] Open
Abstract
Ultrasound imaging is a widely used diagnostic tool but has limitations in the imaging of deep lesions or obese patients where the large depth to aperture size ratio (f-number) reduces image quality. Reducing the f-number can improve image quality, and in this work, we combined three commercial arrays to create a large imaging aperture of 100 mm and 384 elements. To maintain the frame rate given the large number of elements, plane wave imaging was implemented with all three arrays transmitting a coherent wavefront. On wire targets at a depth of 100 mm, the lateral resolution is significantly improved; the lateral resolution was 1.27 mm with one array (1/3 of the aperture) and 0.37 mm with the full aperture. After creating virtual receiving elements to fill the inter-array gaps, an autoregressive filter reduced the grating lobes originating from the inter-array gaps by − 5.2 dB. On a calibrated commercial phantom, the extended field-of-view and improved spatial resolution were verified. The large aperture facilitates aberration correction using a singular value decomposition-based beamformer. Finally, after approval of the Stanford Institutional Review Board, the three-array configuration was applied in imaging the liver of a volunteer, validating the potential for enhanced resolution.
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Affiliation(s)
| | - Xiran Cai
- Stanford University, Palo Alto, CA, USA
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Kamaya A, Fung C, Szpakowski JL, Fetzer DT, Walsh AJ, Alimi Y, Bingham DB, Corwin MT, Dahiya N, Gabriel H, Park WG, Porembka MR, Rodgers SK, Tublin ME, Yuan X, Zhang Y, Middleton WD. Management of Incidentally Detected Gallbladder Polyps: Society of Radiologists in Ultrasound Consensus Conference Recommendations. Radiology 2022; 305:277-289. [PMID: 35787200 DOI: 10.1148/radiol.213079] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gallbladder polyps (also known as polypoid lesions of the gallbladder) are a common incidental finding. The vast majority of gallbladder polyps smaller than 10 mm are not true neoplastic polyps but are benign cholesterol polyps with no inherent risk of malignancy. In addition, recent studies have shown that the overall risk of gallbladder cancer is not increased in patients with small gallbladder polyps, calling into question the rationale for frequent and prolonged follow-up of these common lesions. In 2021, a Society of Radiologists in Ultrasound, or SRU, consensus conference was convened to provide recommendations for the management of incidentally detected gallbladder polyps at US. See also the editorial by Sidhu and Rafailidis in this issue.
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Affiliation(s)
- Aya Kamaya
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Christopher Fung
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Jean-Luc Szpakowski
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - David T Fetzer
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Andrew J Walsh
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Yewande Alimi
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - David B Bingham
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Michael T Corwin
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Nirvikar Dahiya
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Helena Gabriel
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Walter G Park
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Matthew R Porembka
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Shuchi K Rodgers
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Mitchell E Tublin
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Xin Yuan
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - Yang Zhang
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
| | - William D Middleton
- From the Departments of Radiology (A.K.), Pathology (D.B.B.), Medicine (W.G.P.), and Ultrasound (X.Y.), Stanford University School of Medicine, Stanford Hospital and Clinics, 300 Pasteur Dr, H1307, Stanford, CA 94305; Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada (C.F., A.J.W.); Department of Gastroenterology, Kaiser Permanente Northern California, Oakland, Calif (J.L.S.); Departments of Radiology (D.T.F.) and Surgical Oncology (M.R.P.), University of Texas Southwestern Medical Center, Dallas, Tex; Department of Surgery, MedStar Georgetown University Hospital, Washington, DC (Y.A.); Department of Radiology, University of California Davis Medical Center, Sacramento, Calif (M.T.C.); Department of Radiology, Mayo Clinic Scottsdale, Phoenix, Ariz (N.D.); Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (H.G.); Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ (S.K.R.); Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pa (M.E.T.); Joint Pathology Center, Silver Spring, Md (Y.Z.); and Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (W.D.M.)
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Guernsey EK, Kamaya A. Patient-Friendly Summary of the ACR Appropriateness Criteria Crohn Disease-Child. J Am Coll Radiol 2022; 19:e41. [PMID: 35710770 DOI: 10.1016/j.jacr.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 10/18/2022]
Affiliation(s)
| | - Aya Kamaya
- interim Chief, Body Imaging Division, Director of Ultrasound, and Associate Director, Body Imagin Fellowship, Department of Radiology, Stanford University School of Medicine, Stanford, California.
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Middleton WD, Fung C, Dahiya N, Szpakowski JL, Corwin MT, Fetzer DT, Gabriel H, Rodgers SK, Tublin ME, Walsh AJ, Kamaya A. Survey Study on the Experience, Practice Patterns, and Preferences of the Fellows of the Society of Radiologists in Ultrasound for Evaluation and Management of Gallbladder Polyps Detected With Ultrasound. Ultrasound Q 2022; 38:96-102. [PMID: 35221317 DOI: 10.1097/ruq.0000000000000597] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Gallbladder polyps (GPs) are a common incidental finding on ultrasound; however, important differences in recommended management exist among professional society guidelines.An electronic survey was sent to 189 fellows of the Society of Radiologists in Ultrasound. Main outcomes included preferences and current practice patterns for evaluation, management, and surveillance of GPs as well as personal lifetime experience with gallbladder sonography and GPs.A total of 64 subjects (34%) with experience in gallbladder sonography completed the study. The estimated combined total number of gallbladder scans seen by the responders was 3,071,880. None of fellows had ever seen a pedunculated GP <1 cm detected on ultrasound that was proven to be malignant at the time of detection or during subsequent follow-up. All of the fellows used size as a feature to stratify recommendations. The median size threshold currently used by Society of Radiologists in Ultrasound fellows for recommending ultrasound follow-up was 6 mm, and their preferred threshold was 7 mm. The median size threshold for recommending surgical consultation was 10 mm, and the preferred threshold was 10 mm. Wall thickening and shape were considered important factors by 76% and 67% of respondents, respectively.Society of Radiologists in Ultrasound fellows tend to provide recommendations most similar to the American College of Radiology and Canadian Association of Radiology guidelines for management of GPs. Many would prefer guidelines that result in fewer recommendations for follow-up and surgical consultation. Despite a substantial combined experience, this survey did not uncover any case of a small GP that was malignant.
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Affiliation(s)
- William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Christopher Fung
- Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | | | | | - Michael T Corwin
- Department of Radiology, Davis Medical Center, University of California, Sacramento, CA
| | | | - Helena Gabriel
- Department of Radiology, Northwestern University, Chicago, IL
| | - Shuchi K Rodgers
- Department of Radiology, Sidney Kimmel Medical College, Thomas Jefferson University, Cherry Hill, NJ
| | - Mitchell E Tublin
- Department of Radiology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Andrew J Walsh
- Department of Radiology, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Aya Kamaya
- Department of Radiology, Stanford University Stanford Hospital and Clinics, Stanford, CA
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Jha P, Gupta A, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, Kamaya A, Antil N, Barroilhet L, Sadowski EA. Diagnostic Performance of the Ovarian-Adnexal Reporting and Data System (O-RADS) Ultrasound Risk Score in Women in the United States. JAMA Netw Open 2022; 5:e2216370. [PMID: 35679042 PMCID: PMC9185186 DOI: 10.1001/jamanetworkopen.2022.16370] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
IMPORTANCE The American College of Radiology (ACR) Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound (US) risk scoring system has been studied in a selected population of women referred for suspected or known adnexal lesions. This population has a higher frequency of malignant neoplasms than women presenting to radiology departments for pelvic ultrasonography for a variety of indications, potentially impacting the diagnostic performance of the risk scoring system. OBJECTIVE To evaluate the risk of malignant neoplasm and diagnostic performance of O-RADS US risk scoring system in a multi-institutional, nonselected cohort. DESIGN, SETTING, AND PARTICIPANTS This multi-institutional cohort study included a population of nonselected women in the United States who presented to radiology departments for routine pelvic ultrasonography between 2011 and 2014, with pathology confirmation imaging follow up or 2 years of clinical follow up. EXPOSURE Analysis of 1014 adnexal lesions using the O-RADS US risk stratification system. MAIN OUTCOMES AND MEASURES Frequency of ovarian cancer and diagnostic performance of the O-RADS US risk stratification system. RESULTS This study included 913 women with 1014 adnexal lesions. The mean (SD) age of the patients was 42.4 (13.9 years), and 674 of 913 (73.8%) were premenopausal. The overall frequency of malignant neoplasm was 8.4% (85 of 1014 adnexal lesions). The frequency of malignant neoplasm for O-RADS US 2 was 0.5% (3 of 657 lesions; <1% expected); O-RADS US 3, 4.5% (5 of 112 lesions; <10% expected); O-RADS US 4, 11.6% (18 of 155; 10%-50% expected); and O-RADS 5, 65.6% (59 of 90 lesions; >50% expected). O-RADS US 4 was the optimum cutoff for diagnosing cancer with sensitivity of 90.6% (95% CI, 82.3%-95.9%), specificity of 81.9% (95% CI, 79.3%-84.3%), positive predictive value of 31.4% (95% CI, 25.7%-37.7%) and negative predictive value of 99.0% (95% CI, 98.0%-99.6%). CONCLUSIONS AND RELEVANCE In this cohort study of a nonselected patient population, the O-RADS US risk stratification system performed within the expected range as published by the ACR O-RADS US committee. The frequency of malignant neoplasm was at the lower end of the published range, partially because of the lower prevalence of cancer in a nonselected population. However, a high negative predictive value was maintained, and when a lesion can be classified as an O-RADS US 2, the risk of cancer is low, which is reassuring for both clinician and patient.
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Affiliation(s)
- Priyanka Jha
- University of California, San Francisco, San Francisco
| | | | | | | | | | | | - Aya Kamaya
- Stanford University, Stanford, California
| | - Neha Antil
- Stanford University, Stanford, California
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Turco S, Tiyarattanachai T, Ebrahimkheil K, Eisenbrey J, Kamaya A, Mischi M, Lyshchik A, Kaffas AE. Interpretable Machine Learning for Characterization of Focal Liver Lesions by Contrast-Enhanced Ultrasound. IEEE Trans Ultrason Ferroelectr Freq Control 2022; 69:1670-1681. [PMID: 35320099 PMCID: PMC9188683 DOI: 10.1109/tuffc.2022.3161719] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This work proposes an interpretable radiomics approach to differentiate between malignant and benign focal liver lesions (FLLs) on contrast-enhanced ultrasound (CEUS). Although CEUS has shown promise for differential FLLs diagnosis, current clinical assessment is performed only by qualitative analysis of the contrast enhancement patterns. Quantitative analysis is often hampered by the unavoidable presence of motion artifacts and by the complex, spatiotemporal nature of liver contrast enhancement, consisting of multiple, overlapping vascular phases. To fully exploit the wealth of information in CEUS, while coping with these challenges, here we propose combining features extracted by the temporal and spatiotemporal analysis in the arterial phase enhancement with spatial features extracted by texture analysis at different time points. Using the extracted features as input, several machine learning classifiers are optimized to achieve semiautomatic FLLs characterization, for which there is no need for motion compensation and the only manual input required is the location of a suspicious lesion. Clinical validation on 87 FLLs from 72 patients at risk for hepatocellular carcinoma (HCC) showed promising performance, achieving a balanced accuracy of 0.84 in the distinction between benign and malignant lesions. Analysis of feature relevance demonstrates that a combination of spatiotemporal and texture features is needed to achieve the best performance. Interpretation of the most relevant features suggests that aspects related to microvascular perfusion and the microvascular architecture, together with the spatial enhancement characteristics at wash-in and peak enhancement, are important to aid the accurate characterization of FLLs.
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Gupta A, Jha P, Baran TM, Maturen KE, Patel-Lippmann K, Zafar HM, Kamaya A, Antil N, Barroilhet L, Sadowski E. Ovarian Cancer Detection in Average-Risk Women: Classic- versus Nonclassic-appearing Adnexal Lesions at US. Radiology 2022; 303:603-610. [PMID: 35315722 DOI: 10.1148/radiol.212338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Several US risk stratification schemas for assessing adnexal lesions exist. These multiple-subcategory systems may be more multifaceted than necessary for isolated adnexal lesions in average-risk women. Purpose To explore whether a US-based classification scheme of classic versus nonclassic appearance can be used to help appropriately triage women at average risk of ovarian cancer without compromising diagnostic performance. Materials and Methods This retrospective multicenter study included isolated ovarian lesions identified at pelvic US performed between January 2011 and June 2014, reviewed between September 2019 and September 2020. Lesions were considered isolated in the absence of ascites or peritoneal implants. Lesions were classified as classic or nonclassic based on sonographic appearance. Classic lesions included simple cysts, hemorrhagic cysts, endometriomas, and dermoids. Otherwise, lesions were considered nonclassic. Outcomes based on histopathologic results or clinical or imaging follow-up were recorded. Diagnostic performance and frequency of malignancy were calculated. Frequency of malignancy between age groups was compared using the χ2 test, and Poisson regression was used to explore relationships between imaging features and malignancy. Results A total of 970 isolated lesions in 878 women (mean age, 42 years ± 14 [SD]) were included. The malignancy rate for classic lesions was less than 1%. Of 970 lesions, 53 (6%) were malignant. The malignancy rate for nonclassic lesions was 32% (33 of 103) when blood flow was present and 8% (16 of 194) without blood flow (P < .001). For women older than 60 years, the malignancy rate was 50% (10 of 20 lesions) when blood flow was present and 13% (five of 38) without blood flow (P = .004). The sensitivity, specificity, positive predictive value, and negative predictive value of the classic-versus-nonclassic schema was 93% (49 of 53 lesions), 73% (669 of 917 lesions), 17% (49 of 297 lesions), and 99% (669 of 673 lesions), respectively, for detection of malignancy. Conclusion Using a US classification schema of classic- or nonclassic-appearing adnexal lesions resulted in high sensitivity and specificity in the diagnosis of malignancy in ovarian cancer. The highest risk of cancer was in isolated nonclassic lesions with blood flow in women older than 60 years. © RSNA, 2022 See also the editorial by Baumgarten in this issue.
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Affiliation(s)
- Akshya Gupta
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Priyanka Jha
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Timothy M Baran
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Katherine E Maturen
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Krupa Patel-Lippmann
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Hanna M Zafar
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Aya Kamaya
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Neha Antil
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Lisa Barroilhet
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
| | - Elizabeth Sadowski
- From the Department of Imaging Sciences, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14620 (A.G., T.M.B.); Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Calif (P.J.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (K.P.L.); Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pa (H.M.Z.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (A.K., N.A.); and Department of Obstetrics and Gynecology (L.B.) and Department of Radiology (E.S.), University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wis
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Kotsis SV, Kamaya A. Patient-Friendly Summary of the ACR Appropriateness Criteria® Sinonasal Disease: 2021 Update. J Am Coll Radiol 2022; 19:e25. [DOI: 10.1016/j.jacr.2022.02.004] [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] [Received: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/24/2022]
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Tse JR, Gologorsky R, Shen L, Bingham DB, Jeffrey RB, Kamaya A. Evaluation of early sonographic predictors of gangrenous cholecystitis: mucosal discontinuity and echogenic pericholecystic fat. Abdom Radiol (NY) 2022; 47:1061-1070. [PMID: 34985635 DOI: 10.1007/s00261-021-03320-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/07/2022]
Abstract
PURPOSE To identify early sonographic features of gangrenous cholecystitis. MATERIALS AND METHODS 101 patients with acute cholecystitis and a pre-operative sonogram were retrospectively reviewed by three radiologists in this IRB-approved and HIPAA-compliant study. Imaging data were correlated with histologic findings and compared using the Fisher's exact test or Student t test with p < 0.05 to determine statistical significance. RESULTS Forty-eight patients had gangrenous cholecystitis and 53 had non-gangrenous acute cholecystitis. Patients with gangrenous cholecystitis tended to be older (67 ± 17 vs 48 ± 18 years; p = 0.0001), male (ratio of male:female 2:1 vs 0.6:1; p = 0.005), tachycardic (60% vs 28%; p = 0.001), and diabetic (25% vs 8%; p = 0.001). Median time between pre-operative sonogram and surgery was 1 day. On imaging, patients with gangrenous cholecystitis were more likely to have echogenic pericholecystic fat (p = 0.001), mucosal discontinuity (p = 0.010), and frank perforation (p = 0.004), while no statistically significant differences were seen in the presence of sloughed mucosa (p = 0.104), pericholecystic fluid (p = 0.523) or wall striations (p = 0.839). In patients with gangrenous cholecystitis and echogenic pericholecystic fat, a smaller subset had concurrent mucosal discontinuity (57%), and a smaller subset of those had concurrent frank perforation (58%). The positive likelihood ratios for gangrenous cholecystitis with echogenic fat and mucosal discontinuity were 4.6 (95% confidence interval 1.9-11.3) and 14.4 (2.0-106), respectively. CONCLUSION Echogenic pericholecystic fat and mucosal discontinuity are early sonographic findings that may help identify gangrenous cholecystitis prior to late findings of frank perforation.
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Keller CA, Antil N, Jeffrey RB, Kamaya A. Color Doppler Imaging of Vascular Abnormalities of the Uterus. Ultrasound Q 2022; 38:72-82. [PMID: 35239631 DOI: 10.1097/ruq.0000000000000578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Many uterine abnormalities present clinically with bleeding encompassing a broad spectrum of patients from postmenopausal spotting to life-threatening hemorrhage. Color and spectral Doppler imaging of the pelvis is often the first crucial investigation used to quickly establish the correct etiology of the uterine bleeding and guide clinical decision making and patient management.
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Affiliation(s)
- Cody A Keller
- Department of Radiology, Stanford University School of Medicine, Stanford, CA
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Tse J, Shen L, Yoon L, Kamaya A. Growth kinetics and progression rates of cystic renal masses on active surveillance. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.6_suppl.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
298 Background: The Bosniak classification is used to risk stratify the probability of cancer among cystic renal masses using CT or MRI and assigns a class ranging from I-IV. Bosniak III and IV masses have the highest probabilities of cancer and are treated similarly to solid renal masses per 2021 American Urological Association (AUA) Guidelines. The purpose of this study was to determine the growth kinetics and progression rates of unresected Bosniak III and IV masses defined by Bosniak Classification, version 2019 (v2019). Methods: In this retrospective and IRB-approved study, CT and MRI images of 107 cystic renal masses from 100 patients (34 women, 66 men; range 28-92 years) with unresected Bosniak III and IV masses from 2005-2021 were reviewed. Cystic renal masses on baseline imaging were assigned a category based on v2019 by two abdominal radiologists, with discrepancies resolved by a third, such that each mass had a single Bosniak class assignment. Mass dimensions over serial imaging were measured using orthogonal planes by a radiologist with 3D laboratory training. Linear growth rate (mm/year) and volumetric growth rate (mL/year) were calculated. “Progression” off of active surveillance was defined as any of the following: linear growth rate > 5 mm a year, volume doubling rate ≤ 1 year, or increased stage based on TNM. Results: 107 cystic renal masses were categorized as 51 Bosniak III and 56 Bosniak IV masses on baseline exam. Median follow-up time was 406 days. Linear growth rate for Bosniak III masses was 0.4 ± 4.3 mm/year while linear growth rate for Bosniak IV masses was 2.3 ± 4.9 mm/year (p = 0.036; Student’s t-test). 12/51 (24%) Bosniak III masses progressed based on above definitions while 26/56 (46%) Bosniak IV masses progressed (p = 0.016; Fisher’s exact test). 13 masses upgraded from a Bosniak III to IV during surveillance, but category upgrades were not associated with progression (p = 0.131; Fisher’s exact test). 2 patients developed lung metastases; both masses were Bosniak IV and were biopsy proven papillary and clear cell renal cell carcinomas. Conclusions: Although currently treated similarly by AUA Guidelines, unresected Bosniak IV masses grow faster than Bosniak III masses and are more likely to progress off of active surveillance.
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Affiliation(s)
| | | | | | - Aya Kamaya
- Stanford University School of Medicine, Stanford, CA
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Antil N, Raghu PR, Shen L, Tiyarattanachai T, Chang EM, Ferguson CWK, Ho AA, Lutz AM, Mariano AJ, Morimoto LN, Kamaya A. Interobserver agreement between eight observers using IOTA simple rules and O-RADS lexicon descriptors for adnexal masses. Abdom Radiol (NY) 2022; 47:3318-3326. [PMID: 35763052 PMCID: PMC9388428 DOI: 10.1007/s00261-022-03580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 06/04/2022] [Accepted: 06/06/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To evaluate interobserver agreement in assigning imaging features and classifying adnexal masses using the IOTA simple rules versus O-RADS lexicon and identify causes of discrepancy. METHODS Pelvic ultrasound (US) examinations in 114 women with 118 adnexal masses were evaluated by eight radiologists blinded to the final diagnosis (4 attendings and 4 fellows) using IOTA simple rules and O-RADS lexicon. Each feature category was analyzed for interobserver agreement using intraclass correlation coefficient (ICC) for ordinal variables and free marginal kappa for nominal variables. The two-tailed significance level (a) was set at 0.05. RESULTS For IOTA simple rules, interobserver agreement was almost perfect for three malignant lesion categories (M2-4) and substantial for the remaining two (M1, M5) with k-values of 0.80-0.82 and 0.68-0.69, respectively. Interobserver agreement was almost perfect for two benign feature categories (B2, B3), substantial for two (B4, B5) and moderate for one (B1) with k-values of 0.81-0.90, 0.69-0.70 and 0.60, respectively. For O-RADS, interobserver agreement was almost perfect for two out of ten feature categories (ascites and peritoneal nodules) with k-values of 0.89 and 0.97. Interobserver agreement ranged from fair to substantial for the remaining eight feature categories with k-values of 0.39-0.61. Fellows and attendings had ICC values of 0.725 and 0.517, respectively. CONCLUSION O-RADS had variable interobserver agreement with overall good agreement. IOTA simple rules had more uniform interobserver agreement with overall excellent agreement. Greater reader experience did not improve interobserver agreement with O-RADS.
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Affiliation(s)
- Neha Antil
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA USA
| | - Preethi R. Raghu
- Department of Radiology, University of CA – San Francisco, San Francisco, CA USA
| | - Luyao Shen
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA USA
| | | | - Edwina M. Chang
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA USA
| | - Craig W. K. Ferguson
- Department of Radiology, University of Alberta Hostpial, Edmonton, Alberta Canada
| | - Amanzo A. Ho
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA USA
| | - Amelie M. Lutz
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA USA
| | - Aladin J. Mariano
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA USA
| | - L. Nayeli Morimoto
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA USA
| | - Aya Kamaya
- Department of Radiology, Stanford Hospital and Clinics, Stanford, CA USA
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Lockhart R, Kamaya A. Patient-Friendly Summary of the ACR Appropriateness Criteria® Transgender Breast Cancer Screening. J Am Coll Radiol 2022; 19:e19. [DOI: 10.1016/j.jacr.2021.10.015] [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] [Received: 10/08/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
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Pirmoazen AM, Khurana A, Loening AM, Liang T, Shamdasani V, Xie H, El Kaffas A, Kamaya A. Diagnostic Performance of 9 Quantitative Ultrasound Parameters for Detection and Classification of Hepatic Steatosis in Nonalcoholic Fatty Liver Disease. Invest Radiol 2022; 57:23-32. [PMID: 34049335 DOI: 10.1097/rli.0000000000000797] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease worldwide. Quantitative ultrasound (QUS) parameters based on radiofrequency raw data show promise in quantifying liver fat. PURPOSE The aim of this study was to evaluate the diagnostic performance of 9 QUS parameters compared with magnetic resonance imaging (MRI)-estimated proton density fat fraction (PDFF) in detecting and staging hepatic steatosis in patients with or suspected of NAFLD. MATERIALS AND METHODS In this Health Insurance Portability and Accountability Act-compliant institutional review board-approved prospective study, 31 participants with or suspected of NAFLD, without other underlying chronic liver diseases (13 men, 18 women; average age, 52 years [range, 26-90 years]), were examined. The following parameters were obtained: acoustic attenuation coefficient (AC); hepatorenal index (HRI); Nakagami parameter; shear wave elastography measures such as shear wave elasticity, viscosity, and dispersion; and spectroscopy-derived parameters including spectral intercept (SI), spectral slope (SS), and midband fit (MBF). The diagnostic ability (area under the receiver operating characteristic curves and accuracy) of QUS parameters was assessed against different MRI-PDFF cutoffs (the reference standard): 6.4%, 17.4%, and 22.1%. Linearity with MRI-PDFF was evaluated with Spearman correlation coefficients (p). RESULTS The AC, SI, Nakagami, SS, HRI, and MBF strongly correlated with MRI-PDFF (P = 0.89, 0.89, 0.88, -0.87, 0.81, and 0.71, respectively [P < 0.01]), with highest area under the receiver operating characteristic curves (ranging from 0.85 to 1) for identifying hepatic steatosis using 6.4%, 17.4%, and 22.1% MRI-PDFF cutoffs. In contrast, shear wave elasticity, shear wave viscosity, and shear wave dispersion did not strongly correlate to MRI-PDFF (P = 0.45, 0.38, and 0.07, respectively) and had poor diagnostic performance. CONCLUSION The AC, Nakagami, SI, SS, MBF, and HRI best correlate with MRI-PDFF and show high diagnostic performance for detecting and classifying hepatic steatosis in our study population. SUMMARY STATEMENT Quantitative ultrasound is an accurate alternative to MRI-based techniques for evaluating hepatic steatosis in patients with or at risk of NAFLD. KEY FINDINGS Our preliminary results show that specific quantitative ultrasound parameters accurately detect different degrees of hepatic steatosis in NAFLD.
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Affiliation(s)
- Amir M Pirmoazen
- From the Department of Radiology, School of Medicine, Stanford University, California
| | - Aman Khurana
- Departments of Radiology and Biomedical Engineering, University of Kentucky, Lexington
| | - Andreas M Loening
- From the Department of Radiology, School of Medicine, Stanford University, California
| | - Tie Liang
- From the Department of Radiology, School of Medicine, Stanford University, California
| | - Vijay Shamdasani
- Strategy & Business Development, Philips Healthcare, Cambridge, Massachusetts
| | - Hua Xie
- Department of Precision Diagnosis and Image Guided Therapy, Philips Research North America, Cambridge, Massachusetts
| | - Ahmed El Kaffas
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, California
| | - Aya Kamaya
- From the Department of Radiology, School of Medicine, Stanford University, California
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Tiyarattanachai T, Bird KN, Lo EC, Mariano AT, Ho AA, Ferguson CW, Chima RS, Desser TS, Morimoto LN, Kamaya A. Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) Visualization Score: a reliability analysis on inter-reader agreement. Abdom Radiol (NY) 2021; 46:5134-5141. [PMID: 34228197 DOI: 10.1007/s00261-021-03067-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIM The American College of Radiology Ultrasound Liver Imaging Reporting and Data System (ACR US LI-RADS) Visualization Score conveys the expected level of sensitivity of screening and surveillance ultrasound exams in patients at risk for hepatocellular carcinoma (HCC). We sought to determine inter-reader agreement of the Visualization Score which is currently unknown. METHODS Consecutive 6998 ultrasound HCC screening and surveillance studies in 3115 patients from 2017 to 2020 were retrospectively retrieved. Of these, 6154 (87.9%) studies were Visualization A (No or minimal limitations), 709 (10.1%) were Visualization B (Moderate limitations), and 135 (1.9%) were Visualization C (Severe limitations). Randomly sampled 90 studies, with 30 studies in each Visualization category, were included for analysis. Nine radiologists (3 senior attendings, 3 junior attendings and 3 body imaging fellows) blinded to the original categorization independently reviewed each study and assigned a Visualization Score. Intraclass correlation coefficient (ICC) was used to quantify inter-reader agreement. RESULTS ICC among all 9 radiologists was 0.70 (95% CI 0.63-0.77). ICCs among senior attendings, junior attendings and body imaging fellows were 0.68 (CI 0.58-0.76), 0.72 (CI 0.62-0.80) and 0.76 (CI 0.68-0.83), respectively. Subgroup analysis by liver parenchyma was further performed. ICC was highest in the patient group with normal liver parenchyma (0.69, CI 0.56-0.81), followed by steatosis (0.66, CI 0.54-0.79) and cirrhosis (0.58, CI 0.43-0.73), respectively. CONCLUSIONS US LI-RADS Visualization Score is a reliable tool with good inter-reader agreement that can be used to indicate the expected level of sensitivity of a screening and surveillance ultrasound examination for detecting focal liver observations.
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Vij A, Zaheer A, Kamel IR, Porter KK, Arif-Tiwari H, Bashir MR, Fung A, Goldstein A, Herr KD, Kamaya A, Kobi M, Landler MP, Russo GK, Thakrar KH, Turturro MA, Wahab SA, Wardrop RM, Wright CL, Yang X, Carucci LR. ACR Appropriateness Criteria® Epigastric Pain. J Am Coll Radiol 2021; 18:S330-S339. [PMID: 34794592 DOI: 10.1016/j.jacr.2021.08.006] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022]
Abstract
Epigastric pain can have multiple etiologies including myocardial infarction, pancreatitis, acute aortic syndromes, gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, and hiatal hernia. This document focuses on the scenarios in which epigastric pain is accompanied by symptoms such as heartburn, regurgitation, dysphagia, nausea, vomiting, and hematemesis, which raise suspicion for gastroesophageal reflux disease, esophagitis, peptic ulcer disease, gastritis, duodenal ulcer disease, gastric cancer, or hiatal hernia. Although endoscopy may be the test of choice for diagnosing these entities, patients may present with nonspecific or overlapping symptoms, necessitating the use of imaging prior to or instead of endoscopy. The utility of fluoroscopic imaging, CT, MRI, and FDG-PET for these indications are discussed. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Abhinav Vij
- New York University Langone Medical Center, New York, New York; and UT Southwestern Medical Center, Dallas, Texas.
| | - Atif Zaheer
- Johns Hopkins Hospital, Baltimore, Maryland; Chair, Disease Focus Panel for Pancreatitis, Society of Abdominal Radiology; and Associate Editor, Journal Abdominal Radiology
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin K Porter
- Panel Vice-Chair, University of Alabama Medical Center, Birmingham, Alabama; and Board of Directors/President (2021), American Association for Women in Radiology
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Mustafa R Bashir
- Associate Vice-Chair for Research, Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Alice Fung
- Oregon Health & Science University, Portland, Oregon
| | - Alan Goldstein
- Division Chief, Abdominal Imaging, University of Massachusetts Medical School, Worcester, Massachusetts
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California; and President-Elect (2020-2021) and President (2021-2022), Society of Radiologists in Ultrasound
| | | | - Matthew P Landler
- Northwestern University Feinberg School of Medicine, Chicago, Illinois; Primary care physician
| | | | | | - Michael A Turturro
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; American College of Emergency Physicians
| | - Shaun A Wahab
- University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Richard M Wardrop
- The University of Mississippi Medical Center, Jackson, Mississippi; American College of Physicians; Member, American Board of Internal Medicine; Internal Medicine Specialty Board; and Program Director, Cleveland Clinic
| | - Chadwick L Wright
- The Ohio State University Wexner Medical Center, Columbus, Ohio; Board of Directors, American Board of Science in Nuclear Medicine (ABSNM); and Board of Directors, American College of Nuclear Medicine (ACNM)
| | - Xihua Yang
- Phoenix Indian Medical Center, Phoenix, Arizona; American College of Surgeons; and Volunteer Board Member, Franklin Pierce PA School
| | - Laura R Carucci
- Specialty Chair; and Director, CT and MRI, and Section Chief, Abdominal Imaging, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Perez MG, Tse JR, Bird KN, Liang T, Brooke Jeffrey R, Kamaya A. Cystic artery velocity as a predictor of acute cholecystitis. Abdom Radiol (NY) 2021; 46:4720-4728. [PMID: 34216245 DOI: 10.1007/s00261-021-03020-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate angle-corrected peak systolic cystic artery velocity (CAv) as a predictor of acute cholecystitis among patients presenting to the emergency department (ED) with right upper quadrant (RUQ) pain. METHODS In this IRB-approved and retrospective study, CAv was evaluated in 73 patients, 43 who underwent definitive treatment with cholecystectomy or percutaneous cholecystostomy and 30 control patients without clinical suspicion for cholecystitis. In addition to CAv, the following were reviewed by 3 radiologists: CBD diameter, cholelithiasis, impacted stone in the neck, sludge, gallbladder wall thickness > 3 mm, gallbladder transverse dimension ≥ 4 cm, longitudinal dimension ≥ 8 cm, tensile gallbladder fundus sign, pericholecystic fluid, pericholecystic echogenic fat, and sonographic Murphy sign. RESULTS Of the 43 patients who underwent definitive treatment, 25 had acute cholecystitis (34%) and 18 (25%) had chronic cholecystitis. Average CAv measurements were 50 ± 16 cm/s (acute), 28 ± 8 cm/s (chronic), and 22 ± 8 cm/s (control; p < 0.0001). In univariate analysis, among patients who underwent definitive therapy, CAv ≥ 40 cm/s, gallbladder wall thickness, stone impaction, GB long dimension ≥ 8 cm, and elevated WBC were associated with acute cholecystitis (p < 0.05). In multivariate analysis, CAv ≥ 40 cm/s was the only statistically significant variable (p = 0.016). CAv ≥ 40 cm/s alone had a PPV of 94.7% and overall accuracy of 81.4% in diagnosing acute cholecystitis. CONCLUSION CAv ≥ 40 cm/s is highly associated with acute cholecystitis in patients presenting to the ED with RUQ pain.
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Choi HH, Rodgers SK, Fetzer DT, Wasnik AP, Millet JD, Morgan TA, Dawkins A, Gabriel H, Kamaya A. Ultrasound Liver Imaging Reporting and Data System (US LI-RADS): An Overview with Technical and Practical Applications. Acad Radiol 2021; 28:1464-1476. [PMID: 32718745 DOI: 10.1016/j.acra.2020.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022]
Abstract
The Ultrasound Liver Imaging Reporting and Data System (US LI-RADS), introduced in 2017 by the American College of Radiology, standardizes the technique, interpretation, and reporting of screening and surveillance ultrasounds intended to detect hepatocellular carcinoma in high-risk patients. These include patients with cirrhosis of any cause as well as subsets of patients with chronic hepatitis B viral infection. The US LI-RADS scheme is composed of an ultrasound category and a visualization score: ultrasound categories define the exam as negative, subthreshold, or positive and direct next steps in management; visualization scores denote the expected sensitivity of the exam, based on adequacy of liver visualization with ultrasound. Since its introduction, multiple institutions across the United States have implemented US LI-RADS. This review includes a background of hepatocellular carcinoma and US LI-RADS, definition of screening/surveillance population, recommendations and tips for technique, interpretation, and reporting, and preliminary outcomes analysis.
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Affiliation(s)
- Hailey H Choi
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 1001 Potrero Ave. Building 5, 1st floor, San Francisco, CA 94110.
| | - Shuchi K Rodgers
- Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - David T Fetzer
- Department of Radiology, UT Southwestern Medical Center, Dallas Texas
| | - Ashish P Wasnik
- Department of Radiology, Michigan Medicine, University of Michigan, Arbor, Michigan
| | - John D Millet
- Department of Radiology, Michigan Medicine, University of Michigan, Arbor, Michigan
| | - Tara A Morgan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 1001 Potrero Ave. Building 5, 1st floor, San Francisco, CA 94110
| | - Adrian Dawkins
- Department of Radiology, University of Kentucky, Lexington, Kentucky
| | - Helena Gabriel
- Department of Radiology, Northwestern University, Chicago, Illinois
| | - Aya Kamaya
- Department of Radiology, Stanford University Medical Center, Stanford, California
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Tse JR, Shen J, Shah R, Fleischmann D, Kamaya A. Extravasation Volume at Computed Tomography Angiography Correlates With Bleeding Rate and Prognosis in Patients With Overt Gastrointestinal Bleeding. Invest Radiol 2021; 56:394-400. [PMID: 33449577 DOI: 10.1097/rli.0000000000000753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Despite the identification of active extravasation on computed tomography angiography (CTA) in patients with overt gastrointestinal bleeding (GIB), a large proportion do not have active bleeding or require hemostatic therapy at endoscopy, catheter angiography, or surgery. The objective of our proof-of-concept study was to improve triage of patients with GIB by correlating extravasation volume of first-pass CTA with bleeding rate and clinical outcomes. MATERIALS AND METHODS All patients who presented with overt GIB and active extravasation on CTA from January 2014 to July 2019 were reviewed in this retrospective, institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study. Extravasation volume was assessed using 3-dimensional software and correlated with hemostatic therapy (primary endpoint) and with intraprocedural bleeding, blood transfusions, and mortality as secondary endpoints using logistic regression models (P < 0.0125 indicating statistical significance). Odds ratios were used to determine the effect size of a threshold extravasation volume. Quantitative data (extravasation volume, aorta attenuation, extravasation attenuation and time) were input into a mathematical model to calculate bleeding rate. RESULTS Fifty consecutive patients including 6 (12%) upper, 18 (36%) small bowel, and 26 (52%) lower GIB met inclusion criteria. Forty-two underwent catheter angiography, endoscopy, or surgery; 16 had intraprocedural active bleeding, and 24 required hemostatic therapy. Higher extravasation volumes correlated with hemostatic therapy (P = 0.007), intraprocedural active bleeding (P = 0.003), and massive transfusion (P = 0.0001), but not mortality (P = 0.936). Using a threshold volume of 0.80 mL or greater, the odds ratio of hemostatic therapy was 8.1 (95% confidence interval, 2.1-26), active bleeding was 11.8 (2.6-45), and massive transfusion was 18 (2.3-65). With mathematical modeling, extravasation volume had a direct and linear relationship with bleeding rate, and the lowest calculated detectable bleeding rate with CTA was less than 0.1 mL/min. CONCLUSIONS Larger extravasation volumes correlate with higher bleeding rates and may identify patients who require hemostatic therapy, have intraprocedural bleeding, and require blood transfusions. Current CTAs can detect bleeding rates less than 0.1 mL/min.
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Affiliation(s)
- Justin R Tse
- From the Department of Radiological Sciences, David Geffen School of Medicine, University of California, Los Angeles
| | | | - Rajesh Shah
- Interventional Radiology, Stanford University School of Medicine, California
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Eisenbrey JR, Kamaya A, Gummadi S, Bird K, Burrowes D, Arias D, Lallas CD, Trabulsi EJ, Lyshchik A. Effects of Contrast-Enhanced Ultrasound of Indeterminate Renal Masses on Patient Clinical Management: Retrospective Analysis From 2 Institutions. J Ultrasound Med 2021; 40:131-139. [PMID: 32657452 DOI: 10.1002/jum.15383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/28/2020] [Accepted: 06/02/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To investigate the long-term impact of contrast-enhanced ultrasound (CEUS) on the treatment of patients with indeterminate renal masses. METHODS In this retrospective study, consecutive charts of all patients receiving renal CEUS at 1 of 2 academic medical centers between January 1, 2014, and December 31, 2018, were reviewed. Patients were included in the study if they had documented chronic renal disease (estimated glomerular filtration rate < 60 mL/min/1.73 m2 ) or prior nephrectomy and received CEUS for a previously untreated renal mass. RESULTS A total of 215 lesions in 157 patients were used for analysis. Contrast-enhanced ultrasound provided a final treatment recommendation in 71.6% of lesions (154 of 215). Of these 154 lesions, 7.8% (12 of 154) were lost to follow-up despite CEUS suggesting malignancy; 15.6% (24 of 154) went directly for surgical intervention, with malignancy confirmed by pathologic results in 87.5% (21 of 24) of these cases; and the remaining 76.6% (118 of 154) were deemed benign and required no additional follow-up. Of the 118 lesions diagnosed by CEUS as benign and requiring no follow-up, none showed evidence of later renal cell carcinoma development and, only 5.1% (6 of 118) of the total population was referred for further cross-sectional imaging of the mass in question. In 28.4% of all lesions (61 of 215), CEUS resulted in a recommendation for surveillance imaging at a 6- to 12-month interval, and less than 10% (6 of 61) of these underwent additional cross-sectional imaging within the recommended 6 months after CEUS. CONCLUSIONS These findings highlight the impact of CEUS on clinical treatment of indeterminate renal masses, including reducing the use of the potentially nephrotoxic contrast agents and providing a direct pathway to transplant.
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Affiliation(s)
- John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aya Kamaya
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Sriharsha Gummadi
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kristen Bird
- Department of Radiology, Stanford University, Stanford, California, USA
| | - David Burrowes
- Department of Radiology, Stanford University, Stanford, California, USA
| | - Diego Arias
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edouard J Trabulsi
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Elsayes KM, Marks RM, Kamel S, Towbin AJ, Kielar AZ, Patel P, Chernyak V, Fowler KJ, Nassar S, Soliman MA, Kamaya A, Mendiratta-Lala M, Borhani AA, Fetzer DT, Fung AW, Do RKG, Bashir MR, Lee J, Consul N, Olmsted R, Kambadakone A, Taouli B, Furlan A, Sirlin CB, Hsieh P. Online Liver Imaging Course; Pivoting to Transform Radiology Education During the SARS-CoV-2 Pandemic. Acad Radiol 2021; 28:119-127. [PMID: 33109449 PMCID: PMC7538097 DOI: 10.1016/j.acra.2020.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 10/28/2022]
Abstract
PURPOSE The SARS-CoV-2 pandemic has drastically disrupted radiology in-person education. The purpose of this study was to assess the implementation of a virtual teaching method using available technology and its role in the continuity of education of practicing radiologists and trainees during the pandemic. METHODS The authors created the Online Liver Imaging Course (OLIC) that comprised 28 online comprehensive lectures delivered in real-time and on-demand over six weeks. Radiologists and radiology trainees were asked to register to attend the live sessions. At the end of the course, we conducted a 46-question survey among registrants addressing their training level, perception of virtual conferencing, and evaluation of the course content. RESULTS One thousand four hundred and thirty four radiologists and trainees completed interest sign up forms before the start of the course with the first webinar having the highest number of live attendees (343 people). On average, there were 89 live participants per session and 750 YouTube views per recording (as of July 9, 2020). After the end of the course, 487 attendees from 37 countries responded to the postcourse survey for an overall response rate of (33%). Approximately (63%) of participants were practicing radiologists while (37%) were either fellows or residents and rarely medical students. The overwhelming majority (97%) found the OLIC webinar series to be beneficial. Essentially all attendees felt that the webinar sessions met (43%) or exceeded (57%) their expectations. When asked about their perception of virtual conferences after attending OLIC lectures, almost all attendees (99%) enjoyed the virtual conference with a majority (61%) of the respondents who enjoyed the virtual format more than in-person conferences, while (38%) enjoyed the webinar format but preferred in-person conferences. When asked about the willingness to attend virtual webinars in the future, (84%) said that they would attend future virtual conferences even if in-person conferences resume while (15%) were unsure. CONCLUSION The success of the OLIC, attributed to many factors, indicates that videoconferencing technology provides an inexpensive alternative to in-person radiology conferences. The positive responses to our postcourse survey suggest that virtual education will remain to stay. Educational institutions and scientific societies should foster such models.
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Affiliation(s)
- Khaled M Elsayes
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030.
| | - Robert M Marks
- Naval Medical Center San Diego, CA, and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Serageldin Kamel
- Clinical Neurosciences Imaging Center, Yale University School of Medicine, New Haven, Connecticut
| | - Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital; Department of Radiology, University of Cincinnati College of Medicine, Ohio
| | - Ania Z Kielar
- Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - Parth Patel
- McGovern Medical School at UT Health, Houston, Texas
| | | | - Kathryn J Fowler
- Department of Radiology, University of California San Diego, San Diego, California
| | - Sameh Nassar
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Houston, TX, 77030
| | | | - Aya Kamaya
- Department of Radiology, Stanford University Medical Center, Stanford, California
| | | | | | | | - Alice W Fung
- Department of Radiology, Oregon Health and Science University, Portland, Oregon
| | - Richard K G Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - James Lee
- Department of Radiology, University of Kentucky, Lexington, Kentucky
| | - Nikita Consul
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Texas
| | - Richard Olmsted
- Department of Diagnostic Radiology, Baylor College of Medicine, Houston, Texas
| | - Avinash Kambadakone
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Bachir Taouli
- Department of Radiology/Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alessandro Furlan
- Department of Radiology, University of Pittsburgh Medical Center, Pennsylvania
| | - Claude B Sirlin
- Department of Radiology, University of California San Diego, San Diego, California
| | - Peggy Hsieh
- Office of Educational Programs, McGovern Medical School at UT Health, Houston, Texas
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Chernyak V, Horowitz JM, Kamel IR, Arif-Tiwari H, Bashir MR, Cash BD, Farrell J, Goldstein A, Grajo JR, Gupta S, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Liver Lesion-Initial Characterization. J Am Coll Radiol 2020; 17:S429-S446. [PMID: 33153555 DOI: 10.1016/j.jacr.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 02/08/2023]
Abstract
Incidental liver masses are commonly identified on imaging performed for other indications. Since the prevalence of benign focal liver lesions in adults is high, even in patients with primary malignancy, accurate characterization of incidentally detected lesions is of paramount clinical importance. This document reviews utilization of various imaging modalities for characterization of incidentally detected liver lesions, discussed in the context of several clinical scenarios. For each clinical scenario, a summary of current evidence supporting the use of a given diagnostic modality is reported. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | | | - Brooks D Cash
- University of Texas Health Science Center at Houston and McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | - James Farrell
- Interventional Endoscopy and Pancreatic Diseases, New Haven, Connecticut; American Gastroenterological Association
| | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | - Samir Gupta
- Rush University Medical Center, Chicago, Illinois; American College of Surgeons
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Patel MD, Horrow MM, Kamaya A, Frates MC, Dahiya N, Golding L, Chong WK, Gerena M, Ghate S, Glanc P, Goldbach AR, Gupta S, Hill PA, Johnson SI, Kocher MR, Rubin E, Sohaey R, Waltz JT, Wolfman DJ, Middleton WD. Mapping the Ultrasound Landscape to Define Point-of-Care Ultrasound and Diagnostic Ultrasound: A Proposal From the Society of Radiologists in Ultrasound and ACR Commission on Ultrasound. J Am Coll Radiol 2020; 18:42-52. [PMID: 33007309 DOI: 10.1016/j.jacr.2020.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/28/2020] [Accepted: 09/01/2020] [Indexed: 12/29/2022]
Abstract
Current descriptions of ultrasound evaluations, including use of the term "point-of-care ultrasound" (POCUS), are imprecise because they are predicated on distinctions based on the device used to obtain images, the location where the images were obtained, the provider who obtained the images, or the focus of the examination. This is confusing because it does not account for more meaningful distinctions based on the setting, comprehensiveness, and completeness of the evaluation. In this article, the Society of Radiologists in Ultrasound and the members of the American College of Radiology Ultrasound Commission articulate a map of the ultrasound landscape that divides sonographic evaluations into four distinct categories on the basis of setting, comprehensiveness, and completeness. Details of this classification scheme are elaborated, including important clarifications regarding what ensures comprehensiveness and completeness. Practical implications of this framework for future research and reimbursement paradigms are highlighted.
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Affiliation(s)
- Maitray D Patel
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona.
| | - Mindy M Horrow
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Einstein Medical Center, Philadelphia, Pennsylvania
| | - Aya Kamaya
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Stanford Medical Center, Stanford, California
| | - Mary C Frates
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nirvikar Dahiya
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Division Chair, Ultrasound, Department of Radiology, Mayo Clinic Arizona, Phoenix, Arizona
| | - Lauren Golding
- Triad Radiology Associates, Winston Salem, North Carolina; Chair, American College of Radiology Commission on Ultrasound, Reston, Virginia
| | - Wui K Chong
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, Texas; Chair, American College of Radiology Economics Committee on Ultrasound, Reston, Virginia
| | - Marielia Gerena
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Quality and Patient Safety, Department of Radiology and Biomedical Sciences, Loyola University Medical Center, Maywood, Illinois
| | - Sujata Ghate
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Duke University Medical Center, Durham, North Carolina; Treasurer, North Carolina Radiological Society, Lewisville, North Carolina
| | - Phyllis Glanc
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Alyssa R Goldbach
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania
| | - Sonia Gupta
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Ultrasound, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Paul A Hill
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stephen I Johnson
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Section Head, Ultrasound, Department of Radiology, Ochsner Clinic Foundation, New Orleans, Louisiana
| | - Madison R Kocher
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Eric Rubin
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Crozer-Keystone Health System, Springfield, Pennsylvania; Chair, American College of Radiology Commission on Human Resources, Reston, Virginia
| | - Roya Sohaey
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Director of Ultrasound, Department of Radiology, Oregon Health & Science University, Portland, Oregon
| | - Jeffrey T Waltz
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Medical University of South Carolina, Charleston, South Carolina
| | - Darcy J Wolfman
- American College of Radiology Commission on Ultrasound, Reston, Virginia; Department of Radiology, Johns Hopkins School of Medicine, Washington, District of Columbia; Chair, American College of Radiology Ultrasound Accreditation Committee, Reston, Virginia
| | - William D Middleton
- Society of Radiologists in Ultrasound Executive Board, Reston, Virginia; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
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Hindman NM, Arif-Tiwari H, Kamel IR, Al-Refaie WB, Bartel TB, Cash BD, Chernyak V, Goldstein A, Grajo JR, Horowitz JM, Kamaya A, McNamara MM, Porter KK, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria ® Jaundice. J Am Coll Radiol 2020; 16:S126-S140. [PMID: 31054739 DOI: 10.1016/j.jacr.2019.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 02/07/2023]
Abstract
Jaundice is the end result of myriad causes, which makes the role of imaging in this setting particularly challenging. In the United States, the most common causes of all types of jaundice fall into four categories including hepatitis, alcoholic liver disease, blockage of the common bile duct by a gallstone or tumor, and toxic reaction to a drug or medicinal herb. Clinically, differentiating between the various potential etiologies of jaundice requires a detailed history, targeted physical examination, and pertinent laboratory studies, the results of which allow the physician to categorize the type of jaundice into mechanical or nonmechanical causes. Imaging modalities used to evaluate the jaundiced patient (all etiologies) include abdominal ultrasound (US), CT, MR cholangiopancreatography, endoscopic retrograde cholangiopancreatography and endoscopic US. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Waddah B Al-Refaie
- Georgetown University Hospital, Washington, District of Columbia; American College of Surgeons
| | | | - Brooks D Cash
- University of Texas McGovern Medical School, Houston, Texas; American Gastroenterological Association
| | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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45
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Fábrega-Foster K, Kamel IR, Horowitz JM, Arif-Tiwari H, Bashir MR, Chernyak V, Goldstein A, Grajo JR, Hindman NM, Kamaya A, McNamara MM, Porter KK, Scheiman JM, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Pancreatic Cyst. J Am Coll Radiol 2020; 17:S198-S206. [PMID: 32370963 DOI: 10.1016/j.jacr.2020.01.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 02/07/2023]
Abstract
Incidental pancreatic cysts are increasingly detected on imaging studies performed for unrelated indications and may be incompletely characterized on these studies. Adequate morphological characterization is critical due to the small risk of malignant degeneration associated with neoplastic pancreatic cysts, as well as the risk of associated pancreatic adenocarcinoma. For all pancreatic cysts, both size and morphology determine management. Specifically, imaging detection of features, such as pancreatic ductal communication and presence or absence of worrisome features or high-risk stigmata, have important management implications. The recommendations in this publication determine the appropriate initial imaging study to further evaluate a pancreatic cyst that was incidentally detected on a nondedicated imaging study. The recommendations are designed to maximize the yield of diagnostic information in order to better risk-stratify pancreatic cysts and assist in guiding future management. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | | | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | | | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | - James M Scheiman
- University of Virginia Health System, Charlottesville, Virginia; American Gastroenterological Association
| | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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46
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Bashir MR, Horowitz JM, Kamel IR, Arif-Tiwari H, Asrani SK, Chernyak V, Goldstein A, Grajo JR, Hindman NM, Kamaya A, McNamara MM, Porter KK, Solnes LB, Srivastava PK, Zaheer A, Carucci LR. ACR Appropriateness Criteria® Chronic Liver Disease. J Am Coll Radiol 2020; 17:S70-S80. [PMID: 32370979 DOI: 10.1016/j.jacr.2020.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 12/12/2022]
Abstract
The liver fibrosis stage is the most important clinical determinate of morbidity and mortality in patients with chronic liver diseases. With newer therapies, liver fibrosis can be stabilized and possibly reversed, thus accurate diagnosis and staging of liver fibrosis are clinically important. Ultrasound, CT, and conventional MRI can be used to establish the diagnosis of advanced fibrosis/cirrhosis but have limited utility for assessing earlier stages of fibrosis. Elastography-based ultrasound and MRI techniques are more useful for assessment of precirrhotic hepatic fibrosis. In patients with advanced fibrosis at risk for hepatocellular carcinoma (HCC), ultrasound is the surveillance modality recommended by international guidelines in nearly all circumstances. However, in patients in whom ultrasound does not assess the liver well, including those with severe steatosis or obesity, multiphase CT or MRI may have a role in surveillance for HCC. Both multiphase CT and MRI can be used for continued surveillance in patients with a history of HCC, and contrast-enhanced ultrasound may have an emerging role in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | | | - Ihab R Kamel
- Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hina Arif-Tiwari
- University of Arizona, Banner University Medical Center, Tucson, Arizona
| | - Sumeet K Asrani
- Baylor University Medical Center, Dallas, Texas; American Association for the Study of Liver Diseases
| | | | | | - Joseph R Grajo
- University of Florida College of Medicine, Gainesville, Florida
| | | | - Aya Kamaya
- Stanford University Medical Center, Stanford, California
| | | | | | | | - Pavan K Srivastava
- University of Illinois College of Medicine, Chicago, Illinois; American College of Physicians
| | | | - Laura R Carucci
- Specialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia
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Abstract
Ultrasound plays an essential role in the initial evaluation of patients with suspected or confirmed acute pancreatitis. In addition to evaluation of the pancreatic parenchyma, ultrasound is used for assessment of the gallbladder, biliary tree, peripancreatic tissues, and regional vascular structures. While enlarged and edematous pancreas are classic sonographic features of acute pancreatitis, the pancreas may appear sonographically normal in the setting of acute pancreatitis. Nonetheless, sonographic evaluation in this setting is valuable because assessment for etiologic factors such as gallstones or evidence of biliary obstruction are best performed with ultrasound. Complications of pancreatitis such as peripancreatic fluid collections, venous thrombosis, or arterial pseudoaneurysm can be identified with careful and focused ultrasound examination. Knowledge of various scanning techniques can help to mitigate some of the commonly encountered barriers to sonographic visualization of the pancreas and right upper quadrant structures. Ultrasound can also be used for guidance of percutaneous treatment such as drainage of fluid collections or pseudoaneurysm thrombosis. Difficulty in differentiating edematous from necrotizing pancreatitis can be mitigated with the use of contrast-enhanced ultrasound to assess pancreatic parenchymal enhancement.
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Affiliation(s)
- David P Burrowes
- University of Calgary Cumming School of Medicine, 1403 29 St NW, Calgary, AB, T2N 2T9, Canada.
| | - Hailey H Choi
- UCSF, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Shuchi K Rodgers
- Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Philadelphia, PA, 19141, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - David T Fetzer
- UT Southwestern Medical Center, Department of Radiology, 5323 Harry Hines Blvd E6-230, Dallas, TX, 75390-9316, USA
| | - Aya Kamaya
- Stanford University Department of Radiology, 300 Pasteur Drive H1307, Stanford, CA, 94305, USA
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48
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El Kaffas A, Hoogi A, Zhou J, Durot I, Wang H, Rosenberg J, Tseng A, Sagreiya H, Akhbardeh A, Rubin DL, Kamaya A, Hristov D, Willmann JK. Spatial Characterization of Tumor Perfusion Properties from 3D DCE-US Perfusion Maps are Early Predictors of Cancer Treatment Response. Sci Rep 2020; 10:6996. [PMID: 32332790 PMCID: PMC7181711 DOI: 10.1038/s41598-020-63810-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 03/26/2020] [Indexed: 02/08/2023] Open
Abstract
There is a need for noninvasive repeatable biomarkers to detect early cancer treatment response and spare non-responders unnecessary morbidities and costs. Here, we introduce three-dimensional (3D) dynamic contrast enhanced ultrasound (DCE-US) perfusion map characterization as inexpensive, bedside and longitudinal indicator of tumor perfusion for prediction of vascular changes and therapy response. More specifically, we developed computational tools to generate perfusion maps in 3D of tumor blood flow, and identified repeatable quantitative features to use in machine-learning models to capture subtle multi-parametric perfusion properties, including heterogeneity. Models were developed and trained in mice data and tested in a separate mouse cohort, as well as early validation clinical data consisting of patients receiving therapy for liver metastases. Models had excellent (ROC-AUC > 0.9) prediction of response in pre-clinical data, as well as proof-of-concept clinical data. Significant correlations with histological assessments of tumor vasculature were noted (Spearman R > 0.70) in pre-clinical data. Our approach can identify responders based on early perfusion changes, using perfusion properties correlated to gold-standard vascular properties.
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Affiliation(s)
- Ahmed El Kaffas
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, CA, USA. .,Department of Radiology, Integrative Biomedical Imaging Informatics at Stanford, School of Medicine, Stanford University, Stanford, CA, USA. .,Department of Radiology, Body Imaging, Stanford University, Stanford, CA, USA.
| | - Assaf Hoogi
- Department of Radiology, Integrative Biomedical Imaging Informatics at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jianhua Zhou
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Isabelle Durot
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Huaijun Wang
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jarrett Rosenberg
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Albert Tseng
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Hersh Sagreiya
- Department of Radiology, Integrative Biomedical Imaging Informatics at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Alireza Akhbardeh
- Department of Radiology, Integrative Biomedical Imaging Informatics at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Daniel L Rubin
- Department of Radiology, Integrative Biomedical Imaging Informatics at Stanford, School of Medicine, Stanford University, Stanford, CA, USA
| | - Aya Kamaya
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, CA, USA.,Department of Radiology, Body Imaging, Stanford University, Stanford, CA, USA
| | - Dimitre Hristov
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Jürgen K Willmann
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, CA, USA.,Department of Radiology, Body Imaging, Stanford University, Stanford, CA, USA
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Rodgers SK, Fetzer DT, Gabriel H, Seow JH, Choi HH, Maturen KE, Wasnik AP, Morgan TA, Dahiya N, O'Boyle MK, Kono Y, Sirlin CB, Kamaya A. Role of US LI-RADS in the LI-RADS Algorithm. Radiographics 2020; 39:690-708. [PMID: 31059393 DOI: 10.1148/rg.2019180158] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The US Liver Imaging Reporting and Data System (LI-RADS) was released in 2017 and is the newest of the four American College of Radiology (ACR) LI-RADS algorithms. US LI-RADS provides standardized terminology, technical recommendations, and a reporting framework for US examinations performed for screening or surveillance in patients at risk for developing hepatocellular carcinoma (HCC). The appropriate patient population for screening and surveillance includes individuals who are at risk for developing HCC but do not have known or suspected cancer. This includes patients with cirrhosis from any cause and subsets of patients with chronic hepatitis B virus infection in the absence of cirrhosis. In an HCC screening or surveillance study, US LI-RADS recommends assigning two scores that apply to the entire study: the US category, which determines follow-up, and a visualization score, which communicates the expected level of sensitivity of the examination but does not affect management. Three US categories are possible: US-1 negative, a study with no evidence of HCC; US-2 subthreshold, a study in which an observation less than 10 mm is depicted that is not definitely benign; and US-3 positive, a study in which an observation greater than or equal to 10 mm or a new thrombus in vein is identified, for which diagnostic contrast material-enhanced imaging is recommended. Three visualization scores are possible: A (no or minimal limitations), B (moderate limitations), and C (severe limitations). ©RSNA, 2019.
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Affiliation(s)
- Shuchi K Rodgers
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - David T Fetzer
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Helena Gabriel
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - James H Seow
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Hailey H Choi
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Katherine E Maturen
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Ashish P Wasnik
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Tara A Morgan
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Nirvikar Dahiya
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Mary K O'Boyle
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Yuko Kono
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Claude B Sirlin
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
| | - Aya Kamaya
- From the Department of Radiology, Einstein Medical Center, 5501 Old York Rd, Levy Ground, Philadelphia, PA 19141 (S.K.R.); Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (D.T.F.); Department of Radiology, Northwestern Memorial Hospital, Chicago, Ill (H.G.); Department of Radiology, Royal Perth Hospital, Perth, Australia (J.H.S.); Department of Radiology, Stanford University School of Medicine, Stanford, Calif (H.H.C.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (K.E.M., A.P.W.); Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, Calif (T.A.M.); Department of Radiology, Mayo Clinic, Phoenix, Ariz (N.D.); Department of Radiology (M.K.O., Y.K.) and Liver Imaging Group, Department of Radiology (C.B.S.), University of California-San Diego Medical Center, San Diego, Calif; and Department of Radiology, Stanford University Medical Center, Stanford, Calif (A.K.)
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Pirmoazen AM, Khurana A, El Kaffas A, Kamaya A. Quantitative ultrasound approaches for diagnosis and monitoring hepatic steatosis in nonalcoholic fatty liver disease. Theranostics 2020; 10:4277-4289. [PMID: 32226553 PMCID: PMC7086372 DOI: 10.7150/thno.40249] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/14/2020] [Indexed: 12/13/2022] Open
Abstract
Nonalcoholic fatty liver disease is a major global health concern with increasing prevalence, associated with obesity and metabolic syndrome. Recently, quantitative ultrasound-based imaging techniques have dramatically improved the ability of ultrasound to detect and quantify hepatic steatosis. These newer ultrasound techniques possess many inherent advantages similar to conventional ultrasound such as universal availability, real-time capability, and relatively low cost along with quantitative rather than a qualitative assessment of liver fat. In addition, quantitative ultrasound-based imaging techniques are less operator dependent than traditional ultrasound. Here we review several different emerging quantitative ultrasound-based approaches used for detection and quantification of hepatic steatosis in patients at risk for nonalcoholic fatty liver disease. We also briefly summarize other clinically available imaging modalities for evaluating hepatic steatosis such as MRI, CT, and serum analysis.
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Affiliation(s)
- Amir M. Pirmoazen
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
| | - Aman Khurana
- Department of Radiology, University of Kentucky, Lexington, Kentucky
| | - Ahmed El Kaffas
- Department of Radiology, Molecular Imaging Program at Stanford, School of Medicine, Stanford University, Stanford, California
| | - Aya Kamaya
- Department of Radiology, School of Medicine, Stanford University, Stanford, California
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