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Khalil A, Laguna A, I Mehta T, Gowda PC, Gong AJ, Weinstein RM, Garg T, Ring NY, England RW, George Linguraru M, Jones CK, Weiss CR. Whole-lesion assessment of volume and signal changes after sclerotherapy of extremity venous malformations. Eur J Radiol 2024; 174:111397. [PMID: 38452733 DOI: 10.1016/j.ejrad.2024.111397] [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: 10/24/2023] [Revised: 02/12/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To investigate quantitative changes in MRI signal intensity (SI) and lesion volume that indicate treatment response and correlate these changes with clinical outcomes after percutaneous sclerotherapy (PS) of extremity venous malformations (VMs). METHODS VMs were segmented manually on pre- and post-treatment T2-weighted MRI using 3D Slicer to assess changes in lesion volume and SI. Clinical outcomes were scored on a 7-point Likert scale according to patient perception of symptom improvement; treatment response (success or failure) was determined accordingly. RESULTS Eighty-one patients with VMs underwent 125 PS sessions. Treatment success occurred in 77 patients (95 %). Mean (±SD) changes were -7.9 ± 24 cm3 in lesion volume and -123 ± 162 in SI (both, P <.001). Mean reduction in lesion volume was greater in the success group (-9.4 ± 24 cm3) than in the failure group (21 ± 20 cm3) (P =.006). Overall, lesion volume correlated with treatment response (ρ = -0.3, P =.004). On subgroup analysis, volume change correlated with clinical outcomes in children (ρ = -0.3, P =.03), in sodium tetradecyl sulfate-treated lesions (ρ = -0.5, P =.02), and in foot lesions (ρ = -0.6, P =.04). SI change correlated with clinical outcomes in VMs treated in 1 PS session (ρ = -0.3, P =.01) and in bleomycin-treated lesions (ρ = -0.4, P =.04). CONCLUSIONS Change in lesion volume is a reliable indicator of treatment response. Lesion volume and SI correlate with clinical outcomes in specific subgroups.
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Affiliation(s)
- Adham Khalil
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Surgery, Medstar Georgetown University Hospital, Washington, DC
| | - Amanda Laguna
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Tej I Mehta
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; United States Air Force Medical Corps, Falls Church, VA, USA
| | - Prateek C Gowda
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna J Gong
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Tushar Garg
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Natalie Y Ring
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ryan W England
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA; School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Craig K Jones
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Computer Science, The Johns Hopkins University, Baltimore, MD, USA; The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, USA.
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, USA
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Qiao Y, Xiong M, Zhang YJ, Tsappidi S, Kan P, Weiss CR, Hui F, Chen SR. Current and future directions in interventional neuro-oncology-are we there yet? J Neurointerv Surg 2024:jnis-2024-021540. [PMID: 38637150 DOI: 10.1136/jnis-2024-021540] [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: 01/29/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
Advancements in technology and technical expertise increasingly enable neurointerventionalists to deliver safer and more effective endovascular treatments to cancers of the brain, spine, head, and neck. In addition to established neuro-oncological interventions such as pre-surgical tumor embolization and percutaneous ablation, newer modalities focused on direct arterial infusion of chemotherapy, radioisotopes, and radiosensitizers continue to gain traction as complementary treatment options, while stem cell-mediated delivery of theranostic nanoparticles and oncolytic virus are being explored for even greater specificity in targeting cancers across the blood-brain barrier. This article aims to provide an overview of the current state of the art and future directions for the field of interventional neuro-oncology, as well as opportunities and challenges presented by this emerging treatment modality.
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Affiliation(s)
- Yang Qiao
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maggie Xiong
- Department of Diagnostic and Interventional Imaging, The University of Texas Health Science Center at Houston, Houston, Texas, USA
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Yi Jonathan Zhang
- Department of Neurointerventional Surgery, The Queen's Health Systems, Honolulu, Hawaii, USA
| | - Samuel Tsappidi
- Department of Neurointerventional Surgery, The Queen's Health Systems, Honolulu, Hawaii, USA
| | - Peter Kan
- Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Clifford R Weiss
- Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, USA
| | - Ferdinand Hui
- Department of Neurointerventional Surgery, The Queen's Health Systems, Honolulu, Hawaii, USA
| | - Stephen R Chen
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Quint EE, Liu Y, Shafaat O, Ghildayal N, Crosby H, Kamireddy A, Pol RA, Orandi BJ, Segev DL, Weiss CR, McAdams-DeMarco MA. Abdominal computed tomography measurements of body composition and waitlist mortality in kidney transplant candidates. Am J Transplant 2024; 24:591-605. [PMID: 37949413 PMCID: PMC10982050 DOI: 10.1016/j.ajt.2023.11.002] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/10/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
Body mass index is often used to determine kidney transplant (KT) candidacy. However, this measure of body composition (BC) has several limitations, including the inability to accurately capture dry weight. Objective computed tomography (CT)-based measures may improve pre-KT risk stratification and capture physiological aging more accurately. We quantified the association between CT-based BC measurements and waitlist mortality in a retrospective study of 828 KT candidates (2010-2022) with clinically obtained CT scans using adjusted competing risk regression. In total, 42.5% of candidates had myopenia, 11.4% had myopenic obesity (MO), 68.8% had myosteatosis, 24.8% had sarcopenia (probable = 11.2%, confirmed = 10.5%, and severe = 3.1%), and 8.6% had sarcopenic obesity. Myopenia, MO, and sarcopenic obesity were not associated with mortality. Patients with myosteatosis (adjusted subhazard ratio [aSHR] = 1.62, 95% confidence interval [CI]: 1.07-2.45; after confounder adjustment) or sarcopenia (probable: aSHR = 1.78, 95% CI: 1.10-2.88; confirmed: aSHR = 1.68, 95% CI: 1.01-2.82; and severe: aSHR = 2.51, 95% CI: 1.12-5.66; after full adjustment) were at increased risk of mortality. When stratified by age, MO (aSHR = 2.21, 95% CI: 1.28-3.83; P interaction = .005) and myosteatosis (aSHR = 1.95, 95% CI: 1.18-3.21; P interaction = .038) were associated with elevated risk only among candidates <65 years. MO was only associated with waitlist mortality among frail candidates (adjusted hazard ratio = 2.54, 95% CI: 1.28-5.05; P interaction = .021). Transplant centers should consider using BC metrics in addition to body mass index when a CT scan is available to improve pre-KT risk stratification at KT evaluation.
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Affiliation(s)
- Evelien E Quint
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Yi Liu
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Omid Shafaat
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nidhi Ghildayal
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Helen Crosby
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Arun Kamireddy
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert A Pol
- Division of Transplant Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Babak J Orandi
- Division of Endocrinology, Joan & Sanford Weill Medical College of Cornell University, New York, NY, USA
| | - Dorry L Segev
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mara A McAdams-DeMarco
- Department of Surgery, New York University Grossman School of Medicine, New York, NY, USA; Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.
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Latif MA, Bailey C, Weiss CR. Persistence After Treatment of Pulmonary Arteriovenous Malformations in Children. Cardiovasc Intervent Radiol 2024; 47:394-396. [PMID: 38062174 DOI: 10.1007/s00270-023-03625-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/14/2023] [Indexed: 03/09/2024]
Affiliation(s)
- Muhammad A Latif
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA
- Division of Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Christopher Bailey
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Interventional Radiology Center, The Johns Hopkins University School of Medicine, 7203 Sheikh Zayed Tower, Suite 7, 1800 Orleans Street, Baltimore, MD, 21287, USA.
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Gong AJ, Bosworth EC, Garg T, Weiss CR. Prospective Study of Polytetrafluoroethylene-Covered Microplugs and Detachable Coils for Embolization of Pulmonary Arteriovenous Malformations: Technical Results, Procedure Times, and Costs. J Vasc Interv Radiol 2024; 35:362-369. [PMID: 38123126 DOI: 10.1016/j.jvir.2023.12.008] [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] [Received: 06/14/2023] [Revised: 11/17/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE To determine time to occlusion and procedure costs of embolization of pulmonary arteriovenous malformations (PAVMs) using a polytetrafluoroethylene-covered microplug compared with embolization using detachable coils. MATERIALS AND METHODS In this prospective study, 37 patients (mean age, 39.1 years [SD ± 17.6]) with 82 PAVMs underwent embolization with microplug or detachable coils between April 2019 and January 2023. Technical success, procedure time intervals, and costs were analyzed. RESULTS In 37 patients, 82 PAVMs and 101 feeding arteries were successfully treated (microplug, 64; microplug + another device, 5; detachable coils alone, 32). Time from embolic device inserted into the catheter to device deployed and time to occlusion differed significantly between microplug and detachable coil cohorts (P < .0001 for both). Embolization with ≥1 microplug had a significantly shorter occlusion time than embolization with detachable coils (median, 10.0 minutes saved per feeding artery) (P < .0001). Compared with detachable coil embolization, microplug embolization saved a median of 9.0 minutes per feeding artery (P < .0001) and reduced room cost by a median of $429 per feeding artery (P < .0001). Device costs per feeding artery did not differ significantly between microplug ($2,790) and detachable coil embolization ($3,147) (P = .87). CONCLUSIONS Compared with coils, microplugs had an equally high technical success rate but significant time to occlusion and room costs savings per feeding artery. Total room cost and device cost together did not differ significantly between microplugs and coils. Microplugs may be considered technically effective and at least cost-neutral for PAVM embolization where clinically appropriate.
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Affiliation(s)
- Anna J Gong
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eugene C Bosworth
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tushar Garg
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, the Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Mirza-Aghazadeh-Attari M, Srinivas T, Kamireddy A, Kim A, Weiss CR. Radiomics Features Extracted From Pre- and Postprocedural Imaging in Early Prediction of Treatment Response in Patients Undergoing Transarterial Radioembolization of Hepatic Lesions: A Systematic Review, Meta-Analysis, and Quality Appraisal Study. J Am Coll Radiol 2024:S1546-1440(24)00002-4. [PMID: 38220040 DOI: 10.1016/j.jacr.2023.12.029] [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: 10/23/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
INTRODUCTION Transarterial radioembolization (TARE) is one of the most promising therapeutic options for hepatic masses. Radiomics features, which are quantitative numeric features extracted from medical images, are considered to have potential in predicting treatment response in TARE. This article aims to provide meta-analytic evidence and critically appraise the methodology of radiomics studies published in this regard. METHODS A systematic search was performed on PubMed, Scopus, Embase, and Web of Science. All relevant articles were retrieved, and the characteristics of the studies were extracted. The Radiomics Quality Score and Checklist for Evaluation of Radiomics Research were used to assess the methodologic quality of the studies. Pooled sensitivity, specificity, and area under the receiver operating characteristic curve in predicting objective response were determined. RESULTS The systematic review included 15 studies. The average Radiomics Quality Score of these studies was 11.4 ± 2.1, and the average Checklist for Evaluation of Radiomics Research score was 33± 6.7. There was a notable correlation (correlation coefficient = 0.73) between the two metrics. Adherence to quality measures differed considerably among the studies and even within different components of the same studies. The pooled sensitivity and specificity of the radiomics models in predicting complete or partial response were 83.5% (95% confidence interval 76%-88.9%) and 86.7% (95% confidence interval 78%-92%), respectively. CONCLUSION Radiomics models show great potential in predicting treatment response in TARE of hepatic lesions. However, the heterogeneity seen between the methodologic quality of studies may limit the generalizability of the results. Future initiatives should aim to develop radiomics signatures using multiple external datasets and adhere to quality measures in radiomics methodology.
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Affiliation(s)
- Mohammad Mirza-Aghazadeh-Attari
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Tara Srinivas
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Arun Kamireddy
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Alan Kim
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland.
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Srinivas T, Lulseged B, Mirza Aghazadeh Attari M, Borahay M, Weiss CR. Patient Characteristics Associated With Embolization Versus Hysterectomy for Uterine Fibroids: A Systematic Review and Meta-Analysis. J Am Coll Radiol 2024:S1546-1440(23)01037-2. [PMID: 38191081 DOI: 10.1016/j.jacr.2023.12.018] [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: 10/12/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024]
Abstract
INTRODUCTION Black and underinsured women in the United States are more likely than their counterparts to develop uterine fibroids (UFs) and experience more severe symptoms. Uterine artery embolization (UAE), a uterine-sparing therapeutic procedure, is less invasive than the common alternative, open hysterectomy. To determine whether demographic disparities persist in UF treatment utilization, we reviewed patient characteristics associated with UAE versus hysterectomy for UF among studies of US clinical practices. METHODS A systematic literature review was conducted via PubMed, Embase, and CINAHL (PROSPERO CRD42023455051), yielding 1,350 articles (January 1, 1995, to July 15, 2023) that outlined demographic characteristics of UAE compared with hysterectomy. Two readers screened for inclusion criteria, yielding 13 full-text US-based comparative studies specifying at least one common demographic characteristic. Random effects meta-analysis was performed on the data (STATA v18.0). Egger's regression test was used to quantify publication bias. RESULTS Nine (138,960 patients), four (183,643 patients), and seven (312,270 patients) studies were analyzed for race, insurance status, and age as predictors of treatment modality, respectively. Black race (odds ratio = 3.35, P < .01) and young age (P < .05) were associated with UAE, whereas private insurance (relative to Medicare and/or Medicaid) was not (odds ratio = 1.06, P = .52). Between-study heterogeneity (I2 > 50%) was detected in all three meta-analyses. Small-study bias was detected for age but not race or insurance. CONCLUSIONS AND IMPLICATIONS Knowledge of demographic characteristics of patients with UFs receiving UAE versus hysterectomy is sparse (n = 13 studies). Among these studies, which seem to be racially well distributed, Black and younger women are more likely to receive UAE than their counterparts.
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Affiliation(s)
- Tara Srinivas
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Mohammad Mirza Aghazadeh Attari
- Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Vascular and Interventional Radiology, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mostafa Borahay
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland; Director of the Division of General Gynecology & Obstetrics, Johns Hopkins Bayview Medical Center and Associate Professor of Gynecology and Obstetrics
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; Director of the Johns Hopkins HHT Center of Excellence and Professor of Radiology and Radiological Science.
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Gong AJ, Bolsegui ML, Lee EE, Mathai SC, Weiss CR. Assessing the Psychometric Validity of the Epistaxis Severity Score: Internal Consistency and Test-Retest Reliability. Am J Rhinol Allergy 2024; 38:38-46. [PMID: 37822162 DOI: 10.1177/19458924231207137] [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] [Indexed: 10/13/2023]
Abstract
BACKGROUND The Epistaxis Severity Score (ESS) is the gold-standard patient-reported outcome measure for evaluating nosebleed severity in patients with hereditary hemorrhagic telangiectasia (HHT). To date, the ESS has been assessed only for content validity and concurrent validity. OBJECTIVE We evaluate the internal consistency and test-retest reliability of the ESS. MATERIALS AND METHODS After receiving institutional review board approval, we sent an online survey battery, including the ESS survey, to 305 (39% male) English-speaking HHT patients ≥18 years old at a single center. Of those, 140 (46%) patients completed the battery, and 110/140 (79%) reported epistaxis. Cronbach's alpha and correlation analyses were used to evaluate internal consistency. For the test-retest reliability evaluation, we recruited 69 HHT patients during HHT clinic to complete 2 self-administered ESS surveys 2 weeks apart. Participants also completed a modified Clinical Global Impression-Improvement scale with readministration of the ESS survey. We calculated the intraclass correlation coefficient in a 2-way mixed model with absolute agreement. RESULTS The ESS survey demonstrated low internal consistency (Cronbach's alpha = 0.495), suggesting that it measured multiple unrelated concepts. Factor analysis revealed 3 latent factors with moderate intercorrelation, suggesting the presence of 3 related but distinct constructs underlying the ESS. However, the ESS demonstrated excellent test-retest reliability (intraclass correlation coefficient = 0.955; 95% CI, 0.91-0.98). CONCLUSION Although the ESS demonstrates high test-retest reliability, it may not adequately assess different dimensions of nosebleed severity. Additional correlated survey questions and sub-scores may be needed to increase internal consistency to accurately measure each component of epistaxis severity. It is necessary to acknowledge epistaxis severity from different dimensions and to consider evaluating individual ESS items separately for a comprehensive understanding.
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Affiliation(s)
- Anna J Gong
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | - Marisabel Linares Bolsegui
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
| | | | - Stephen C Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD
| | - Clifford R Weiss
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD
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Felix BM, Young OM, Andreou JT, Sarker S, Fuge MD, Krieger A, Weiss CR, Bailey CR, Sochol RD. FABRICATION OF MULTILUMEN MICROFLUIDIC TUBING FOR EX SITU DIRECT LASER WRITING. Proc IEEE Int Conf Micro Electro Mech Syst 2024; 2024:1158-1161. [PMID: 38516341 PMCID: PMC10955428 DOI: 10.1109/mems58180.2024.10439522] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Among the numerous additive manufacturing or "three-dimensional (3D) printing" techniques, two-photon Direct Laser Writing (DLW) is distinctively suited for applications that demand high geometric versatility with micron-to-submicron-scale feature resolutions. Recently, "ex situ DLW (esDLW)" has emerged as a powerful approach for printing 3D microfluidic structures directly atop meso/macroscale fluidic tubing that can be manipulated by hand; however, difficulties in creating custom esDLW-compatible multilumen tubing at such scales has hindered progress. To address this impediment, here we introduce a novel methodology for fabricating submillimeter multilumen tubing for esDLW 3D printing. Preliminary fabrication results demonstrate the utility of the presented strategy for resolving 743 μm-in-diameter tubing with three lumens-each with an inner diameter (ID) of 80 μm. Experimental results not only revealed independent flow of discrete fluorescently labelled fluids through each of the three lumens, but also effective esDLW-printing of a demonstrative 3D "MEMS" microstructure atop the tubing. These results suggest that the presented approach could offer a promising pathway to enable geometrically sophisticated microfluidic systems to be 3D printed with input and/or output ports fully sealed to multiple, distinct lumens of fluidic tubing for emerging applications in fields ranging from drug delivery and medical diagnostics to soft surgical robotics.
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Affiliation(s)
- Bailey M Felix
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
| | - Olivia M Young
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Jordi T Andreou
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Sunandita Sarker
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Mark D Fuge
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
| | - Axel Krieger
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher R Bailey
- Division of Vascular and Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ryan D Sochol
- Fischell Department of Bioengineering, University of Maryland, College Park, MD, USA
- Department of Mechanical Engineering, University of Maryland, College Park, MD, USA
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Gong AJ, Garg T, Khalil A, Gowda PC, Mathai SC, Rowan NR, Merlo CA, Weiss CR. Health-Related Quality of Life Outcome Measures in Individuals With Hereditary Hemorrhagic Telangiectasia: A Scoping Review. Am J Rhinol Allergy 2024; 38:60-76. [PMID: 37855028 DOI: 10.1177/19458924231207123] [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] [Indexed: 10/20/2023]
Abstract
BACKGROUND Studies evaluating health-related quality of life (HRQOL) in patients with hereditary hemorrhagic telangiectasia (HHT) have expanded rapidly in the past decade. These studies have evaluated QOL aspects ranging from the general QOL for patients living with HHT to intervention-specific outcomes. However, few tools have been fully validated across the spectrum of disease manifestations and interventions in HHT. OBJECTIVE In this scoping review, we aim to map the literature on HHT-QOL metrics, identify gaps, inform future QOL research, and facilitate future metric development. METHODS We analyzed articles in English that assessed at least 1 measure of general HRQOL, including physical health, mental health, social health, or intervention-specific QOL in patients with HHT. Searches across 2 bibliographic databases (PubMed and Scopus) yielded 186 articles after duplicates were removed. Sixty-three studies met eligibility criteria: 22 prospective studies (34.9%), 20 retrospective studies (31.7%), 12 cross-sectional studies (17.5%), 6 randomized controlled trials or secondary analyses of a randomized controlled trials (9.5%), 2 qualitative studies (3.2%), and 1 case-control study (1.6%). Two additional studies-1 prospective and 1 cross-sectional study-were identified at the October 2022 14th International HHT Conference and included, making a total of 65 studies. RESULTS The 65 eligible studies used 30 QOL instruments. Twenty studies characterized baseline HRQOL, and 45 studies evaluated QOL before and after treatment. Of those 45 studies, 37 evaluated HRQOL before and after therapies targeting epistaxis and nasal symptoms, 4 targeted therapies for liver arteriovenous malformations and high-output heart failure, 3 evaluated therapies for both epistaxis and gastrointestinal bleeding, and 1 evaluated treatment targeting gastrointestinal bleeding alone. CONCLUSIONS Comparison of results across studies remains challenging given the heterogeneity in outcomes measures. Further development of HHT-specific patient-reported outcomes instruments that capture the global illness experience of HHT is needed.
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Affiliation(s)
- Anna J Gong
- Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tushar Garg
- Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adham Khalil
- Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Prateek C Gowda
- Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Stephen C Mathai
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nicholas R Rowan
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christian A Merlo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Clifford R Weiss
- Division of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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11
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Fu Y, Abiola G, Tunacao J, Vairavamurthy JP, Nwoke F, Dreher M, Shin EJ, Anders RA, Kraitchman DL, Weiss CR. Balancing Safety and Efficacy to Determine the Most Suitable Size of Imaging-Visible Embolic Microspheres for Bariatric Arterial Embolization in a Preclinical Model. J Vasc Interv Radiol 2023; 34:2224-2232.e3. [PMID: 37684003 DOI: 10.1016/j.jvir.2023.08.042] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/20/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
OBJECTIVES To identify the most suitable size of imaging-visible embolic agents with balanced safety and efficacy for bariatric arterial embolization (BAE) in a preclinical model. MATERIALS AND METHODS Twenty-seven pigs were divided into 3 cohorts. In Cohort I, 16 pigs were randomized to receive (n = 4 each) 40-100-μm microspheres in 1 or 2 fundal arteries, 70-340-μm radiopaque microspheres in 2 fundal arteries, or saline. In Cohort II, 3 pigs underwent renal arterial embolization with either custom-made 100-200-μm, 200-250-μm, 200-300-μm, or 300-400-μm radiopaque microspheres or Bead Block 300-500 μm with microsphere distribution assessed histologically. In Cohort III, 8 pigs underwent BAE in 2 fundal arteries with tailored 100-200-μm radiopaque microspheres (n = 5) or saline (n = 3). RESULTS In Cohort I, no significant differences in weight or ghrelin expression were observed between BAE and control animals. Moderate-to-severe gastric ulcerations were noted in all BAE animals. In Cohort II, renal embolization with 100-200-μm microspheres occluded vessels with a mean diameter of 139 μm ± 31, which is within the lower range of actual diameters of Bead Block 300-500 μm. In Cohort III, BAE with 100-200-μm microspheres resulted in significantly lower weight gain (42.3% ± 5.7% vs 51.6% ± 2.9% at 8 weeks; P = .04), fundal ghrelin cell density (16.1 ± 6.7 vs 23.6 ± 12.6; P = .045), and plasma ghrelin levels (1,709 pg/mL ± 172 vs 4,343 pg/mL ± 1,555; P < .01) compared with controls and superficial gastric ulcers (5/5). CONCLUSIONS In this preclinical model, tailored 100-200-μm microspheres were shown to be most suitable for BAE in terms of safety and efficacy.
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Affiliation(s)
- Yingli Fu
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Godwin Abiola
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jessa Tunacao
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jenanan P Vairavamurthy
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Franklin Nwoke
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Dreher
- Peripheral Interventions Division, Boston Scientific Corporation, Marlborough, Massachusetts
| | - Eun Ji Shin
- Department of Gastroenterology and Hematology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert A Anders
- Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Dara L Kraitchman
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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12
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Patel P, Thomas R, Hamady M, Hague J, Raja J, Tan T, Bloom S, Richards T, Weiss CR, Prechtl CG, Smith C, Sasikaran T, Hesketh R, Bourmpaki E, Johnson NA, Fiorentino F, Ahmed AR. EMBIO trial study protocol: left gastric artery embolisation for weight loss in patients living with obesity with a BMI 35-50 kg/m 2. BMJ Open 2023; 13:e072327. [PMID: 37770263 PMCID: PMC10546152 DOI: 10.1136/bmjopen-2023-072327] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/17/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION Left gastric artery embolisation (LGAE) is a well-established treatment for major upper gastrointestinal (GI) bleeding when control is not established via upper GI endoscopy and recently has shown promising results for weight loss in small single arm studies. LGAE could be a treatment option in between our current tier-3 and tier-4 services for obesity. EMBIO is a National Institute for Health Research funded trial, a multicentre double-blinded randomised controlled trial between Imperial College National Health Service Trust and University College London Hospital, comparing LGAE versus Placebo procedure. The key aims of the trial is to evaluate LGAE efficacy on weight loss, its mechanism of action, safety profile and obesity-related comorbidities. METHODS AND ANALYSIS 76 participants will be recruited from the existing tier-3 database after providing informed consent. Key inclusion criteria include adults aged 18-70 with a body mass index 35-50 kg/m2 and appropriate anatomy of the left gastric artery and coeliac plexus on CT Angiogram. Key exclusion criteria included previous major abdominal and bariatric surgery, weight >150 kg, type 2 diabetes on any medications other than metformin and the use of weight modifying medications. Participants will undergo mechanistic visits 1 week prior to the intervention and 3, 6 and 12 months postintervention. Informed consent will be received from each participant and they will be randomised in a 1:1 ratio to left gastric artery embolisation and placebo treatment. Blinding strategies include the use of moderate doses of sedation, visual and auditory isolation. All participants will enter a tier-3 weight management programme postintervention. The primary analysis will estimate the difference between the groups in the mean per cent weight loss at 12 months. ETHICS AND DISSEMINATION This trial shall be conducted in full conformity with the 1964 Declaration of Helsinki and all subsequent revisions. Local research ethics approval was granted by London-Central Research Ethics Committee, (Reference 19/LO/0509) on 11 October 2019. The Medicines and Healthcare products Regulatory Agency (MHRA) issued the Letter of No Objection on 8 April 2022 (Reference CI/2022/0008/GB). The trial's development and progress are monitored by an independent trial steering committee and data monitoring and ethics committee. The researchers plan to disseminate results at conferences, in peer- reviewed journals as well as lay media and to patient organisations. TRIAL REGISTRATION NUMBER ISRCTN16158402.
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Affiliation(s)
- Prashant Patel
- Department of Cancer and Surgery, Imperial College London - St Mary's Campus, London, UK
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Robert Thomas
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Mohamad Hamady
- Surgery and Cancer, Imperial College London, London, UK
- Interventional Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Julian Hague
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jowad Raja
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tricia Tan
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Stephen Bloom
- Clinical Director, North West London Pathology, Head of Division of Diabetes, Endocrinology and Metabolism, Imperial College London, Hammersmith Hospital, London, UK
| | - Toby Richards
- Department of Cancer and Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Clifford R Weiss
- Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Claire Smith
- Imperial Clinical Trials Unit, Imperial College London, London, UK
| | | | - Richard Hesketh
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Elli Bourmpaki
- Department of Interventional Radiology, University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Ahmed R Ahmed
- Department of Cancer and Surgery, Imperial College London, London, UK
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13
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Yuan F, Gong A, Gowda P, Khalil A, Farhan A, Hafezi-Nejad N, Bailey CR, Mitchell SE, Gutierrez-Hernandez S, Ritzl EK, Weiss CR. Intraoperative Neuromonitoring during Peripheral Arteriovenous Malformation Embolization. J Vasc Interv Radiol 2023; 34:1609-1617.e2. [PMID: 37187436 DOI: 10.1016/j.jvir.2023.05.016] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/27/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023] Open
Abstract
PURPOSE To evaluate whether intraoperative neuromonitoring (IONM), including pre-embolization lidocaine injection challenge ("provocative testing") is associated with reduced risk of irreversible nerve injury during embolization of peripheral arteriovenous malformations (AVMs). MATERIALS AND METHODS Medical records of patients with peripheral AVMs who underwent embolotherapy with IONM with provocative testing between 2012 and 2021 were reviewed retrospectively. Data collected included patient demographic characteristics, AVM location and size, embolic agent used, IONM signal changes after lidocaine and embolic agent injections, postprocedural adverse events, and clinical outcomes. Decisions regarding whether embolization would proceed at specific locations were based on IONM findings after the lidocaine challenge and as embolization proceeded. RESULTS A cohort of 17 patients (mean age, 27 years ± 19; 5 women) who underwent 59 image-guided embolization procedures with adequate IONM data was identified. No permanent neurologic deficits occurred. Transient neurologic deficits were observed in 3 patients (4 sessions), comprising skin numbness (2 patients), extremity weakness (1 patient), and extremity weakness and numbness (1 patient). All neurologic deficits resolved by postoperative day 4 without additional treatment. CONCLUSIONS IONM, including provocative testing, during AVM embolization may minimize potential nerve injury.
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Affiliation(s)
- Frank Yuan
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland. https://twitter.com/DrFrankYuan
| | - Anna Gong
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Prateek Gowda
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adham Khalil
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahmed Farhan
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nima Hafezi-Nejad
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R Bailey
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sally E Mitchell
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Eva K Ritzl
- Divisions of Epilepsy and Neurocritical Care, Departments of Neurology and Anesthesia and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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14
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Weiss CR, Hafezi-Nejad N. Interventional Radiology: Past, Present, and Future. Radiology 2023; 308:e230809. [PMID: 37489986 DOI: 10.1148/radiol.230809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Affiliation(s)
- Clifford R Weiss
- From the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower, Suite 7203, Baltimore, MD 21287
| | - Nima Hafezi-Nejad
- From the Johns Hopkins University School of Medicine, 1800 Orleans St, Zayed Tower, Suite 7203, Baltimore, MD 21287
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15
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Weinstein RM, Gowda PC, Yuan F, Khalil A, Motaghi M, Garg T, Gong AJ, Lin DD, Weiss CR. Risk factors and clinical features associated with basal ganglia manganese deposition in patients with hereditary hemorrhagic telangiectasia. Clin Imaging 2023; 101:183-189. [PMID: 37390610 DOI: 10.1016/j.clinimag.2023.06.012] [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: 02/15/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND T1-hyperintensity of the basal ganglia (BG) due to manganese deposition is a known radiologic finding in patients with hereditary hemorrhagic telangiectasia (HHT), but risk factors and associated clinical manifestations are unclear. This study conducted a quantitative analysis of the association of T1-hyperintensity in HHT patients with specific risk factors, signs, and symptoms. METHODS Patients seen at our center between 2005 and 2020 with a definitive diagnosis of HHT who had an available non-contrast T1-weighted brain MRI were included. Hyperintensity was evaluated using oval regions of interest measurements. The BG: thalamus intensity ratio was used to quantitatively evaluate T1-hyperintensity. Patient laboratory values and clinical findings were collected from electronic medical records. Hyperintensity was analyzed for its association with laboratory values, and clinical findings. Variables were analyzed through regression analysis. RESULTS A total of 239 patients were included in this study. On 1.5 T scanners, values that were significant on multivariable regression analysis were age (p < .001), hepatic AVMs (p < .001), iron deficiency anemia (p = .0021), and cirrhosis (p = .016). On 3 T scanners, values that were significant on multivariable analysis were hepatic AVMs (p = .0024) and cirrhosis (p = .0056). On 3 T scanners, hyperintensity was significantly associated with tremor (OR = 1.17, p = .033), restless leg syndrome (OR = 1.22, p = .0086), and memory problems (OR = 1.17, p = .046). CONCLUSIONS BG hyperintensity due to manganese deposition is significantly associated with hepatic risk factors on 1.5 T and 3 T scanners and iron deficiency anemia on 1.5 T scanners. On 3 T scanners, T1-hyperintensity is associated with neuropsychiatric signs and symptoms, such as tremor, restless leg syndrome, and memory problems.
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Affiliation(s)
- Robert M Weinstein
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Prateek C Gowda
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Frank Yuan
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America
| | - Adham Khalil
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America
| | - Mina Motaghi
- Georgia Southern University, Jiann-Ping Hsu College of Public Health, Department of Biostatistics, Epidemiology and Environmental Health Sciences, United States of America
| | - Tushar Garg
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America
| | - Anna J Gong
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Doris D Lin
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Neuroradiology, United States of America
| | - Clifford R Weiss
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America.
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16
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Latif MA, Bailey CR, Motaghi M, Areda MA, Galiatsatos P, Mitchell S, Weiss CR. Reply to: “Further Consideration Required for Pulmonary Arteriovenous Malformations”. AJR Am J Roentgenol 2023; 220:908-909. [PMID: 37095670 DOI: 10.2214/ajr.23.29019] [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: 04/09/2023]
Affiliation(s)
| | | | | | | | | | - Sally Mitchell
- The Johns Hopkins University School of Medicine, Baltimore, MD
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17
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Yeom S, Cohen B, Weiss CR, Montano C, Wohler E, Sobreira N, Hammill AM, Comi A. Genetic testing in the evaluation of individuals with clinical diagnosis of atypical Sturge-Weber syndrome. Am J Med Genet A 2023; 191:983-994. [PMID: 36710374 DOI: 10.1002/ajmg.a.63106] [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: 10/28/2022] [Revised: 12/10/2022] [Accepted: 12/13/2022] [Indexed: 01/31/2023]
Abstract
Sturge-Weber Syndrome (SWS) is a rare vascular malformation disorder characterized by abnormal blood vessels in the brain, skin, and eye. SWS is most commonly caused by a somatic mosaic GNAQ-p.Arg183Gln variant. In this series, 12 patients presented for clinical evaluation of SWS but were noted to have atypical features, and therefore germline and/or somatic genetic testing was performed. Atypical features included extensive capillary malformation on the body as well as the face, frontal bossing, macrocephaly, telangiectasia, overgrowth of extremities, absence of neurologic signs and symptoms, and family history of vascular malformations. Five patients had a somatic GNAQ or GNA11 pathogenic variant, one patient had a somatic mosaic likely-pathogenic variant in PIK3CA, and another one had a somatic mosaic deletion that disrupted PTPRD. The other five patients had germline variants in RASA1, EPHB4, or KIT. Our findings suggest that patients presenting for SWS evaluation who have atypical clinical characteristics may have pathogenic germline or somatic variants in genes other than GNAQ or GNA11. Broad germline and somatic genetic testing in these patients with atypical findings may have implications for medical care, prognosis, and trial eligibility.
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Affiliation(s)
- SangEun Yeom
- Department of Neurology and Developmental Medicine, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA
| | - Bernard Cohen
- Departments of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Division of Interventional Radiology, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolina Montano
- National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elizabeth Wohler
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adrienne M Hammill
- Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Anne Comi
- Department of Neurology and Developmental Medicine, Hugo Moser Kennedy Krieger Research Institute, Baltimore, Maryland, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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18
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Albokhari D, Bailey CR, Hwang F, Weiss CR, Forsberg J, Sobreira N. Venous malformation may be a feature of EXT1-related hereditary multiple exostoses: A report of two unrelated probands. Am J Med Genet A 2023; 191:1570-1575. [PMID: 36869625 DOI: 10.1002/ajmg.a.63158] [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: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/05/2023]
Abstract
Hereditary multiple exostoses (HME), also known as hereditary multiple osteochondroma (HMO), is an autosomal dominant disorder caused by pathogenic variants in exostosin-1 or -2 (EXT1 or EXT2). It is characterized by the formation of multiple benign growing osteochondromas (exostoses) that most commonly affect the long bones; however, it may also occur throughout the body. Although many of these lesions are clinically asymptomatic, some can lead to chronic pain and skeletal deformities and interfere with adjacent neurovascular structures. Here, we report two unrelated probands that presented with a clinical and molecular diagnosis of HME with venous malformation, a clinical feature not previously reported in individuals with HME.
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Affiliation(s)
- Daniah Albokhari
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Pediatrics, Taibah University, College of Medicine, Madinah, Saudi Arabia
| | - Christopher R Bailey
- Division of Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Francis Hwang
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Division of Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiologic Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jonathan Forsberg
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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Shafaat O, Liu Y, Jackson KR, Motter JD, Boyarsky BJ, Latif MA, Yuan F, Khalil A, King EA, Zaheer A, Summers RM, Segev DL, McAdams-DeMarco M, Weiss CR. Association between Abdominal CT Measurements of Body Composition before Deceased Donor Liver Transplant with Posttransplant Outcomes. Radiology 2023; 306:e212403. [PMID: 36283115 PMCID: PMC9968774 DOI: 10.1148/radiol.212403] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 09/24/2021] [Revised: 09/02/2022] [Accepted: 09/19/2022] [Indexed: 11/11/2022]
Abstract
Background Pre-liver transplant (LT) sarcopenia is associated with poor survival. Methods exist for measuring body composition with use of CT scans; however, it is unclear which components best predict post-LT outcomes. Purpose To quantify the association between abdominal CT-based body composition measurements and post-LT mortality in a large North American cohort. Materials and Methods This was a retrospective cohort of adult first-time deceased-donor LT recipients from 2009 to 2018 who underwent pre-LT abdominal CT scans, including at the L3 vertebral level, at Johns Hopkins Hospital. Measurements included sarcopenia (skeletal muscle index [SMI] <50 in men and <39 in women), sarcopenic obesity, myosteatosis (skeletal muscle CT attenuation <41 mean HU for body mass index [BMI] <25 and <33 mean HU for BMI ≥25), visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), and VAT/SAT ratio. Covariates in the adjusted models were selected with use of least absolute shrinkage and selection operator regression with lambda chosen by means of 10-fold cross-validation. Cox proportional hazards models were used to quantify associations with post-LT mortality. Model discrimination was quantified using the Harrell C-statistic. Results A total of 454 recipients (median age, 57 years [IQR, 50-62 years]; 294 men) were evaluated. In the adjusted model, pre-LT sarcopenia was associated with a higher hazard ratio (HR) of post-LT mortality (HR, 1.6 [95% CI: 1.1, 2.4]; C-statistic, 0.64; P = .02). SMI was significantly negatively associated with survival after adjustment for covariates. There was no evidence that myosteatosis was associated with mortality (HR, 1.3 [95% CI: 0.86, 2.1]; C-statistic, 0.64; P = .21). There was no evidence that BMI (HR, 1.2 [95% CI: 0.95, 1.4]), VAT (HR, 1.0 [95% CI: 0.98, 1.1]), SAT (HR, 1.0 [95% CI: 0.97, 1.0]), and VAT/SAT ratio (HR, 1.1 [95% CI: 0.90, 1.4]) were associated with mortality (P = .15-.77). Conclusions Sarcopenia, as assessed on routine pre-liver transplant (LT) abdominal CT scans, was the only factor significantly associated with post-LT mortality. © RSNA, 2022 See also the editorial by Ruehm in this issue.
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Affiliation(s)
| | | | - Kyle R. Jackson
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Jennifer D. Motter
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Brian J. Boyarsky
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Muhammad A. Latif
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Frank Yuan
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Adham Khalil
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Elizabeth A. King
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Atif Zaheer
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Ronald M. Summers
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
| | - Dorry L. Segev
- From the Division of Vascular and Interventional Radiology (O.S., M.A.L., F.Y., A.K., C.R.W.) and Division of Abdominal Radiology (A.Z.), The Russell H. Morgan Department of Radiology and Radiological Science, and the Department of Surgery (O.S., Y.L., K.R.J., J.D.M., B.J.B., E.A.K., D.L.S., M.M.D.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Ste 7203, Baltimore, MD 21287; Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bethesda, Md (R.M.S.); and Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Md (D.L.S., M.M.D.)
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Garg T, Weiss CR, Gade TPF, Glasgow E, Palacios V, Doshi P, Oklu R, Sheth RA. Society of Interventional Radiology Foundation Funding to National Institutes of Health Funding: Report from the Society of Interventional Radiology Foundation/National Institutes of Health Task Force. J Vasc Interv Radiol 2023; 34:485-490. [PMID: 36400118 DOI: 10.1016/j.jvir.2022.11.010] [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] [Received: 08/13/2022] [Revised: 10/29/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
The Society of Interventional Radiology Foundation (SIRF) aims to support interventional radiology (IR) investigators by awarding numerous grants to promote the advancement of scientific knowledge in IR. Over the last 19 years, SIRF has awarded 227 research grants, amounting to more than $4.7 million. To increase the engagement of interventional radiologists and IR scientists with the National Institutes of Health (NIH), SIRF created a SIRF/NIH taskforce in 2020. Over the past couple of years, the task force has been working to assess the return on investment of SIRF grants in terms of NIH funding because this metric is an effective measure of assessing the early success of foundation funding. The objectives of this report are to assess SIRF funding from 2002 to 2020 and investigate the conversion of this funding into NIH grants by the same investigators. During the study period, more than $37.6 million in NIH funds were awarded to SIRF awardees, which shows a return of 8 NIH dollars for every 1 SIRF dollar invested.
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Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Terence P F Gade
- Penn Image-Guided Interventions Laboratory, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Emily Glasgow
- Society of Interventional Radiology Foundation, Fairfax, Virginia
| | | | - Pooja Doshi
- Society of Interventional Radiology Foundation, Fairfax, Virginia
| | - Rahmi Oklu
- Division of Vascular and Interventional Radiology, Laboratory for Patient Inspired Engineering, Mayo Clinic, Phoenix, Arizona
| | - Rahul A Sheth
- Department of Interventional Radiology, Division of Diagnostic Imaging, the University of Texas MD Anderson Cancer Center, Houston, Texas.
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21
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Lu A, Huang H, Hu Y, Zbijewski W, Unberath M, Siewerdsen JH, Weiss CR, Sisniega A. Deformable Motion Compensation for Intraprocedural Vascular Cone-beam CT with Sequential Projection Domain Targeting and Vessel-Enhancing Autofocus. Proc SPIE Int Soc Opt Eng 2023; 12466:124660P. [PMID: 37937266 PMCID: PMC10629230 DOI: 10.1117/12.2652137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Purpose Cone-beam CT (CBCT) is used in interventional radiology (IR) for identification of complex vascular anatomy, difficult to visualize in 2D fluoroscopy. However, long acquisition time makes CBCT susceptible to soft-tissue deformable motion that degrades visibility of fine vessels. We propose a targeted framework to compensate for deformable intra-scan motion via learned full-sequence models for identification of vascular anatomy coupled to an autofocus function specifically tailored to vascular imaging. Methods The vessel-targeted autofocus acts in two stages: (i) identification of vascular and catheter targets in the projection domain; and, (ii) autofocus optimization for a 4D vector field through an objective function that quantifies vascular visibility. Target identification is based on a deep learning model that operates on the complete sequence of projections, via a transformer encoder-decoder architecture that uses spatial-temporal self-attention modules to infer long-range feature correlations, enabling identification of vascular anatomy with highly variable conspicuity. The vascular autofocus function is derived through eigenvalues of the local image Hessian, which quantify the local image structure for identification of bright tubular structures. Motion compensation was achieved via spatial transformer operators that impart time dependent deformations to NPAR = 90 partial angle reconstructions, allowing for efficient minimization via gradient backpropagation. The framework was trained and evaluated in synthetic abdominal CBCTs obtained from liver MDCT volumes and including realistic models of contrast-enhanced vascularity with 15 to 30 end branches, 1 - 3.5 mm vessel diameter, and 1400 HU contrast. Results The targeted autofocus resulted in qualitative and quantitative improvement in vascular visibility in both simulated and clinical intra-procedural CBCT. The transformer-based target identification module resulted in superior detection of target vascularity and a lower number of false positives, compared to a baseline U-Net model acting on individual projection views, reflected as a 1.97x improvement in intersection-over-union values. Motion compensation in simulated data yielded improved conspicuity of vascular anatomy, and reduced streak artifacts and blurring around vessels, as well as recovery of shape distortion. These improvements amounted to an average 147% improvement in cross correlation computed against the motion-free ground truth, relative to the un-compensated reconstruction. Conclusion Targeted autofocus yielded improved visibility of vascular anatomy in abdominal CBCT, providing better potential for intra-procedural tracking of fine vascular anatomy in 3D images. The proposed method poses an efficient solution to motion compensation in task-specific imaging, with future application to a wider range of imaging scenarios.
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Affiliation(s)
- Alexander Lu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Heyuan Huang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Yicheng Hu
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Wojtek Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - Mathias Unberath
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Jeffrey H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Departments of Imaging Physics, Neurosurgery, and Radiation Physics, The University of Texas M.D. Anderson Cancer Center, TX, USA
| | - Clifford R Weiss
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Alejandro Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
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Huang H, Siewerdsen JH, Lu A, Hu Y, Zbijewski W, Unberath M, Weiss CR, Sisniega A. Multi-Stage Adaptive Spline Autofocus (MASA) with a Learned Metric for Deformable Motion Compensation in Interventional Cone-Beam CT. Proc SPIE Int Soc Opt Eng 2023; 12463:1246314. [PMID: 37937146 PMCID: PMC10629227 DOI: 10.1117/12.2654361] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
Purpose Cone-beam CT (CBCT) is widespread in abdominal interventional imaging, but its long acquisition time makes it susceptible to patient motion. Image-based autofocus has shown success in CBCT deformable motion compensation, via deep autofocus metrics and multi-region optimization, but it is challenged by the large parameter dimensionality required to capture intricate motion trajectories. This work leverages the differentiable nature of deep autofocus metrics to build a novel optimization strategy, Multi-Stage Adaptive Spine Autofocus (MASA), for compensation of complex deformable motion in abdominal CBCT. Methods MASA poses the autofocus problem as a multi-stage adaptive sampling strategy of the motion trajectory, sampled with Hermite spline basis with variable amplitude and knot temporal positioning. The adaptive method permits simultaneous optimization of the sampling phase, local temporal sampling density, and time-dependent amplitude of the motion trajectory. The optimization is performed in a multi-stage schedule with increasing number of knots that progressively accommodates complex trajectories in late stages, preconditioned by coarser components from early stages, and with minimal increase in dimensionality. MASA was evaluated in controlled simulation experiments with two types of motion trajectories: i) combinations of slow drifts with sudden jerk (sigmoid) motion; and ii) combinations of periodic motion sources of varying frequency into multi-frequency trajectories. Further validation was obtained in clinical data from liver CBCT featuring motion of contrast-enhanced vessels, and soft-tissue structures. Results The adaptive sampling strategy provided successful motion compensation in sigmoid trajectories, compared to fixed sampling strategies (mean SSIM increase of 0.026 compared to 0.011). Inspection of the estimated motion showed the capability of MASA to automatically allocate larger sampling density to parts of the scan timeline featuring sudden motion, effectively accommodating complex motion without increasing the problem dimension. Experiments on multi-frequency trajectories with 3-stage MASA (5, 10, and 15 knots) yielded a twofold SSIM increase compared to single-stage autofocus with 15 knots (0.076 vs 0.040, respectively). Application of MASA to clinical datasets resulted in simultaneous improvement on the delineation of both contrast-enhanced vessels and soft-tissue structures in the liver. Conclusion A new autofocus framework, MASA, was developed including a novel multi-stage technique for adaptive temporal sampling of the motion trajectory in combination with fully differentiable deep autofocus metrics. This novel adaptive sampling approach is a crucial step for application of deformable motion compensation to complex temporal motion trajectories.
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Affiliation(s)
- H Huang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD USA
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston TX USA
| | - A Lu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - Y Hu
- Department of Computer Science, Johns Hopkins University, Baltimore, MD USA
| | - W Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - M Unberath
- Department of Computer Science, Johns Hopkins University, Baltimore, MD USA
| | - C R Weiss
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD USA
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
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Garg T, Gong AJ, Khalil A, Gowda PC, Weinstein RM, Holly BP, Weiss CR. Racial and Ethnic Disparities among Participants in Hepatocellular Carcinoma Clinical Studies Evaluating Transarterial Therapies. J Vasc Interv Radiol 2023; 34:4-10.e3. [PMID: 36167300 DOI: 10.1016/j.jvir.2022.09.016] [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] [Received: 03/30/2022] [Revised: 08/31/2022] [Accepted: 09/17/2022] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To evaluate the racial and ethnic representation of transarterial therapy for hepatocellular carcinoma (HCC) clinical trials in the United States. MATERIALS AND METHODS The ClinicalTrials.gov database was examined to identify all completed studies with transarterial therapies for the management of HCC in the United States and extract information about the observed number of participants for each racial and ethnic group (based on the Office of Management and Budget definitions). The expected number of participants was calculated by multiplying the total number of participants in a trial with the U.S.-population HCC-based proportion for each group. The effects of the study phase, funding source, number of centers involved in the study, and the location of the participating center on racial and ethnic distribution were explored. RESULTS Seventy-nine relevant studies were identified, of which 27 (34.2%) and 18 (22.8%) reported ethnic and race characteristics, respectively. Most study participants were White (81%, 1,591/1,964) by ethnicity and not Hispanic or Latino (93%, 937/1,008) by race. In terms of the observed-to-expected ratios by race and ethnicity in all trials, White and not Hispanic or Latino participants were overrepresented with a ratio of 1.22 (1.10-1.37) and 1.33 (1.26-1.41), respectively, and all other racial and ethnic groups were underrepresented. The enrollment of African Americans and Asian Americans varied by the study phase, and a higher enrollment of African Americans was noted in the National Institutes of Health-funded and multicenter studies (P < .05). CONCLUSIONS This cross-sectional study demonstrates that in HCC transarterial therapy clinical trials, racial and ethnic minorities were underrepresented and the majority of the studies identified failed to report this demographic information.
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Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland. https://twitter.com/gargtushark
| | - Anna J Gong
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adham Khalil
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Prateek C Gowda
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert M Weinstein
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian P Holly
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Garg T, Som A, Smirniotopoulos J, Badar Z, Daye D, Weiss CR. Increasing Access to the National Institutes of Health Career Development Awards for Interventional Radiologists. Acad Radiol 2022; 29:1913-1914. [PMID: 35570125 DOI: 10.1016/j.acra.2022.04.009] [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: 04/09/2022] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 01/26/2023]
Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology (T.G., C.R.W.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Park 300, 1800 Orleans Street, Baltimore, Maryland; Division of Vascular and Interventional Radiology (A.S., D.D.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Division of Vascular and Interventional Radiology (J.S.), MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Columbia, Maryland; Division of Vascular and Interventional Radiology (Z.B.), UHN Department of Radiology, University of Toronto, Toronto, ON, Canada.
| | - Avik Som
- Division of Vascular and Interventional Radiology (T.G., C.R.W.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Park 300, 1800 Orleans Street, Baltimore, Maryland; Division of Vascular and Interventional Radiology (A.S., D.D.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Division of Vascular and Interventional Radiology (J.S.), MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Columbia, Maryland; Division of Vascular and Interventional Radiology (Z.B.), UHN Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - John Smirniotopoulos
- Division of Vascular and Interventional Radiology (T.G., C.R.W.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Park 300, 1800 Orleans Street, Baltimore, Maryland; Division of Vascular and Interventional Radiology (A.S., D.D.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Division of Vascular and Interventional Radiology (J.S.), MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Columbia, Maryland; Division of Vascular and Interventional Radiology (Z.B.), UHN Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - Zain Badar
- Division of Vascular and Interventional Radiology (T.G., C.R.W.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Park 300, 1800 Orleans Street, Baltimore, Maryland; Division of Vascular and Interventional Radiology (A.S., D.D.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Division of Vascular and Interventional Radiology (J.S.), MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Columbia, Maryland; Division of Vascular and Interventional Radiology (Z.B.), UHN Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - Dania Daye
- Division of Vascular and Interventional Radiology (T.G., C.R.W.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Park 300, 1800 Orleans Street, Baltimore, Maryland; Division of Vascular and Interventional Radiology (A.S., D.D.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Division of Vascular and Interventional Radiology (J.S.), MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Columbia, Maryland; Division of Vascular and Interventional Radiology (Z.B.), UHN Department of Radiology, University of Toronto, Toronto, ON, Canada
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology (T.G., C.R.W.), Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Park 300, 1800 Orleans Street, Baltimore, Maryland; Division of Vascular and Interventional Radiology (A.S., D.D.), Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Division of Vascular and Interventional Radiology (J.S.), MedStar Georgetown University Hospital, MedStar Washington Hospital Center, Columbia, Maryland; Division of Vascular and Interventional Radiology (Z.B.), UHN Department of Radiology, University of Toronto, Toronto, ON, Canada
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Khalil A, Garg T, Weiss CR. Percutaneous Cryoablation for Symptomatic Peripheral Congenital Hemangioma. J Vasc Interv Radiol 2022; 33:1349-1354. [PMID: 35850453 DOI: 10.1016/j.jvir.2022.07.013] [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] [Received: 02/04/2022] [Revised: 05/25/2022] [Accepted: 07/09/2022] [Indexed: 12/15/2022] Open
Abstract
Congenital hemangiomas (CHs) are rare, benign vascular tumors that are present at birth. They are divided into 3 major subtypes: rapidly involuting CHs, partially involuting CHs, and noninvoluting CHs (NICHs). There is a paucity of data in the literature regarding NICH and its management. Most symptomatic patients with NICH are managed with surgery. However, endovascular embolization, direct percutaneous sclerotherapy, or laser treatment can be used on a case-by-case basis. In this report, 3 cases with peripheral symptomatic NICH treated with percutaneous cryoablation are presented.
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Affiliation(s)
- Adham Khalil
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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26
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Reynolds T, Ma YQ, Kanawati AJ, Constantinidis A, Williams Z, Gang G, Dillon O, Russ T, Wang W, Ehtiati T, Weiss CR, Theodore N, Siewerdsen JH, Stayman JW, O'Brien RT. Extended Intraoperative Longitudinal 3-Dimensional Cone Beam Computed Tomography Imaging With a Continuous Multi-Turn Reverse Helical Scan. Invest Radiol 2022; 57:764-772. [PMID: 35510875 PMCID: PMC9547812 DOI: 10.1097/rli.0000000000000885] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Cone beam computed tomography (CBCT) imaging is becoming an indispensable intraoperative tool; however, the current field of view prevents visualization of long anatomical sites, limiting clinical utility. Here, we demonstrate the longitudinal extension of the intraoperative CBCT field of view using a multi-turn reverse helical scan and assess potential clinical utility in interventional procedures. MATERIALS AND METHODS A fixed-room robotic CBCT imaging system, with additional real-time control, was used to implement a multi-turn reverse helical scan. The scan consists of C-arm rotation, through a series of clockwise and anticlockwise rotations, combined with simultaneous programmed table translation. The motion properties and geometric accuracy of the multi-turn reverse helical imaging trajectory were examined using a simple geometric phantom. To assess potential clinical utility, a pedicle screw posterior fixation procedure in the thoracic spine from T1 to T12 was performed on an ovine cadaver. The multi-turn reverse helical scan was used to provide postoperative assessment of the screw insertion via cortical breach grading and mean screw angle error measurements (axial and sagittal) from 2 observers. For all screw angle measurements, the intraclass correlation coefficient was calculated to determine observer reliability. RESULTS The multi-turn reverse helical scans took 100 seconds to complete and increased the longitudinal coverage by 370% from 17 cm to 80 cm. Geometric accuracy was examined by comparing the measured to actual dimensions (0.2 ± 0.1 mm) and angles (0.2 ± 0.1 degrees) of a simple geometric phantom, indicating that the multi-turn reverse helical scan provided submillimeter and degree accuracy with no distortion. During the pedicle screw procedure in an ovine cadaver, the multi-turn reverse helical scan identified 4 cortical breaches, confirmed via the postoperative CT scan. Directly comparing the screw insertion angles (n = 22) measured in the postoperative multi-turn reverse helical and CT scans revealed an average difference of 3.3 ± 2.6 degrees in axial angle and 1.9 ± 1.5 degrees in the sagittal angle from 2 expert observers. The intraclass correlation coefficient was above 0.900 for all measurements (axial and sagittal) across all scan types (conventional CT, multi-turn reverse helical, and conventional CBCT), indicating excellent reliability between observers. CONCLUSIONS Extended longitudinal field-of-view intraoperative 3-dimensional imaging with a multi-turn reverse helical scan is feasible on a clinical robotic CBCT imaging system, enabling long anatomical sites to be visualized in a single image, including in the presence of metal hardware.
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Affiliation(s)
- Tess Reynolds
- From the The University of Sydney, Sydney, Australia
| | | | | | | | - Zoe Williams
- From the The University of Sydney, Sydney, Australia
| | | | - Owen Dillon
- From the The University of Sydney, Sydney, Australia
| | - Tom Russ
- University of Mannheim, Baden-Württemberg, Germany
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27
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Chen X, Shafaat O, Liu Y, King EA, Weiss CR, Xue QL, Walston JD, Segev DL, DeMarco MA. Moving toward clinical implementation of the physical frailty phenotype in kidney transplantation. Am J Transplant 2022; 22:2277-2278. [PMID: 35486021 PMCID: PMC9427715 DOI: 10.1111/ajt.17080] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/20/2022] [Accepted: 04/22/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Omid Shafaat
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Radiology and Radiological Science, The Russell H. Morgan, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yi Liu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth A King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Department of Radiology and Radiological Science, The Russell H. Morgan, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Qian-Li Xue
- Department of Medicine, Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeremy D Walston
- Department of Medicine, Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Mara A DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Garg T, Weiss CR, Sheth RA. Techniques for Profiling the Cellular Immune Response and Their Implications for Interventional Oncology. Cancers (Basel) 2022; 14:3628. [PMID: 35892890 PMCID: PMC9332307 DOI: 10.3390/cancers14153628] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/07/2022] Open
Abstract
In recent years there has been increased interest in using the immune contexture of the primary tumors to predict the patient's prognosis. The tumor microenvironment of patients with cancers consists of different types of lymphocytes, tumor-infiltrating leukocytes, dendritic cells, and others. Different technologies can be used for the evaluation of the tumor microenvironment, all of which require a tissue or cell sample. Image-guided tissue sampling is a cornerstone in the diagnosis, stratification, and longitudinal evaluation of therapeutic efficacy for cancer patients receiving immunotherapies. Therefore, interventional radiologists (IRs) play an essential role in the evaluation of patients treated with systemically administered immunotherapies. This review provides a detailed description of different technologies used for immune assessment and analysis of the data collected from the use of these technologies. The detailed approach provided herein is intended to provide the reader with the knowledge necessary to not only interpret studies containing such data but also design and apply these tools for clinical practice and future research studies.
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Affiliation(s)
- Tushar Garg
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (T.G.); (C.R.W.)
| | - Clifford R. Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA; (T.G.); (C.R.W.)
| | - Rahul A. Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
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Affiliation(s)
- Christopher R Bailey
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology (C.R.B., C.R.W.), and Johns Hopkins Department of Psychiatry and Behavioral Sciences (A.M.B.), Johns Hopkins Hospital, 1800 Orleans St, 7203 Sheikh Zayed Tower, Suite 7, Baltimore, MD 21287; and Department of Radiology, Weill Cornell Hospital Medicine, New York, NY (A.S.M.)
| | - Allison M Bailey
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology (C.R.B., C.R.W.), and Johns Hopkins Department of Psychiatry and Behavioral Sciences (A.M.B.), Johns Hopkins Hospital, 1800 Orleans St, 7203 Sheikh Zayed Tower, Suite 7, Baltimore, MD 21287; and Department of Radiology, Weill Cornell Hospital Medicine, New York, NY (A.S.M.)
| | - Anna Sophia McKenney
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology (C.R.B., C.R.W.), and Johns Hopkins Department of Psychiatry and Behavioral Sciences (A.M.B.), Johns Hopkins Hospital, 1800 Orleans St, 7203 Sheikh Zayed Tower, Suite 7, Baltimore, MD 21287; and Department of Radiology, Weill Cornell Hospital Medicine, New York, NY (A.S.M.)
| | - Clifford R Weiss
- From the Russell H. Morgan Department of Radiology and Radiological Sciences, Division of Vascular and Interventional Radiology (C.R.B., C.R.W.), and Johns Hopkins Department of Psychiatry and Behavioral Sciences (A.M.B.), Johns Hopkins Hospital, 1800 Orleans St, 7203 Sheikh Zayed Tower, Suite 7, Baltimore, MD 21287; and Department of Radiology, Weill Cornell Hospital Medicine, New York, NY (A.S.M.)
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Garg T, Chu LC, Zimmerman SL, Weiss CR, FCIRSE MDFSIR, Fishman EK, Azadi JR. Prevalence of Hepatic Steatosis in Adults Presenting to the Emergency Department Identified by Unenhanced Chest CT. Curr Probl Diagn Radiol 2022; 52:35-40. [DOI: 10.1067/j.cpradiol.2022.07.014] [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: 07/09/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022]
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Huang H, Siewerdsen JH, Zbijewski W, Weiss CR, Unberath M, Ehtiati T, Sisniega A. Reference-free learning-based similarity metric for motion compensation in cone-beam CT. Phys Med Biol 2022; 67. [PMID: 35636391 DOI: 10.1088/1361-6560/ac749a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 03/11/2022] [Accepted: 05/30/2022] [Indexed: 11/12/2022]
Abstract
Purpose. Patient motion artifacts present a prevalent challenge to image quality in interventional cone-beam CT (CBCT). We propose a novel reference-free similarity metric (DL-VIF) that leverages the capability of deep convolutional neural networks (CNN) to learn features associated with motion artifacts within realistic anatomical features. DL-VIF aims to address shortcomings of conventional metrics of motion-induced image quality degradation that favor characteristics associated with motion-free images, such as sharpness or piecewise constancy, but lack any awareness of the underlying anatomy, potentially promoting images depicting unrealistic image content. DL-VIF was integrated in an autofocus motion compensation framework to test its performance for motion estimation in interventional CBCT.Methods. DL-VIF is a reference-free surrogate for the previously reported visual image fidelity (VIF) metric, computed against a motion-free reference, generated using a CNN trained using simulated motion-corrupted and motion-free CBCT data. Relatively shallow (2-ResBlock) and deep (3-Resblock) CNN architectures were trained and tested to assess sensitivity to motion artifacts and generalizability to unseen anatomy and motion patterns. DL-VIF was integrated into an autofocus framework for rigid motion compensation in head/brain CBCT and assessed in simulation and cadaver studies in comparison to a conventional gradient entropy metric.Results. The 2-ResBlock architecture better reflected motion severity and extrapolated to unseen data, whereas 3-ResBlock was found more susceptible to overfitting, limiting its generalizability to unseen scenarios. DL-VIF outperformed gradient entropy in simulation studies yielding average multi-resolution structural similarity index (SSIM) improvement over uncompensated image of 0.068 and 0.034, respectively, referenced to motion-free images. DL-VIF was also more robust in motion compensation, evidenced by reduced variance in SSIM for various motion patterns (σDL-VIF = 0.008 versusσgradient entropy = 0.019). Similarly, in cadaver studies, DL-VIF demonstrated superior motion compensation compared to gradient entropy (an average SSIM improvement of 0.043 (5%) versus little improvement and even degradation in SSIM, respectively) and visually improved image quality even in severely motion-corrupted images.Conclusion: The studies demonstrated the feasibility of building reference-free similarity metrics for quantification of motion-induced image quality degradation and distortion of anatomical structures in CBCT. DL-VIF provides a reliable surrogate for motion severity, penalizes unrealistic distortions, and presents a valuable new objective function for autofocus motion compensation in CBCT.
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Affiliation(s)
- H Huang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America.,Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, United States of America.,Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States of America
| | - W Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
| | - C R Weiss
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, United States of America
| | - M Unberath
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States of America
| | - T Ehtiati
- Siemens Medical Solutions USA, Inc., Imaging & Therapy Systems, Hoffman Estates, IL, United States of America
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, United States of America
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Galiatsatos P, Wilson C, O'Brien J, Gong AJ, Angiolillo D, Johnson J, Myers C, Strout S, Mathai S, Robinson G, Rowan NR, Weiss CR. A lack of race and ethnicity data in the treatment of hereditary hemorrhagic telangiectasia: a systematic review of intravenous bevacizumab efficacy. Orphanet J Rare Dis 2022; 17:220. [PMID: 35698080 PMCID: PMC9195340 DOI: 10.1186/s13023-022-02371-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 05/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND For extreme hereditary hemorrhagic telangiectasia (HHT) disease, treatments such as intravenous bevacizumab are often utilized. However, whether its efficacy is similar across diverse races and ethnicities is unclear. METHODS In this systematic review, we performed a search for English-language articles identified through PubMed, Embase, and Scopus databases whose research occurred in the United States (US). Search terms related to HHT, epistaxis, and intravenous bevacizumab. We searched specifically for the intervention of intravenous bevacizumab because the term serves as a suitable surrogate to convey a patient who has both a diagnosis of HHT and established care. We focused on number of patients recruited in intravenous bevacizumab trials who were identified by race or ethnicity. RESULTS Our search identified 79 studies, of which four were conducted in the US. These four were selected for our systematic review. In these studies, 58 total patients were evaluated (ranging from 5 to 34 participants), whereby, information on age and gender were included. However, none of the US-based studies shared race or ethnicity data. CONCLUSION Inability to find studies regarding intravenous bevacizumab use in patients with HHT in which race and ethnicity are reported limits our ability to understand the therapy's efficacy in specific populations. Without emphasis on race and ethnicity in such trials, showing the potential of HHT-related diversity in individuals with this disease may reaffirm implicit bias around HHT diagnosis and treatment. Future work on HHT should emphasize sociodemographic data collection and reporting in an effort to understand this disease in diverse populations.
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Affiliation(s)
- Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA. .,The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA. .,Office of Diversity, Inclusion, and Health Equity, Baltimore, MD, USA. .,Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 4th Floor, Asthma and Allergy Building, Baltimore, MD, 21224, USA.
| | - Cheri Wilson
- Office of Diversity, Inclusion, and Health Equity, Baltimore, MD, USA
| | - Jaime O'Brien
- Albert Gnaegi Center for Health Care Ethics, Saint Louis University, Saint Louis, MO, USA
| | - Anna J Gong
- The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Dylan Angiolillo
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 4th Floor, Asthma and Allergy Building, Baltimore, MD, 21224, USA
| | - James Johnson
- Medicine for the Greater Good, Johns Hopkins School of Medicine, 4940 Eastern Avenue, 4th Floor, Asthma and Allergy Building, Baltimore, MD, 21224, USA
| | - Carlie Myers
- Division of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sara Strout
- Department of Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stephen Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Gina Robinson
- The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Nicholas R Rowan
- The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA
| | - Clifford R Weiss
- The Center of Clinical Excellence for Hereditary Hemorrhagic Telangiectasias at the Johns Hopkins Hospital, Baltimore, MD, USA
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Hu Y, Huang H, Siewerdsen JH, Zbijewski W, Unberath M, Weiss CR, Sisniega A. Simulation of Random Deformable Motion in Soft-Tissue Cone-Beam CT with Learned Models. Proc SPIE Int Soc Opt Eng 2022; 12304:1230413. [PMID: 36381251 PMCID: PMC9654724 DOI: 10.1117/12.2646720] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Cone-beam CT (CBCT) is widely used for guidance in interventional radiology but it is susceptible to motion artifacts. Motion in interventional CBCT features a complex combination of diverse sources including quasi-periodic, consistent motion patterns such as respiratory motion, and aperiodic, quasi-random, motion such as peristalsis. Recent developments in image-based motion compensation methods include approaches that combine autofocus techniques with deep learning models for extraction of image features pertinent to CBCT motion. Training of such deep autofocus models requires the generation of large amounts of realistic, motion-corrupted CBCT. Previous works on motion simulation were mostly focused on quasi-periodic motion patterns, and reliable simulation of complex combined motion with quasi-random components remains an unaddressed challenge. This work presents a framework aimed at synthesis of realistic motion trajectories for simulation of deformable motion in soft-tissue CBCT. The approach leveraged the capability of conditional generative adversarial network (GAN) models to learn the complex underlying motion present in unlabeled, motion-corrupted, CBCT volumes. The approach is designed for training with unpaired clinical CBCT in an unsupervised fashion. This work presents a first feasibility study, in which the model was trained with simulated data featuring known motion, providing a controlled scenario for validation of the proposed approach prior to extension to clinical data. Our proof-of-concept study illustrated the potential of the model to generate realistic, variable simulation of CBCT deformable motion fields, consistent with three trends underlying the designed training data: i) the synthetic motion induced only diffeomorphic deformations - with Jacobian Determinant larger than zero; ii) the synthetic motion showed median displacement of 0. 5 mm in regions predominantly static in the training (e.g., the posterior aspect of the patient laying supine), compared to a median displacement of 3.8 mm in regions more prone to motion in the training; and iii) the synthetic motion exhibited predominant directionality consistent with the training set, resulting in larger motion in the superior-inferior direction (median and maximum amplitude of 4.58 mm and 20 mm, > 2x larger than the two remaining direction). Together, the proposed framework shows the feasibility for realistic motion simulation and synthesis of variable CBCT data.
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Affiliation(s)
- Y Hu
- Dept. of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - H Huang
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - J H Siewerdsen
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - W Zbijewski
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
| | - M Unberath
- Dept. of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - C R Weiss
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - A Sisniega
- Dept. of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
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Fanning RP, Strout S, Rowan NR, Weiss CR, Galiatsatos P. The Impact on COVID-19 by Intravenous Bevacizumab Used for Hereditary Hemorrhagic Telangiectasia: A Case Report. J Med Cases 2022; 13:307-311. [PMID: 35837077 PMCID: PMC9239510 DOI: 10.14740/jmc3948] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 05/12/2022] [Indexed: 11/11/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) continues as an infectious pandemic. With emphasis on mitigating its impact globally, strategies have been emphasized on prevention to treatment in severe cases. As for pharmacotherapies, many have been researched, with a few being recommended for patients with COVID-19 depending upon their severity. Bevacizumab, a recombinant monoclonal antibody often used for oncological disease and rare genetic disorders, has gained attention in combatting COVID-19 due to the pharmacotherapy’s ability to inhibit vascular endothelial growth factor A (VEGF-A). VEGF has been identified as significantly upregulated in the lungs of persons who have died of COVID-19, raising interest for VEGF to be a potential target for patients with COVID-19. We present a case of a patient who was admitted due to complications of a rare genetic disorder, called hereditary hemorrhagic telangiectasia (HHT), warranting intravenous bevacizumab, who subsequently was diagnosed with COVID-19 pneumonia. We discuss the patient’s outcome and contribute to the growing potential of bevacizumab in the treatment of COVID-19.
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Affiliation(s)
- Ryan Patrick Fanning
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- The Hereditary Hemorrhagic Telangiectasia Center for Clinical Excellence, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sara Strout
- The Hereditary Hemorrhagic Telangiectasia Center for Clinical Excellence, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nicholas R. Rowan
- The Hereditary Hemorrhagic Telangiectasia Center for Clinical Excellence, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Clifford R. Weiss
- The Hereditary Hemorrhagic Telangiectasia Center for Clinical Excellence, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Panagis Galiatsatos
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- The Hereditary Hemorrhagic Telangiectasia Center for Clinical Excellence, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Corresponding Author: Panagis Galiatsatos, Division of Pulmonary and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21224, USA.
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Farhan A, Latif MA, Minhas A, Weiss CR. Cardiac and Hemodynamic Manifestations of Hereditary Hemorrhagic Telangiectasia. Int J Angiol 2022; 31:75-82. [PMID: 35923582 PMCID: PMC9341259 DOI: 10.1055/s-0042-1745842] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
The autosomal dominant trait hereditary hemorrhagic telangiectasia (HHT) causes multiorgan dysplastic lesions of the vasculature that can activate multiple physiological cascades leading to a broad array of cardiovascular diseases. Up to 78% of patients with HHT develop hepatic arteriovenous malformations (AVMs), which cause a hyperdynamic circulatory state secondary to hepatic/portal shunting. This condition can eventually progress to high-output cardiac failure (HOCF) with continued peripheral tissue hypoxemia. Treatment for HOCF is often limited to supportive measures (diuretics and treatment of anemia); however, recent studies using systemic bevacizumab have shown promise by substantially reducing the cardiac index. In the context of liver AVMs and high cardiac output, the pulmonary vasculature can also experience high flow. Without adequate dilation of pulmonary vessels, post-capillary pulmonary hypertension can develop. Another form of pulmonary hypertension observed in HHT, pulmonary arterial hypertension, is caused by HHT-related mutations in ENG and ACVRL1 causing congestive arteriopathy. Post-capillary pathogenesis is addressed by reducing the high-output state, whereas the pre-capillary state is treated with supportive mechanisms (diuretics, oxygen) and agents targeting pulmonary vasoreactivity: endothelin-1 receptor antagonists and phosphodiesterase-5 inhibitors. If either form of pulmonary hypertension is left untreated or proves refractory and progresses, the common hemodynamic complication is right heart failure. Targeted right heart therapies involve similar strategies to those of pulmonary arterial hypertension, with several experimental approaches under study. In this review, we describe in detail the mechanisms of pathogenesis, diagnosis, and treatment of the hemodynamic complications and associated cardiovascular diseases that may arise in patients with HHT.
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Affiliation(s)
- Ahmed Farhan
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad A. Latif
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Anum Minhas
- Division of Cardiology, Heart and Vascular Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R. Weiss
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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36
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Huang H, Siewerdsen JH, Zbijewski W, Weiss CR, Unberath M, Sisniega A. Context-Aware, Reference-Free Local Motion Metric for CBCT Deformable Motion Compensation. Proc SPIE Int Soc Opt Eng 2022; 12304:1230412. [PMID: 36381250 PMCID: PMC9665334 DOI: 10.1117/12.2646857] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Deformable motion is one of the main challenges to image quality in interventional cone beam CT (CBCT). Autofocus methods have been successfully applied for deformable motion compensation in CBCT, using multi-region joint optimization approaches that leverage the moderately smooth spatial variation motion of the deformable motion field with a local neighborhood. However, conventional autofocus metrics enforce images featuring sharp image-appearance, but do not guarantee the preservation of anatomical structures. Our previous work (DL-VIF) showed that deep convolutional neural networks (CNNs) can reproduce metrics of structural similarity (visual information fidelity - VIF), removing the need for a matched motion-free reference, and providing quantification of motion degradation and structural integrity. Application of DL-VIF within local neighborhoods is challenged by the large variability of local image content across a CBCT volume, and requires global context information for successful evaluation of motion effects. In this work, we propose a novel deep autofocus metric, based on a context-aware, multi-resolution, deep CNN design. In addition to the inclusion of contextual information, the resulting metric generates a voxel-wise distribution of reference-free VIF values. The new metric, denoted CADL-VIF, was trained on simulated CBCT abdomen scans with deformable motion at random locations and with amplitude up to 30 mm. The CADL-VIF achieved good correlation with the ground truth VIF map across all test cases with R2 = 0.843 and slope = 0.941. When integrated into a multi-ROI deformable motion compensation method, CADL-VIF consistently reduced motion artifacts, yielding an average increase in SSIM of 0.129 in regions with severe motion and 0.113 in regions with mild motion. This work demonstrated the capability of CADL-VIF to recognize anatomical structures and penalize unrealistic images, which is a key step in developing reliable autofocus for complex deformable motion compensation in CBCT.
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Affiliation(s)
- H Huang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
- Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - W Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
| | - C R Weiss
- Department of Radiology, Johns Hopkins University, Baltimore, MD
| | - M Unberath
- Department of Computer Science, Johns Hopkins University, Baltimore, MD
| | - A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD
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Raman AG, Jones C, Weiss CR. Machine Learning for Hepatocellular Carcinoma Segmentation at MRI: Radiology In Training. Radiology 2022; 304:509-515. [PMID: 35536132 DOI: 10.1148/radiol.212386] [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: 11/11/2022]
Abstract
A 68-year-old woman with a history of hepatocellular carcinoma underwent conventional transarterial chemoembolization. Manual tumor segmentation on images, which can be used to assess disease progression, is time consuming and may suffer from interobserver reliability issues. The authors present a how-to guide to develop machine learning algorithms for fully automatic segmentation of hepatocellular carcinoma and other tumors for lesion tracking over time.
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Affiliation(s)
- Alex G Raman
- From the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St, Pomona, CA 91766 (A.G.R.); Department of Computer Science, Malone Center for Engineering in Healthcare, Johns Hopkins University, Balrimore, Md (C.J.); and Department of Radiology and Radiologic Science, Division of Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD (C.R.W.)
| | - Craig Jones
- From the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St, Pomona, CA 91766 (A.G.R.); Department of Computer Science, Malone Center for Engineering in Healthcare, Johns Hopkins University, Balrimore, Md (C.J.); and Department of Radiology and Radiologic Science, Division of Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD (C.R.W.)
| | - Clifford R Weiss
- From the Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, 309 E 2nd St, Pomona, CA 91766 (A.G.R.); Department of Computer Science, Malone Center for Engineering in Healthcare, Johns Hopkins University, Balrimore, Md (C.J.); and Department of Radiology and Radiologic Science, Division of Interventional Radiology, Johns Hopkins Hospital, Baltimore, MD (C.R.W.)
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Chen X, Shafaat O, Liu Y, King EA, Weiss CR, Xue QL, Walston JD, Segev DL, McAdams-DeMarco MA. Revision of frailty assessment in kidney transplant recipients: Replacing unintentional weight loss with CT-assessed sarcopenia in the physical frailty phenotype. Am J Transplant 2022; 22:1145-1157. [PMID: 34953170 PMCID: PMC8983565 DOI: 10.1111/ajt.16934] [Citation(s) in RCA: 5] [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: 07/14/2021] [Revised: 12/12/2021] [Accepted: 12/18/2021] [Indexed: 01/25/2023]
Abstract
Kidney transplantation (KT) experts did not support the use of subjective unintentional weight loss to measure shrinking in the physical frailty phenotype (PFP); a clinically feasible and predictive measure of shrinking is needed. To test whether unintentional weight loss could be replaced by an assessment of sarcopenia using existing CT scans, we performed a prospective cohort study of adult KT recipients with original PFP (oPFP) measured at admission (December 2008-February 2020). We ascertained sarcopenia by calculating skeletal muscle index from available, clinically obtained CTs within 1-year pre-KT (male < 50 cm2 /m2 ; female < 39 cm2 /m2 ) and combined it with the original four components to determine new PFP (nPFP) scores. Frailty was classified by frailty score: 0: non-frail; 1-2: pre-frail; ≥3: frail. Mortality and graft loss hazard ratios (HRs) were estimated using adjusted Cox proportional hazard models. Model discrimination was quantified using Harrell's C-statistic. Among 1113 recipients, 18.6% and 17.1% were frail by oPFP and nPFP, respectively. Compared to non-frail recipients, frail patients by either PFP had higher risks of mortality (oPFP HR = 1.67, 95% CI: 1.07-2.62, C = 0.710; nPFP HR = 1.68, 95% CI: 1.06-2.66, C = 0.710) and graft loss (oPFP HR = 1.67, 95% CI: 1.17-2.40, C = 0.631; nPFP HR = 1.66, 95% CI: 1.15-2.40, C = 0.634) with similar discriminations. oPFP and nPFP are equally useful in risk prediction for KT recipients; oPFP may aid in screening patients for pre-KT interventions, while nPFP may assist in nuanced clinical decision-making.
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Affiliation(s)
- Xiaomeng Chen
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Omid Shafaat
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States,The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Yi Liu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Elizabeth A. King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Clifford R. Weiss
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Qian-Li Xue
- Department of Medicine, Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Jeremy D. Walston
- Department of Medicine, Division of Geriatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Mara A. McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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England RW, Arun A, Vosler PS, Lo SFL, Gujar SK, Tariq N, Weiss CR, Luciano MG, Hui FK. Catheter-directed venography for evaluating internal jugular vein pseudo-occlusion. J Clin Neurosci 2022; 98:6-10. [DOI: 10.1016/j.jocn.2022.01.024] [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: 08/04/2021] [Revised: 01/05/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
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Sisniega A, Lu A, Huang H, Zbijewski W, Unberath M, Siewerdsen JH, Weiss CR. Targeted Deformable Motion Compensation for Vascular Interventional Cone-Beam CT Imaging. Proc SPIE Int Soc Opt Eng 2022; 12031:120311H. [PMID: 36381563 PMCID: PMC9654751 DOI: 10.1117/12.2613232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Purpose Cone-beam CT has become commonplace for 3D guidance in interventional radiology (IR), especially for vascular procedures in which identification of small vascular structures is crucial. However, its long image acquisition time poses a limit to image quality due to soft-tissue deformable motion that hampers visibility of small vessels. Autofocus motion compensation has shown promising potential for soft-tissue deformable motion compensation, but it lacks specific target to the imaging task. This work presents an approach for deformable motion compensation targeted at imaging of vascular structures. Methods The proposed method consists on a two-stage framework for: i) identification of contrast-enhanced blood vessels in 2D projection data and delineation of an approximate region covering the vascular target in the volume space, and, ii) a novel autofocus approach including a metric designed to promote the presence of vascular structures acting solely in the region of interest. The vesselness of the image is quantified via evaluation of the properties of the 3D image Hessian, yielding a vesselness filter that gives larger values to voxels candidate to be part of a tubular structure. A cost metric is designed to promote large vesselness values and spatial sparsity, as expected in regions of fine vascularity. A targeted autofocus method was designed by combining the presented metric with a conventional autofocus term acting outside of the region of interest. The resulting method was evaluated on simulated data including synthetic vascularity merged with real anatomical features obtained from MDCT data. Further evaluation was obtained in two clinical datasets obtained during TACE procedures with a robotic C-arm (Artis Zeego, Siemens Healthineers). Results The targeted vascular autofocus effectively restored the shape and contrast of the contrast-enhanced vascularity in the simulation cases, resulting in improved visibility and reduced artifacts. Segmentations performed with a single threshold value on the target vascular regions yielded a net increase of up to 42% in DICE coefficient computed against the static reference. Motion compensation in clinical datasets resulted in improved visibility of vascular structures, observed in maximum intensity projections of the contrast-enhanced liver vessel tree. Conclusion Targeted motion compensation for vascular imaging showed promising performance for increased identification of small vascular structures in presence of motion. The development of autofocus metrics and methods tailored to vascular imaging opens the way for reliable compensation of deformable motion while preserving the integrity of anatomical structures in the image.
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Affiliation(s)
- A Sisniega
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - A Lu
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - H Huang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - W Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
| | - M Unberath
- Department of Computer Science, Johns Hopkins University, Baltimore, MD USA
| | - J H Siewerdsen
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD USA
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD USA
| | - C R Weiss
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD USA
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Khalil A, Bailey CR, Weiss CR. Percutaneous Sclerotherapy of a Large Trans-Spatial Oropharyngeal Venous Malformation Using Multimodality Guidance. J Vasc Interv Radiol 2022; 33:92-93.e1. [PMID: 34980455 DOI: 10.1016/j.jvir.2021.09.017] [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: 07/02/2021] [Revised: 08/30/2021] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Adham Khalil
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christopher R Bailey
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Vascular and Interventional Radiology, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Vairavamurthy J, Yuan F, Anders RA, Kraitchman DL, Weiss CR. Identifying the Ideal Target Vessel Size for Bariatric Embolization: Histologic Analysis of Swine and Human Gastric Fundi. J Vasc Interv Radiol 2022; 33:28-32. [PMID: 34980451 PMCID: PMC8740629 DOI: 10.1016/j.jvir.2021.09.018] [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] [Received: 05/27/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 01/03/2023] Open
Abstract
This study aimed to identify the ideal arteriole size to target in bariatric embolization, with the goal of maximizing weight loss efficacy while maintaining patient safety. Although all published clinical trials of bariatric embolization have used embolic microspheres that were at least 300 μm in diameter, optimal weight loss outcomes have been achieved safely in swine using 50-μm embolics. Human fundal remnants from bariatric surgery were compared with swine fundal sections after bariatric embolization with 50-μm embolic microspheres to assess the ideal fundal vessel size for bariatric embolization. In swine, the 50-μm embolic microspheres deposited in the luminal half of the submucosa with a mean arteriole size of 49 μm ± 30. The mean arteriole diameter in the corresponding submucosal layer of the human gastric fundi was 40 μm ± 30. These measurements may inform future clinical trials and direct the development of embolic agents for bariatric embolization.
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Affiliation(s)
- Jenanan Vairavamurthy
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Frank Yuan
- Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, MD
| | - Robert A. Anders
- Department of Pathology, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, MD
| | - Dara L. Kraitchman
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University, Baltimore, MD
| | - Clifford R. Weiss
- Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, Baltimore, MD;,Address for correspondence: Clifford R. Weiss, MD, FSIR, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD 21287 (; Telephone: 410-614-1046; Fax: 410-614-1977)
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Kolarich AR, Solomon AJ, Bailey C, Latif MA, Rowan NR, Galiatsatos P, Weiss CR. Imaging Manifestations and Interventional Treatments for Hereditary Hemorrhagic Telangiectasia. Radiographics 2021; 41:2157-2175. [PMID: 34723698 DOI: 10.1148/rg.2021210100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Hemorrhagic hereditary telangiectasia (HHT) is a rare autosomal dominant disorder that causes multisystem vascular malformations including mucocutaneous telangiectasias and arteriovenous malformations (AVMs). Clinical and genetic screening of patients with signs, symptoms, or a family history suggestive of HHT is recommended to confirm the diagnosis on the basis of the Curaçao criteria and prevent associated complications. Patients with HHT frequently have epistaxis and gastrointestinal bleeding from telangiectasias. Pulmonary AVMs are common right-to-left shunts between pulmonary arteries and veins that can result in dyspnea and exercise intolerance, heart failure, migraine headaches, stroke or transient ischemic attacks, brain abscesses, or in rare cases, pulmonary hemorrhage. Primary neurologic complications from cerebral AVMs, which can take on many forms, are less common but particularly severe complications of HHT. Multimodality imaging, including transthoracic echocardiography, Doppler US, CT, and MRI, is used in the screening and initial characterization of vascular lesions in patients with HHT. Diagnostic angiography is an important tool in characterization of and interventional treatments for HHT, particularly those in the lungs and central nervous system. A multidisciplinary approach to early diagnosis, treatment, imaging, and surveillance at high-volume HHT Centers of Excellence is recommended. Although a variety of idiopathic, traumatic, or genetic conditions can result in similar clinical and imaging features, the Curaçao criteria are particularly useful for the proper diagnosis of HHT. Imaging and treatment options are reviewed, with a focus on screening, diagnosis, and posttreatment findings, with the use of updated international guidelines. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Andrew R Kolarich
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R.K., A.J.S., C.B., M.A.L., C.R.W.), Department of Otolarygology-Head and Neck Surgery (N.R.R.), and Department of Medicine, Division of Pulmonology (P.G.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287
| | - Alex J Solomon
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R.K., A.J.S., C.B., M.A.L., C.R.W.), Department of Otolarygology-Head and Neck Surgery (N.R.R.), and Department of Medicine, Division of Pulmonology (P.G.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287
| | - Christopher Bailey
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R.K., A.J.S., C.B., M.A.L., C.R.W.), Department of Otolarygology-Head and Neck Surgery (N.R.R.), and Department of Medicine, Division of Pulmonology (P.G.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287
| | - Muhammad Aamir Latif
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R.K., A.J.S., C.B., M.A.L., C.R.W.), Department of Otolarygology-Head and Neck Surgery (N.R.R.), and Department of Medicine, Division of Pulmonology (P.G.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287
| | - Nicholas R Rowan
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R.K., A.J.S., C.B., M.A.L., C.R.W.), Department of Otolarygology-Head and Neck Surgery (N.R.R.), and Department of Medicine, Division of Pulmonology (P.G.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287
| | - Panagis Galiatsatos
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R.K., A.J.S., C.B., M.A.L., C.R.W.), Department of Otolarygology-Head and Neck Surgery (N.R.R.), and Department of Medicine, Division of Pulmonology (P.G.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287
| | - Clifford R Weiss
- From the Russell H. Morgan Department of Radiology and Radiological Science (A.R.K., A.J.S., C.B., M.A.L., C.R.W.), Department of Otolarygology-Head and Neck Surgery (N.R.R.), and Department of Medicine, Division of Pulmonology (P.G.), The Johns Hopkins University School of Medicine, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287
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Farhan A, Yuan F, Partan E, Weiss CR. Clinical manifestations of patients with GDF2 mutations associated with hereditary hemorrhagic telangiectasia type 5. Am J Med Genet A 2021; 188:199-209. [PMID: 34611981 DOI: 10.1002/ajmg.a.62522] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/05/2021] [Accepted: 09/11/2021] [Indexed: 12/29/2022]
Abstract
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant fibrovascular dysplasia caused by mutations in ENG, ACVRL1, and SMAD4. Increasingly, there has been an appreciation for vascular conditions with phenotypic overlap to HHT but which have distinct clinical manifestations and arise from novel or uncharacterized gene variants. This study reported on a cohort of four unrelated probands who were diagnosed with a rare form of GDF2-related HHT5, for which only five prior cases have been described. Two patients harbored heterozygous missense variants not previously annotated as pathogenic (p.Val403Ile; p.Glu355Gln). Clinically, these patients had features resembling HHT1, including cerebrovascular involvement of their disease (first report documenting cerebral involvement of HHT5), but with earlier onset of epistaxis and a unique anatomic distribution of dermal capillary lesions that involved the upper forelimbs, trunk, and head. The other two patients harbored interstitial deletions larger than five megabases between 10q11.22 and 10q11.23 that included GDF2. To our knowledge, this is the first report detailing large genomic deletions leading to HHT5. These patients also demonstrated mucocutaneous capillary dysplasias, including intranasal vascular lesions complicated by childhood-onset epistasis, with a number of extravascular findings related to their 10q11.21q11.23 deletion. In conclusion, patients with GDF2-related HHT may present with a number of unique characteristics that differ from classically reported features of HHT.
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Affiliation(s)
- Ahmed Farhan
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Frank Yuan
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elizabeth Partan
- McKusick-Nathans Institute of Genetic Medicine, Department of Genetic Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Ring NY, Latif MA, Hafezi-Nejad N, Holly BP, Weiss CR. Prevalence of and Factors Associated with Arterial Aneurysms in Patients with Hereditary Hemorrhagic Telangiectasia: 17-Year Retrospective Series of 418 Patients. J Vasc Interv Radiol 2021; 32:1661-1669. [PMID: 34478850 DOI: 10.1016/j.jvir.2021.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To estimate the prevalence of and identify characteristics associated with the presence of aneurysms in a cohort of patients with hereditary hemorrhagic telangiectasia (HHT). MATERIALS AND METHODS In the study institution's HHT database, 418 patients with a definite HHT diagnosis were identified based on the clinical Curaçao criteria and/or an HHT-associated genetic mutation. Regression modeling was used to evaluate the association between arterial aneurysms and older age, male sex, smoking, alcohol consumption, hypertension, hyperlipidemia, genetic mutations, the presence of arteriovenous malformations (AVMs) unrelated to the aneurysms, and HHT-related genetic mutations. RESULTS Forty-three (10.3%) patients had at least 1 aneurysm. Sixteen (3.8%) patients had multiple aneurysms. Of the variables analyzed, older age (odds ratio [OR] = 1.02; 95% confidence interval [CI]: 1.0-1.1), the presence of anatomically and flow-unrelated AVMs (OR = 3.2; 95% CI: 1.3-8.0), and the presence of activin A receptor type II-like 1 (ACVRL1) mutation (OR = 4.0; 95% CI: 1.5-10) were associated with the presence of at least 1 aneurysm. CONCLUSIONS In this cohort of patients with HHT, the prevalence of intracranial and visceral arterial aneurysms was estimated to be 10.3%. Older age, the presence of unrelated AVMs, and the presence of the ACVRL1 mutation were associated with the presence of arterial aneurysms. Further study is required to assess the clinical importance and risk of rupture of aneurysms in patients with HHT.
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Affiliation(s)
- Natalie Y Ring
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad A Latif
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology and Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nima Hafezi-Nejad
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian P Holly
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Yuan F, Latif MA, Shafaat O, Prologo JD, Hill JO, Gudzune KA, Marrone AK, Kraitchman DL, Rogers AM, Khaitan L, Oklu R, Pereira K, Steele K, White SB, Weiss CR. Interventional Radiology Obesity Therapeutics: Proceedings from the Society of Interventional Radiology Foundation Research Consensus Panel. J Vasc Interv Radiol 2021; 32:1388.e1-1388.e14. [PMID: 34462083 DOI: 10.1016/j.jvir.2021.05.029] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/28/2021] [Accepted: 05/01/2021] [Indexed: 02/06/2023] Open
Abstract
The Society of Interventional Radiology Foundation commissioned a Research Consensus Panel to establish a research agenda on "Obesity Therapeutics" in interventional radiology (IR). The meeting convened a multidisciplinary group of physicians and scientists with expertise in obesity therapeutics. The meeting was intended to review current evidence on obesity therapies, familiarize attendees with the regulatory evaluation process, and identify research deficiencies in IR bariatric interventions, with the goal of prioritizing future high-quality research that would move the field forward. The panelists agreed that a weight loss of >8%-10% from baseline at 6-12 months is a desirable therapeutic endpoint for future IR weight loss therapies. The final consensus on the highest priority research was to design a blinded randomized controlled trial of IR weight loss interventions versus sham control arms, with patients receiving behavioral therapy.
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Affiliation(s)
- Frank Yuan
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad A Latif
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology and Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Omid Shafaat
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - J David Prologo
- Department of Radiology, Division of Vascular and Interventional Radiology, Emory University School of Medicine, Atlanta, Georgia
| | - James O Hill
- Department of Nutrition Sciences, School of Health Professions, Nutrition Obesity Research Center, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kimberly A Gudzune
- Department of Obesity Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - April K Marrone
- Division of Renal, Gastrointestinal, Obesity and Transplant Devices, Office of GastroRenal, ObGyn, General Hospital and Urology Devices, Office of Product Evaluation and Quality, Center for Devices and Radiological Health, U.S. Food and Drug Administration, Silver Spring, Maryland
| | - Dara L Kraitchman
- Division of MR Research, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ann M Rogers
- Department of Surgery, Penn State Health Surgical Specialties, Milton S. Hershey Medical Center, Hershey, Pennsylvania
| | - Leena Khaitan
- Department of Surgery, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - Rahmi Oklu
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, Scottsdale, Arizona
| | - Keith Pereira
- Department of Radiology, Division of Interventional Radiology, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Kimberley Steele
- Department of General Surgery, Bariatric Surgery Program, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Clifford R Weiss
- Division of Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Marshall CH, Tunacao J, Danda V, Tsai HL, Barber J, Gawande R, Weiss CR, Denmeade SR, Joshu C. Reversing the effects of androgen-deprivation therapy in men with metastatic castration-resistant prostate cancer. BJU Int 2021; 128:366-373. [PMID: 33765326 PMCID: PMC9844547 DOI: 10.1111/bju.15408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate whether bipolar androgen therapy (BAT), involving rapid cyclic administration of high-dose testosterone, as a novel treatment for metastatic castration-resistant prostate cancer (mCRPC) promotes improvements in body composition and associated improvements in lipid profiles and quality of life. PATIENTS AND METHODS Men from two completed trials with computed tomography imaging at baseline and after three cycles of BAT were included. Cross-sectional areas of psoas muscle, visceral and subcutaneous fat were measured at the L3 vertebral level. Functional Assessment of Chronic Illness Therapy - Fatigue questionnaire and 36-item short-form health survey were used to assess quality of life. RESULTS The 60 included patients lost a mean (sd) of 7.8 (8.2)% of subcutaneous fat, 9.8 (18.2)% of visceral fat, and gained 12.2 (6.7)% muscle mass. Changes in subcutaneous and visceral fat were positively correlated with each other (Spearman's correlation coefficient 0.58, 95% confidence interval 0.35-0.71) independent of the effects of age, body mass index, and duration of androgen-deprivation therapy. Energy, physical function, and measures of limitations due to physical health were all significantly improved at 3 months. The improvements in body composition were not correlated with decreases in lipid levels or observed improvements in quality of life. CONCLUSIONS In the present study, BAT was associated with significant improvements in body composition, lipid parameters, and quality of life. This has promising implications for the long-term health of men with mCRPC.
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Affiliation(s)
| | - Jessa Tunacao
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Varun Danda
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Hua-Ling Tsai
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Barber
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rakhee Gawande
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clifford R. Weiss
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Samuel R. Denmeade
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Corinne Joshu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Lam S, Guthrie KS, Latif MA, Weiss CR. Genetic counseling and testing for hereditary hemorrhagic telangiectasia. Clin Genet 2021; 101:275-284. [PMID: 34415050 DOI: 10.1111/cge.14050] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/04/2021] [Accepted: 08/15/2021] [Indexed: 12/13/2022]
Abstract
Genetic counseling is an important means of identifying a patient's genetic risk of hereditary hemorrhagic telangiectasia (HHT) and assisting patients in making informed decisions about their health. With an increase in understanding of the genetic mechanisms underlying HHT over the last decade, genetic counseling is increasingly being incorporated into the care of patients affected by HHT. In addition to refining the diagnosis of symptomatic patients, genetic testing can help to distinguish asymptomatic, at-risk patients from those who are unaffected by HHT. The purpose of this review article is to summarize the current knowledge regarding the role of genetic counseling and genetic testing in identifying and managing HHT in at-risk populations. This article also reviews the guidelines, outcomes, risks, and challenges of genetic counseling and testing for HHT in various patient populations, and provides an algorithm for the use of genetic counseling in symptomatic and asymptomatic patients.
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Affiliation(s)
- Shravika Lam
- Russel H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kelsey S Guthrie
- Institute of Genetic Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Muhammad A Latif
- Russel H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Clifford R Weiss
- Russel H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Al-Samkari H, Kasthuri RS, Parambil JG, Albitar HA, Almodallal YA, Vázquez C, Serra MM, Dupuis-Girod S, Wilsen CB, McWilliams JP, Fountain EH, Gossage JR, Weiss CR, Latif MA, Issachar A, Mei-Zahav M, Meek ME, Conrad M, Rodriguez-Lopez J, Kuter DJ, Iyer VN. An international, multicenter study of intravenous bevacizumab for bleeding in hereditary hemorrhagic telangiectasia: the InHIBIT-Bleed study. Haematologica 2021; 106:2161-2169. [PMID: 32675221 PMCID: PMC8327711 DOI: 10.3324/haematol.2020.261859] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 06/04/2020] [Indexed: 12/13/2022] Open
Abstract
Hereditary hemorrhagic telangiectasia (HHT, Osler-Weber-Rendu disease) is a rare multisystem vascular disorder that causes chronic gastrointestinal bleeding, epistaxis, and severe anemia. Bevacizumab, an anti-vascular endothelial growth factor antibody, may be effective to treat bleeding in HHT. This international, multicenter, retrospective study evaluated the use of systemic bevacizumab to treat HHTassociated bleeding and anemia at 12 HHT treatment centers. Hemoglobin, Epistaxis Severity Score (ESS), red cell units transfused, and intravenous iron infusions before and after treatment were evaluated using paired means testing and mixed-effects linear models. Bevacizumab was given to 238 HHT patients for a median of 12 (range, 1-96) months. Compared with pretreatment, bevacizumab increased mean hemoglobin by 3.2 g/dL (95% confidence interval: 2.9-3.5 g/dL); i.e., from a mean hemoglobin of 8.6 (8.5-8.8) g/dL to 11.8 (11.5-12.1) g/dL; P<0.0001) and decreased the ESS by 3.4 (3.2-3.7) points (mean ESS 6.8 [6.6-7.1] versus 3.4 [3.2-3.7]; P<0.0001) during the first year of treatment. Compared with 6 months before treatment, the number of red blood cell units transfused decreased by 82% (median of 6.0 [interquartile range, 0.0-13.0] units versus 0 [0.0-1.0] units; P<0.0001) and iron infusions decreased by 70% (median of 6.0 [1.0-18.0] infusions versus 1.0 [0.0-4.0] infusions, P<0.0001) during the first 6 months of bevacizumab treatment. Outcomes were similar regardless of the underlying pathogenic mutation. Following initial induction infusions, continuous/scheduled bevacizumab maintenance achieved higher hemoglobin and lower ESS than intermittent/as-needed maintenance but with more drug exposure. Bevacizumab was well tolerated: hypertension, fatigue, and proteinuria were the most common adverse events. Venous thromboembolism occurred in 2% of patients. In conclusion, systemic bevacizumab was safe and effective for managing chronic bleeding and anemia in HHT.
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Affiliation(s)
- Hanny Al-Samkari
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raj S Kasthuri
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Hasan A Albitar
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Carolina Vázquez
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Marcelo M Serra
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Sophie Dupuis-Girod
- Centre de Reference pour la maladie de Rendu-Osler, Hospices Civils de Lyon, Lyon, France
| | - Craig B Wilsen
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Justin P McWilliams
- Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Evan H Fountain
- Division of Pulmonary, Critical Care, and Sleep Medicine, Augusta University, Augusta, GA, USA
| | - James R Gossage
- Division of Pulmonary, Critical Care, and Sleep Medicine, Augusta University, Augusta, GA, USA
| | - Clifford R Weiss
- Div. of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Muhammad A Latif
- Div. of Interventional Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Assaf Issachar
- Schneider Children's Medical Center of Israel, Tel Aviv University, Israel
| | - Meir Mei-Zahav
- Schneider Children's Medical Center of Israel, Tel Aviv University, Israel
| | - Mary E Meek
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Miles Conrad
- Dept. of Radiology, University of California San Francisco Medical Center, San Francisco, CA, USA
| | - Josanna Rodriguez-Lopez
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - David J Kuter
- Division of Hematology, Massachusetts General Hospital, Boston, MA, USA
| | - Vivek N Iyer
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Yuan F, Bailey CR, Khalil A, Weiss CR. Emerging Role of Sirolimus in the Treatment of Diffuse Venous Malformation in a Woman with Klippel-Trenaunay Syndrome. Cardiovasc Intervent Radiol 2021; 44:1672-1674. [PMID: 34231008 DOI: 10.1007/s00270-021-02902-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Frank Yuan
- Division of Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA
| | - Christopher R Bailey
- Division of Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA
| | - Adham Khalil
- Division of Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA
| | - Clifford R Weiss
- Division of Interventional Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower 7203, Baltimore, MD, 21287, USA.
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