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Mazor N, Dar G, Lederman R, Lev-Cohain N, Sosna J, Joskowicz L. MC3DU-Net: a multisequence cascaded pipeline for the detection and segmentation of pancreatic cysts in MRI. Int J Comput Assist Radiol Surg 2024; 19:423-432. [PMID: 37796412 DOI: 10.1007/s11548-023-03020-y] [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: 03/14/2023] [Accepted: 09/12/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Radiological detection and follow-up of pancreatic cysts in multisequence MRI studies are required to assess the likelihood of their malignancy and to determine their treatment. The evaluation requires expertise and has not been automated. This paper presents MC3DU-Net, a novel multisequence cascaded pipeline for the detection and segmentation of pancreatic cysts in MRI studies consisting of coronal MRCP and axial TSE MRI sequences. METHODS MC3DU-Net leverages the information in both sequences by computing a pancreas Region of Interest (ROI) segmentation in the TSE MRI scan, transferring it to MRCP scan, and then detecting and segmenting the cysts in the ROI of the MRCP scan. Both the voxel-level ROI of the pancreas and the segmentation of the cysts are performed with 3D U-Nets trained with Hard Negative Patch Mining, a new technique for class imbalance correction and for the reduction in false positives. RESULTS MC3DU-Net was evaluated on a dataset of 158 MRI patient studies with a training/validation/testing split of 118/17/23. Ground truth segmentations of a total of 840 cysts were manually obtained by expert clinicians. MC3DU-Net achieves a mean recall of 0.80 ± 0.19, a mean precision of 0.75 ± 0.26, a mean Dice score of 0.80 ± 0.19 and a mean ASSD of 0.60 ± 0.53 for pancreatic cysts of diameter > 5 mm, which is the clinically relevant endpoint. CONCLUSION MC3DU-Net is the first fully automatic method for detection and segmentation of pancreatic cysts in MRI. Automatic detection and segmentation of pancreatic cysts in MRI can be performed accurately and reliably. It may provide a method for precise disease evaluation and may serve as a second expert reader.
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Affiliation(s)
- Nir Mazor
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gili Dar
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Richard Lederman
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Rochman S, Szeskin A, Lederman R, Sosna J, Joskowicz L. Graph-based automatic detection and classification of lesion changes in pairs of CT studies for oncology follow-up. Int J Comput Assist Radiol Surg 2024; 19:241-251. [PMID: 37540449 DOI: 10.1007/s11548-023-03000-2] [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: 01/08/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE Radiological follow-up of oncology patients requires the quantitative analysis of lesion changes in longitudinal imaging studies, which is time-consuming, requires expertise, and is subject to variability. This paper presents a comprehensive graph-based method for the automatic detection and classification of lesion changes in current and prior CT scans. METHODS The inputs are the current and prior CT scans and their organ and lesion segmentations. Classification of lesion changes is formalized as bipartite graph matching where lesion pairings are computed by adaptive overlap-based lesion matching. Six types of lesion changes are computed by connected components analysis. The method was evaluated on 208 pairs of lung and liver CT scans from 57 patients with 4600 lesions, 1713 lesion matchings and 2887 lesion changes. Ground-truth lesion segmentations, lesion matchings and lesion changes were created by an expert radiologist. RESULTS Our method yields a lesion matching rate accuracy of 99.7% (394/395) and 95.0% (1252/1318) for the lung and liver datasets. Precision and recall are > 0.99 and 0.94 and 0.95 (respectively) for the detection of lesion changes. The analysis of lesion changes helped the radiologist detect 48 missed lesions and 8 spurious lesions in the input ground-truth lesion datasets. CONCLUSION The classification of lesion classification provides the clinician with a readily accessible and intuitive identification and classification of the lesion changes and their patterns in support of clinical decision making. Comprehensive automatic computer-aided lesion matching and analysis of lesion changes may improve quantitative follow-up and evaluation of disease status, assessment of treatment efficacy and response to therapy.
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Affiliation(s)
- Shalom Rochman
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
| | - Adi Szeskin
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel
| | - Richard Lederman
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, 9190401, Jerusalem, Israel.
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Dar G, Goldberg SN, Levy S, Nevo A, Daud M, Sosna J, Lev-Cohain N. Optimal CT windowing on low-monoenergetic images using a simplex algorithm-based approach for abdominal inflammatory processes. Eur J Radiol 2024; 170:111262. [PMID: 38141262 DOI: 10.1016/j.ejrad.2023.111262] [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: 11/03/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND OBJECTIVES: To determine optimal window settings for conspicuity of abdominal inflammatory processes on 50 keV low-monoenergetic images derived from dual-energy spectral CT (DECT). METHODS A retrospective study of 30 patients with clinically proven pancreatitis (15/30) or pyelonephritis (15/30) with inflammatory lesions visible on DECT scans were selected to serve as reference populations. 50 keV low-monoenergetic images in the portal venous phase were iteratively evaluated by 6 abdominal radiologists in twenty-one different windows (7-350HU center; 120-580HU width), selected using a simplex optimization algorithm. Each reader graded the conspicuity of the parenchymal hypodense lesions and image background quality. Three-dimensional contour maps expressing the relationship between overall reader grade and window center and width were constructed and used to find the ideal window for inflammatory pancreatic and renal processes and the image background quality. Finally, 15 appendicitis cases were reviewed on optimal pancreas and kidney windows and the manufacturer recommended conventional abdominal window settings for conventional imaging. RESULTS Convergence to optimal windowing was achieved based upon a total of 3,780 reads (21 window settings × 6 readers × 15 cases for pancreas and kidney). Highest conspicuity grade (>4.5 ± 0.0) for pancreas inflammatory lesions was seen at 116HU/430HU, whereas hypodense pyelonephritis had highest conspicuity at 290HU/570HU. This rendered an ideal "compromise" window (>4 ± 0.2) of 150HU/450HU which differed substantially from conventional manufacturer recommended settings of 50HU/380HU (2.1 ± 1.0, p = 0.00001). Appendix mucosal enhancement was best visualized at manufacturer settings. CONCLUSIONS Optimal visualization of inflammatory processes in abdominal organs on 50 keV low-monoenergetic images may require tailored refinement of window settings.
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Affiliation(s)
- Gili Dar
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Shiran Levy
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Adam Nevo
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Marron Daud
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, 19000 Ein Karem, Jerusalem, Israel.
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Joskowicz L, Szeskin A, Rochman S, Dodi A, Lederman R, Fruchtman-Brot H, Azraq Y, Sosna J. Follow-up of liver metastases: a comparison of deep learning and RECIST 1.1. Eur Radiol 2023; 33:9320-9327. [PMID: 37480549 DOI: 10.1007/s00330-023-09926-0] [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: 01/07/2023] [Revised: 04/25/2023] [Accepted: 05/14/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVES To compare liver metastases changes in CT assessed by radiologists using RECIST 1.1 and with aided simultaneous deep learning-based volumetric lesion changes analysis. METHODS A total of 86 abdominal CT studies from 43 patients (prior and current scans) of abdominal CT scans of patients with 1041 liver metastases (mean = 12.1, std = 11.9, range 1-49) were analyzed. Two radiologists performed readings of all pairs; conventional with RECIST 1.1 and with computer-aided assessment. For computer-aided reading, we used a novel simultaneous multi-channel 3D R2U-Net classifier trained and validated on other scans. The reference was established by having an expert radiologist validate the computed lesion detection and segmentation. The results were then verified and modified as needed by another independent radiologist. The primary outcome measure was the disease status assessment with the conventional and the computer-aided readings with respect to the reference. RESULTS For conventional and computer-aided reading, there was a difference in disease status classification in 40 out of 86 (46.51%) and 10 out of 86 (27.9%) CT studies with respect to the reference, respectively. Computer-aided reading improved conventional reading in 30 CT studies by 34.5% for two readers (23.2% and 46.51%) with respect to the reference standard. The main reason for the difference between the two readings was lesion volume differences (p = 0.01). CONCLUSIONS AI-based computer-aided analysis of liver metastases may improve the accuracy of the evaluation of neoplastic liver disease status. CLINICAL RELEVANCE STATEMENT AI may aid radiologists to improve the accuracy of evaluating changes over time in metastasis of the liver. KEY POINTS • Classification of liver metastasis changes improved significantly in one-third of the cases with an automatically generated comprehensive lesion and lesion changes report. • Simultaneous deep learning changes detection and volumetric assessment may improve the evaluation of liver metastases temporal changes potentially improving disease management.
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Affiliation(s)
- Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Szeskin
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shalom Rochman
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviv Dodi
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Richard Lederman
- Dept of Radiology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, POB 12000, 91120, Jerusalem, Israel
| | - Hila Fruchtman-Brot
- Dept of Radiology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, POB 12000, 91120, Jerusalem, Israel
| | - Yusef Azraq
- Dept of Radiology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, POB 12000, 91120, Jerusalem, Israel
| | - Jacob Sosna
- Dept of Radiology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, POB 12000, 91120, Jerusalem, Israel.
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Yeshua T, Ladyzhensky S, Abu-Nasser A, Abdalla-Aslan R, Boharon T, Itzhak-Pur A, Alexander A, Chaurasia A, Cohen A, Sosna J, Leichter I, Nadler C. Deep learning for detection and 3D segmentation of maxillofacial bone lesions in cone beam CT. Eur Radiol 2023; 33:7507-7518. [PMID: 37191921 DOI: 10.1007/s00330-023-09726-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To develop an automated deep-learning algorithm for detection and 3D segmentation of incidental bone lesions in maxillofacial CBCT scans. METHODS The dataset included 82 cone beam CT (CBCT) scans, 41 with histologically confirmed benign bone lesions (BL) and 41 control scans (without lesions), obtained using three CBCT devices with diverse imaging protocols. Lesions were marked in all axial slices by experienced maxillofacial radiologists. All cases were divided into sub-datasets: training (20,214 axial images), validation (4530 axial images), and testing (6795 axial images). A Mask-RCNN algorithm segmented the bone lesions in each axial slice. Analysis of sequential slices was used for improving the Mask-RCNN performance and classifying each CBCT scan as containing bone lesions or not. Finally, the algorithm generated 3D segmentations of the lesions and calculated their volumes. RESULTS The algorithm correctly classified all CBCT cases as containing bone lesions or not, with an accuracy of 100%. The algorithm detected the bone lesion in axial images with high sensitivity (95.9%) and high precision (98.9%) with an average dice coefficient of 83.5%. CONCLUSIONS The developed algorithm detected and segmented bone lesions in CBCT scans with high accuracy and may serve as a computerized tool for detecting incidental bone lesions in CBCT imaging. CLINICAL RELEVANCE Our novel deep-learning algorithm detects incidental hypodense bone lesions in cone beam CT scans, using various imaging devices and protocols. This algorithm may reduce patients' morbidity and mortality, particularly since currently, cone beam CT interpretation is not always preformed. KEY POINTS • A deep learning algorithm was developed for automatic detection and 3D segmentation of various maxillofacial bone lesions in CBCT scans, irrespective of the CBCT device or the scanning protocol. • The developed algorithm can detect incidental jaw lesions with high accuracy, generates a 3D segmentation of the lesion, and calculates the lesion volume.
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Affiliation(s)
- Talia Yeshua
- Department of Applied Physics, The Jerusalem College of Technology, Jerusalem, Israel
| | - Shmuel Ladyzhensky
- Department of Applied Physics, The Jerusalem College of Technology, Jerusalem, Israel
| | - Amal Abu-Nasser
- Oral Maxillofacial Imaging, Department of Oral Medicine, Sedation and Imaging, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ragda Abdalla-Aslan
- Department of Oral Medicine, Sedation and Imaging, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Tami Boharon
- Department of Software Engineering, The Jerusalem College of Technology, Jerusalem, Israel
| | - Avital Itzhak-Pur
- Department of Software Engineering, The Jerusalem College of Technology, Jerusalem, Israel
| | - Asher Alexander
- Department of Software Engineering, The Jerusalem College of Technology, Jerusalem, Israel
| | - Akhilanand Chaurasia
- Department of Oral Medicine and Radiology, King George's Medical University, Lucknow, India
| | - Adir Cohen
- Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Isaac Leichter
- Department of Applied Physics, The Jerusalem College of Technology, Jerusalem, Israel
- Department of Radiology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Chen Nadler
- Department of Oral Medicine, Sedation and Imaging, Faculty of Dental Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
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Shaul D, Lev-Cohain N, Sapir G, Sosna J, Gomori JM, Joskowicz L, Katz-Brull R. Real-time influence of intracellular acidification and Na + /H + exchanger inhibition on in-cell pyruvate metabolism in the perfused mouse heart: A 31 P-NMR and hyperpolarized 13 C-NMR study. NMR Biomed 2023; 36:e4993. [PMID: 37424280 DOI: 10.1002/nbm.4993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 07/11/2023]
Abstract
Disruption of acid-base balance is linked to various diseases and conditions. In the heart, intracellular acidification is associated with heart failure, maladaptive cardiac hypertrophy, and myocardial ischemia. Previously, we have reported that the ratio of the in-cell lactate dehydrogenase (LDH) to pyruvate dehydrogenase (PDH) activities is correlated with cardiac pH. To further characterize the basis for this correlation, these in-cell activities were investigated under induced intracellular acidification without and with Na+ /H+ exchanger (NHE1) inhibition by zoniporide. Male mouse hearts (n = 30) were isolated and perfused retrogradely. Intracellular acidification was performed in two ways: (1) with the NH4 Cl prepulse methodology; and (2) by combining the NH4 Cl prepulse with zoniporide. 31 P NMR spectroscopy was used to determine the intracellular cardiac pH and to quantify the adenosine triphosphate and phosphocreatine content. Hyperpolarized [1-13 C]pyruvate was obtained using dissolution dynamic nuclear polarization. 13 C NMR spectroscopy was used to monitor hyperpolarized [1-13 C]pyruvate metabolism and determine enzyme activities in real time at a temporal resolution of a few seconds using the product-selective saturating excitation approach. The intracellular acidification induced by the NH4 Cl prepulse led to reduced LDH and PDH activities (-16% and -39%, respectively). This finding is in line with previous evidence of reduced myocardial contraction and therefore reduced metabolic activity upon intracellular acidification. Concomitantly, the LDH/PDH activity ratio increased with the reduction in pH, as previously reported. Combining the NH4 Cl prepulse with zoniporide led to a greater reduction in LDH activity (-29%) and to increased PDH activity (+40%). These changes resulted in a surprising decrease in the LDH/PDH ratio, as opposed to previous predictions. Zoniporide alone (without intracellular acidification) did not change these enzyme activities. A possible explanation for the enzymatic changes observed during the combination of the NH4 Cl prepulse and NHE1 inhibition may be related to mitochondrial NHE1 inhibition, which likely negates the mitochondrial matrix acidification. This effect, combined with the increased acidity in the cytosol, would result in an enhanced H+ gradient across the mitochondrial membrane and a temporarily higher pyruvate transport into the mitochondria, thereby increasing the PDH activity at the expense of the cytosolic LDH activity. These findings demonstrate the complexity of in-cell cardiac metabolism and its dependence on intracellular acidification. This study demonstrates the capabilities and limitations of hyperpolarized [1-13 C]pyruvate in the characterization of intracellular acidification as regards cardiac pathologies.
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Affiliation(s)
- David Shaul
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem, Israel
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- The Wohl Institute for Translational Medicine, Hadassah Medical Organization, Jerusalem, Israel
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Gofrit ON, Gofrit B, Roditi Y, Popovtzer A, Frank S, Sosna J, Orevi M, Goldberg SN. The different clonal origins of metachronous and synchronous metastases. J Cancer Res Clin Oncol 2023; 149:11085-11092. [PMID: 37340186 PMCID: PMC10465669 DOI: 10.1007/s00432-023-05007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/16/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Metastases are the leading cause of mortality in cancer patients. Linear and parallel are the two prominent models of metastatic progression. Metastases can be detected synchronously along with the primary tumor or metachronously, following treatment of localized disease. The aim of the study was to determine whether synchronous metastases (SM) and metachronous metastases (MM) differ only in lead-time or stem from different biological processes. MATERIALS AND METHODS We retrospectively studied the chest CTs of 791 patients inflicted by eleven malignancy types that were treated in our institution in the years 2010-2020. Patient's population included 396 with SM and 395 with MM. The diameter of 15,427 lung metastases was measured. Clonal origin was deduced from the linear/parallel ratio (LPR)-a computerized analysis of metastases diameters. LPR of 1 suggests pure linear dissemination and - 1 pure parallel. RESULTS Patients with MM were significantly older (average of 62.9 vs 60.7 years, p = 0.02), and higher percentage of them were males (58.7% vs 51.1%, p = 0.03). Median overall survival of patients with MM and SM was remarkably similar (23 months and 26 months respectively, p = 0.774) when calculated from the time of metastases diagnosis. Parallel dissemination (LPR ≤ 0) was found in 35.4% of patients with MM compared to only 19.8% of the patients with SM (p < 0.00001). CONCLUSION Patients with SM and MM differ in demography and in clonal origin. Different therapeutic approaches may be considered in these two conditions.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, P.O.B 12000, 91120, Jerusalem, Israel.
| | - Ben Gofrit
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Roditi
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steve Frank
- Department of Oncology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Marina Orevi
- Department of Nuclear Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Ben-Arie G, Sosna J. Predicting Infectious Complications after US-guided Ablation of Liver Malignancies: Personalized Patient Care. Radiology 2023; 308:e231681. [PMID: 37552070 DOI: 10.1148/radiol.231681] [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] [Indexed: 08/09/2023]
Affiliation(s)
- Gal Ben-Arie
- From the Department of Medical Imaging, Soroka Medical Center, Rager Blvd, PO Box 151, Be'er Sheva, Israel 84101 (G.B.A.); Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel (G.B.A.); and Department of Radiology, Hebrew University School of Medicine, Hadassah Medical Center, Jerusalem, Israel (J.S.)
| | - Jacob Sosna
- From the Department of Medical Imaging, Soroka Medical Center, Rager Blvd, PO Box 151, Be'er Sheva, Israel 84101 (G.B.A.); Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel (G.B.A.); and Department of Radiology, Hebrew University School of Medicine, Hadassah Medical Center, Jerusalem, Israel (J.S.)
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Shaul D, Sapir G, Lev-Cohain N, Sosna J, Gomori JM, Katz-Brull R. Investigating Cardiac Metabolism in the Isolated Perfused Mouse Heart with Hyperpolarized [1-13C]Pyruvate and 13C/31P NMR Spectroscopy. J Vis Exp 2023. [PMID: 37154556 DOI: 10.3791/63188] [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: 05/10/2023] Open
Abstract
Metabolism is the basis of important processes in cellular life. Characterizing how metabolic networks function in living tissues provides crucial information for understanding the mechanism of diseases and designing treatments. In this work, we describe procedures and methodologies for studying in-cell metabolic activity in a retrogradely perfused mouse heart in real-time. The heart was isolated in situ, in conjunction with cardiac arrest to minimize the myocardial ischemia and was perfused inside a nuclear magnetic resonance (NMR) spectrometer. While in the spectrometer and under continuous perfusion, hyperpolarized [1-13C]pyruvate was administered to the heart, and the subsequent hyperpolarized [1-13C]lactate and [13C]bicarbonate production rates served to determine, in real-time, the rates of lactate dehydrogenase and pyruvate dehydrogenase production. This metabolic activity of hyperpolarized [1-13C]pyruvate was quantified with NMR spectroscopy in a model free-manner using the product selective saturating-excitations acquisition approach. 31P spectroscopy was applied in between the hyperpolarized acquisitions to monitor the cardiac energetics and pH. This system is uniquely useful for studying metabolic activity in the healthy and diseased mouse heart.
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Affiliation(s)
- David Shaul
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem; The Wohl Institute for Translational Medicine
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem; The Wohl Institute for Translational Medicine
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem; The Wohl Institute for Translational Medicine;
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Markus T, Saban M, Sosna J, Assaf J, Cohen D, Vaknin S, Luxenburg O, Singer C, Shaham D. Does clinical decision support system promote expert consensus for appropriate imaging referrals? Chest-abdominal-pelvis CT as a case study. Insights Imaging 2023; 14:45. [PMID: 36929357 PMCID: PMC10020384 DOI: 10.1186/s13244-023-01371-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/03/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES We assessed the appropriateness of chest-abdominal-pelvis (CAP) CT scan use in the Emergency Department (ED), based on expert physicians and the ESR iGuide, a clinical decision support system (CDSS). METHODS A retrospective cross-study was conducted. We included 100 cases of CAP-CT scans ordered at the ED. Four experts rated the appropriateness of the cases on a 7-point scale, before and after using the decision support tool. RESULTS Before using the ESR iGuide the overall mean rating of the experts was 5.2 ± 1.066, and it increased slightly after using the system (5.85 ± 0.911 (p < 0.01)). Using a threshold of 5 (on a 7-level scale), the experts considered only 63% of the tests appropriate before using the ESR iGuide. The number increased to 89% after consultation with the system. The degree of overall agreement among the experts was 0.388 before ESR iGuide consultation and 0.572 after consultation. According to the ESR iGuide, for 85% of the cases, CAP CT was not a recommended option (score 0). Abdominal-Pelvis CT was "usually appropriate" for 65 out of the 85 (76%) cases (score 7-9). 9% of the cases did not require CT as first exam modality. CONCLUSIONS According to both the experts and the ESR iGuide, inappropriate testing was prevalent, in terms of both frequency of the scans and also inappropriately chosen body regions. These findings raise the need for unified workflows that might be achieved using a CDSS. Further studies are needed to investigate the CDSS contribution to the informed decision-making and increased uniformity among different expert physicians when ordering the appropriate test.
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Affiliation(s)
- Talya Markus
- Department of Radiology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba medical center, Ramat Gan, Israel.,Nursing Department, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv-Yafo, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel.
| | - Jacob Assaf
- Emergency Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Dotan Cohen
- Department of Radiology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
| | - Sharona Vaknin
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba medical center, Ramat Gan, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
| | - Clara Singer
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba medical center, Ramat Gan, Israel
| | - Dorith Shaham
- Department of Radiology, Hadassah Hebrew University Medical Center, 91120, Jerusalem, Israel
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11
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Gofrit ON, Gofrit B, Roditi Y, Popovtzer A, Frank S, Sosna J, Goldberg SN. Is it time for redefining oligometastatic disease? Analysis of lung metastases CT in ten tumor types. Discov Oncol 2023; 14:19. [PMID: 36745242 PMCID: PMC9902583 DOI: 10.1007/s12672-023-00625-2] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/31/2023] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Oligometastatic disease (OD) is usually defined arbitrarily as a condition in which there are ≤ 5 metastases. Given limited disease, it is expected that patients with OD should have better prognosis compared to other metastatic patients and that they can potentially benefit from metastasis-directed therapy (MDT). In this study, we attempted to redefine OD based upon objective evidence that fulfill these assumptions. METHODS Chest CTSs of 773 patients with 15,947 lung metastases originating from ten malignancy types were evaluated. The number and largest diameter of each metastasis was recorded. Metastatic cluster was defined as a cluster of two or more metastases with diameter difference ≤ 1 mm. The prognostic power of seven statistical models on overall survival (OS) was analyzed. FINDINGS Both the number of metastases and metastatic clusters had a highly significant impact on OS (p < 0.0001, p = 0.003 respectively). Patients with a single metastasis or a single cluster of metastases (regardless of metastases number), equaling 16.2% of all patients, had significantly better prognosis compared to other patients (p = 0.0002). If metastases diameter variability is ignored, as in the standard definition of OD, then patients with 2-5 and 6-10 metastases would have a similar prognosis. INTERPRETATION Patients with a single cluster of metastases, theoretically originating from a single clone, have significantly better prognosis compared to patients with more than one cluster. Using this definition can potentially improve the results of MDT. The upper limit of metastases number should be determined by the technical capabilities of the MDT used.
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Affiliation(s)
- Ofer N Gofrit
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, 12000, 91120, Jerusalem, Israel.
| | - Ben Gofrit
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Roditi
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steve Frank
- Department of Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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12
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Bilic P, Christ P, Li HB, Vorontsov E, Ben-Cohen A, Kaissis G, Szeskin A, Jacobs C, Mamani GEH, Chartrand G, Lohöfer F, Holch JW, Sommer W, Hofmann F, Hostettler A, Lev-Cohain N, Drozdzal M, Amitai MM, Vivanti R, Sosna J, Ezhov I, Sekuboyina A, Navarro F, Kofler F, Paetzold JC, Shit S, Hu X, Lipková J, Rempfler M, Piraud M, Kirschke J, Wiestler B, Zhang Z, Hülsemeyer C, Beetz M, Ettlinger F, Antonelli M, Bae W, Bellver M, Bi L, Chen H, Chlebus G, Dam EB, Dou Q, Fu CW, Georgescu B, Giró-I-Nieto X, Gruen F, Han X, Heng PA, Hesser J, Moltz JH, Igel C, Isensee F, Jäger P, Jia F, Kaluva KC, Khened M, Kim I, Kim JH, Kim S, Kohl S, Konopczynski T, Kori A, Krishnamurthi G, Li F, Li H, Li J, Li X, Lowengrub J, Ma J, Maier-Hein K, Maninis KK, Meine H, Merhof D, Pai A, Perslev M, Petersen J, Pont-Tuset J, Qi J, Qi X, Rippel O, Roth K, Sarasua I, Schenk A, Shen Z, Torres J, Wachinger C, Wang C, Weninger L, Wu J, Xu D, Yang X, Yu SCH, Yuan Y, Yue M, Zhang L, Cardoso J, Bakas S, Braren R, Heinemann V, Pal C, Tang A, Kadoury S, Soler L, van Ginneken B, Greenspan H, Joskowicz L, Menze B. The Liver Tumor Segmentation Benchmark (LiTS). Med Image Anal 2023; 84:102680. [PMID: 36481607 PMCID: PMC10631490 DOI: 10.1016/j.media.2022.102680] [Citation(s) in RCA: 61] [Impact Index Per Article: 61.0] [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: 09/19/2021] [Revised: 09/27/2022] [Accepted: 10/29/2022] [Indexed: 11/18/2022]
Abstract
In this work, we report the set-up and results of the Liver Tumor Segmentation Benchmark (LiTS), which was organized in conjunction with the IEEE International Symposium on Biomedical Imaging (ISBI) 2017 and the International Conferences on Medical Image Computing and Computer-Assisted Intervention (MICCAI) 2017 and 2018. The image dataset is diverse and contains primary and secondary tumors with varied sizes and appearances with various lesion-to-background levels (hyper-/hypo-dense), created in collaboration with seven hospitals and research institutions. Seventy-five submitted liver and liver tumor segmentation algorithms were trained on a set of 131 computed tomography (CT) volumes and were tested on 70 unseen test images acquired from different patients. We found that not a single algorithm performed best for both liver and liver tumors in the three events. The best liver segmentation algorithm achieved a Dice score of 0.963, whereas, for tumor segmentation, the best algorithms achieved Dices scores of 0.674 (ISBI 2017), 0.702 (MICCAI 2017), and 0.739 (MICCAI 2018). Retrospectively, we performed additional analysis on liver tumor detection and revealed that not all top-performing segmentation algorithms worked well for tumor detection. The best liver tumor detection method achieved a lesion-wise recall of 0.458 (ISBI 2017), 0.515 (MICCAI 2017), and 0.554 (MICCAI 2018), indicating the need for further research. LiTS remains an active benchmark and resource for research, e.g., contributing the liver-related segmentation tasks in http://medicaldecathlon.com/. In addition, both data and online evaluation are accessible via https://competitions.codalab.org/competitions/17094.
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Affiliation(s)
- Patrick Bilic
- Department of Informatics, Technical University of Munich, Germany
| | - Patrick Christ
- Department of Informatics, Technical University of Munich, Germany
| | - Hongwei Bran Li
- Department of Informatics, Technical University of Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland.
| | | | - Avi Ben-Cohen
- Department of Biomedical Engineering, Tel-Aviv University, Israel
| | - Georgios Kaissis
- Institute for AI in Medicine, Technical University of Munich, Germany; Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Computing, Imperial College London, London, United Kingdom
| | - Adi Szeskin
- School of Computer Science and Engineering, the Hebrew University of Jerusalem, Israel
| | - Colin Jacobs
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Gabriel Chartrand
- The University of Montréal Hospital Research Centre (CRCHUM) Montréal, Québec, Canada
| | - Fabian Lohöfer
- Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Julian Walter Holch
- Department of Medicine III, University Hospital, LMU Munich, Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany; Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Wieland Sommer
- Department of Radiology, University Hospital, LMU Munich, Germany
| | - Felix Hofmann
- Department of General, Visceral and Transplantation Surgery, University Hospital, LMU Munich, Germany; Department of Radiology, University Hospital, LMU Munich, Germany
| | - Alexandre Hostettler
- Department of Surgical Data Science, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), France
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel
| | | | | | | | - Jacob Sosna
- Department of Radiology, Hadassah University Medical Center, Jerusalem, Israel
| | - Ivan Ezhov
- Department of Informatics, Technical University of Munich, Germany
| | - Anjany Sekuboyina
- Department of Informatics, Technical University of Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland
| | - Fernando Navarro
- Department of Informatics, Technical University of Munich, Germany; Department of Radiation Oncology and Radiotherapy, Klinikum rechts der Isar, Technical University of Munich, Germany; TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Germany
| | - Florian Kofler
- Department of Informatics, Technical University of Munich, Germany; Institute for diagnostic and interventional neuroradiology, Klinikum rechts der Isar,Technical University of Munich, Germany; Helmholtz AI, Helmholtz Zentrum München, Neuherberg, Germany; TranslaTUM - Central Institute for Translational Cancer Research, Technical University of Munich, Germany
| | - Johannes C Paetzold
- Department of Computing, Imperial College London, London, United Kingdom; Institute for Tissue Engineering and Regenerative Medicine, Helmholtz Zentrum München, Neuherberg, Germany
| | - Suprosanna Shit
- Department of Informatics, Technical University of Munich, Germany
| | - Xiaobin Hu
- Department of Informatics, Technical University of Munich, Germany
| | - Jana Lipková
- Brigham and Women's Hospital, Harvard Medical School, USA
| | - Markus Rempfler
- Department of Informatics, Technical University of Munich, Germany
| | - Marie Piraud
- Department of Informatics, Technical University of Munich, Germany; Helmholtz AI, Helmholtz Zentrum München, Neuherberg, Germany
| | - Jan Kirschke
- Institute for diagnostic and interventional neuroradiology, Klinikum rechts der Isar,Technical University of Munich, Germany
| | - Benedikt Wiestler
- Institute for diagnostic and interventional neuroradiology, Klinikum rechts der Isar,Technical University of Munich, Germany
| | - Zhiheng Zhang
- Department of Hepatobiliary Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, China
| | | | - Marcel Beetz
- Department of Informatics, Technical University of Munich, Germany
| | | | - Michela Antonelli
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | | | | | - Lei Bi
- School of Computer Science, the University of Sydney, Australia
| | - Hao Chen
- Department of Computer Science and Engineering, The Hong Kong University of Science and Technology, China
| | - Grzegorz Chlebus
- Fraunhofer MEVIS, Bremen, Germany; Diagnostic Image Analysis Group, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erik B Dam
- Department of Computer Science, University of Copenhagen, Denmark
| | - Qi Dou
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi-Wing Fu
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Xavier Giró-I-Nieto
- Signal Theory and Communications Department, Universitat Politecnica de Catalunya, Catalonia, Spain
| | - Felix Gruen
- Institute of Control Engineering, Technische Universität Braunschweig, Germany
| | - Xu Han
- Department of computer science, UNC Chapel Hill, USA
| | - Pheng-Ann Heng
- Department of Computer Science and Engineering, The Chinese University of Hong Kong, Hong Kong, China
| | - Jürgen Hesser
- Mannheim Institute for Intelligent Systems in Medicine, department of Medicine Mannheim, Heidelberg University, Germany; Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Germany; Central Institute for Computer Engineering (ZITI), Heidelberg University, Germany
| | | | - Christian Igel
- Department of Computer Science, University of Copenhagen, Denmark
| | - Fabian Isensee
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany; Helmholtz Imaging, Germany
| | - Paul Jäger
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany; Helmholtz Imaging, Germany
| | - Fucang Jia
- Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, China
| | - Krishna Chaitanya Kaluva
- Medical Imaging and Reconstruction Lab, Department of Engineering Design, Indian Institute of Technology Madras, India
| | - Mahendra Khened
- Medical Imaging and Reconstruction Lab, Department of Engineering Design, Indian Institute of Technology Madras, India
| | | | - Jae-Hun Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, South Korea
| | | | - Simon Kohl
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tomasz Konopczynski
- Interdisciplinary Center for Scientific Computing (IWR), Heidelberg University, Germany
| | - Avinash Kori
- Medical Imaging and Reconstruction Lab, Department of Engineering Design, Indian Institute of Technology Madras, India
| | - Ganapathy Krishnamurthi
- Medical Imaging and Reconstruction Lab, Department of Engineering Design, Indian Institute of Technology Madras, India
| | - Fan Li
- Sensetime, Shanghai, China
| | - Hongchao Li
- Department of Computer Science, Guangdong University of Foreign Studies, China
| | - Junbo Li
- Philips Research China, Philips China Innovation Campus, Shanghai, China
| | - Xiaomeng Li
- Department of Electrical and Electronic Engineering, The University of Hong Kong, China
| | - John Lowengrub
- Departments of Mathematics, Biomedical Engineering, University of California, Irvine, USA; Center for Complex Biological Systems, University of California, Irvine, USA; Chao Family Comprehensive Cancer Center, University of California, Irvine, USA
| | - Jun Ma
- Department of Mathematics, Nanjing University of Science and Technology, China
| | - Klaus Maier-Hein
- Pattern Analysis and Learning Group, Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany; Helmholtz Imaging, Germany
| | | | - Hans Meine
- Fraunhofer MEVIS, Bremen, Germany; Medical Image Computing Group, FB3, University of Bremen, Germany
| | - Dorit Merhof
- Institute of Imaging & Computer Vision, RWTH Aachen University, Germany
| | - Akshay Pai
- Department of Computer Science, University of Copenhagen, Denmark
| | - Mathias Perslev
- Department of Computer Science, University of Copenhagen, Denmark
| | - Jens Petersen
- Division of Medical Image Computing, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jordi Pont-Tuset
- Eidgenössische Technische Hochschule Zurich (ETHZ), Zurich, Switzerland
| | - Jin Qi
- School of Information and Communication Engineering, University of Electronic Science and Technology of China, China
| | - Xiaojuan Qi
- Department of Electrical and Electronic Engineering, The University of Hong Kong, China
| | - Oliver Rippel
- Institute of Imaging & Computer Vision, RWTH Aachen University, Germany
| | | | - Ignacio Sarasua
- Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Child and Adolescent Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
| | - Andrea Schenk
- Fraunhofer MEVIS, Bremen, Germany; Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Zengming Shen
- Beckman Institute, University of Illinois at Urbana-Champaign, USA; Siemens Healthineers, USA
| | - Jordi Torres
- Barcelona Supercomputing Center, Barcelona, Spain; Universitat Politecnica de Catalunya, Catalonia, Spain
| | - Christian Wachinger
- Department of Informatics, Technical University of Munich, Germany; Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Department of Child and Adolescent Psychiatry, Ludwig-Maximilians-Universität, Munich, Germany
| | - Chunliang Wang
- Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Sweden
| | - Leon Weninger
- Institute of Imaging & Computer Vision, RWTH Aachen University, Germany
| | - Jianrong Wu
- Tencent Healthcare (Shenzhen) Co., Ltd, China
| | | | - Xiaoping Yang
- Department of Mathematics, Nanjing University, China
| | - Simon Chun-Ho Yu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Yading Yuan
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Miao Yue
- CGG Services (Singapore) Pte. Ltd., Singapore
| | - Liping Zhang
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Hong Kong, China
| | - Jorge Cardoso
- School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - Spyridon Bakas
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, PA, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, USA; Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - Rickmer Braren
- German Cancer Consortium (DKTK), Germany; Institute for diagnostic and interventional radiology, Klinikum rechts der Isar, Technical University of Munich, Germany; Comprehensive Cancer Center Munich, Munich, Germany
| | - Volker Heinemann
- Department of Hematology/Oncology & Comprehensive Cancer Center Munich, LMU Klinikum Munich, Germany
| | | | - An Tang
- Department of Radiology, Radiation Oncology and Nuclear Medicine, University of Montréal, Canada
| | | | - Luc Soler
- Department of Surgical Data Science, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), France
| | - Bram van Ginneken
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hayit Greenspan
- Department of Biomedical Engineering, Tel-Aviv University, Israel
| | - Leo Joskowicz
- School of Computer Science and Engineering, the Hebrew University of Jerusalem, Israel
| | - Bjoern Menze
- Department of Informatics, Technical University of Munich, Germany; Department of Quantitative Biomedicine, University of Zurich, Switzerland
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13
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Szeskin A, Rochman S, Weiss S, Lederman R, Sosna J, Joskowicz L. Liver lesion changes analysis in longitudinal CECT scans by simultaneous deep learning voxel classification with SimU-Net. Med Image Anal 2023; 83:102675. [PMID: 36334393 DOI: 10.1016/j.media.2022.102675] [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: 02/24/2022] [Revised: 07/28/2022] [Accepted: 10/27/2022] [Indexed: 11/05/2022]
Abstract
The identification and quantification of liver lesions changes in longitudinal contrast enhanced CT (CECT) scans is required to evaluate disease status and to determine treatment efficacy in support of clinical decision-making. This paper describes a fully automatic end-to-end pipeline for liver lesion changes analysis in consecutive (prior and current) abdominal CECT scans of oncology patients. The three key novelties are: (1) SimU-Net, a simultaneous multi-channel 3D R2U-Net model trained on pairs of registered scans of each patient that identifies the liver lesions and their changes based on the lesion and healthy tissue appearance differences; (2) a model-based bipartite graph lesions matching method for the analysis of lesion changes at the lesion level; (3) a method for longitudinal analysis of one or more of consecutive scans of a patient based on SimU-Net that handles major liver deformations and incorporates lesion segmentations from previous analysis. To validate our methods, five experimental studies were conducted on a unique dataset of 3491 liver lesions in 735 pairs from 218 clinical abdominal CECT scans of 71 patients with metastatic disease manually delineated by an expert radiologist. The pipeline with the SimU-Net model, trained and validated on 385 pairs and tested on 249 pairs, yields a mean lesion detection recall of 0.86±0.14, a precision of 0.74±0.23 and a lesion segmentation Dice of 0.82±0.14 for lesions > 5 mm. This outperforms a reference standalone 3D R2-UNet mdel that analyzes each scan individually by ∼50% in precision with similar recall and Dice score on the same training and test datasets. For lesions matching, the precision is 0.86±0.18 and the recall is 0.90±0.15. For lesion classification, the specificity is 0.97±0.07, the precision is 0.85±0.31, and the recall is 0.86±0.23. Our new methods provide accurate and comprehensive results that may help reduce radiologists' time and effort and improve radiological oncology evaluation.
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Affiliation(s)
- Adi Szeskin
- The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 9190401, Israel; The Alexander Grass Center for Bioengineering, The Hebrew University of Jerusalem, Israel
| | - Shalom Rochman
- The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 9190401, Israel
| | - Snir Weiss
- The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 9190401, Israel
| | - Richard Lederman
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Leo Joskowicz
- The Rachel and Selim Benin School of Computer Science and Engineering, The Hebrew University of Jerusalem, Edmond J. Safra Campus, Givat Ram, Jerusalem 9190401, Israel.
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14
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Witkowska A, Levy S, Roth I, Shochat M, Bradbury D, Sosna J, Leichter I, Goldberg SN, Flacke S. Feasibility and Accuracy of a Novel Hands-Free Robotic System for Percutaneous Needle Insertion and Steering. Surg Technol Int 2022; 41:sti41/1624. [PMID: 36255719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSE To assess the performance and accuracy of CT-guided needle insertion for clinical biopsies using a novel, hands-free robotic system that balances accuracy with the duration of the procedure and radiation dose. MATERIALS AND METHODS A prospective, multi-center study was conducted on 60 clinically indicated biopsies of abdominal lesions at two centers (Center 1, n=26; Center 2, n=34). CT datasets were obtained for planning and controlled placement of 17g and 18g needles using a patient-mounted, CT-guided robotic system with 5 degrees of freedom. Planning included target selection, skin entry point, and predetermined checkpoints where additional imaging was performed to permit stepwise correction of the needle trajectory. Success rate, needle tip-to-target distance, number of checkpoints used, number of trajectory corrections, procedure duration, and effective radiation dose were recorded and compared between centers. RESULTS In 55 of 60 procedures (91.7%), the robot positioned the trocar needle successfully on target. In the remaining 5 patients, the procedure was manually performed by the operator due to technical failure (n=3) or patient-related factors (n=2). The average lesion size was 2.8 ± 1.7cm with a lesion depth from the skin of 8.7 ± 2.6cm, and there was no difference between centers. The overall accuracy (needle tip-to-target distance) was 1.71 ± 1.49 (range 0.05-7.20mm), with an accuracy of 2.06 ± 1.45 mm at Center 1 and 1.45 ± 1.52 mm at Center 2 (p=0.1358). Center 1 used significantly more checkpoints (4.96 ± 1.08) and performed target adjustments in 20 of 24 (83%) cases compared to Center 2 (2.77 ± 0.6 checkpoints and target adjustments in 13 of 31 cases, 42%) (p=0.0024). Accordingly, the steering duration from skin entry to the target varied between Centers 1 and 2; 13.1min ± 4.25min vs. 5.7min ± 2.7min, respectively (p <0.001). The average DLP for the entire procedure was 1147 ± 820 mGycm, with a slightly lower average at Center 2 (1031 ± 724 mGycm) compared to Center 1 (1297 ± 925 mGycm) (p=0.236). CONCLUSION Accurate needle-targeting within an error of 2mm can be achieved in patients using a CT-guided robotic system. The variation in the number of checkpoints did not affect system accuracy but was related to shorter steering times and may contribute to a lower radiation dose. Accurate needle insertion using a hands-free CT-guided robotic system may facilitate difficult needle placement and enhance the performance of less-experienced interventionalists.
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Affiliation(s)
- Agnieszka Witkowska
- Department of Radiology, Lahey Hospital and Medical Center,, Tufts University Medical School, Burlington, MA, US
| | - Shiran Levy
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | | | | | | | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Isaac Leichter
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sebastian Flacke
- Department of Radiology, Lahey Hospital and Medical Center,, Tufts University Medical School, Burlington, MA, US
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Gofrit ON, Gofrit B, Roditi Y, Popovtzer A, Frank S, Sosna J, Goldberg SN. Patterns of metastases progression- The linear parallel ratio. PLoS One 2022; 17:e0274942. [PMID: 36129954 PMCID: PMC9491615 DOI: 10.1371/journal.pone.0274942] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Linear and parallel are the two leading models of metastatic progression. In this study we propose a simple way to differentiate between them. While the linear model predicts accumulation of genetic and epigenetic alterations within the primary tumor by founder cells before spreading as waves of metastases, the parallel model suggests preclinical distribution of less advanced disseminated tumor cells with independent selection and expansion at the ectopic sites. Due to identical clonal origin and time of dispatching, linear metastases are expected to have comparable diameters in any specific organ while parallel metastases are expected to appear in variable sizes. Methods and findings Retrospective revision of chest CT of oncological patients with lung metastases was performed. Metastasis number and largest diameters were recorded. The sum number of metastases with a similar diameter (c) and those without (i) was counted and the linear/parallel ratio (LPR) was calculated for each patient using the formula (∑c-∑i)/(∑c+∑i). A LPR ratio of 1 implies pure linear progression pattern and -1 pure parallel. 12,887 metastases were measured in 503 patients with nine malignancy types. The median LPR of the entire group was 0.71 (IQR 0.14–0.93). In carcinomas of the pancreas, prostate, and thyroid the median LPR was 1. Median LPRs were 0.91, 0.65, 0.60, 0.58, 0.50 and 0.43 in renal cell carcinomas, melanomas, colorectal, breast, bladder, and sarcomas, respectively. Conclusions Metastatic spread of thyroid, pancreas, and prostate tumors is almost exclusively by a linear route. The spread of kidney, melanoma, colorectal, breast, bladder and sarcoma is both linear and parallel with increasing dominance of the parallel route in this order. These findings can explain and predict the clinical and genomic features of these tumors and can potentially be used for evaluation of metastatic origin in the individual patient.
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Affiliation(s)
- Ofer N. Gofrit
- Department of Urology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| | - Ben Gofrit
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yuval Roditi
- School of Engineering and Computer Science, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aron Popovtzer
- Department of Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Steve Frank
- Department of Oncology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S. Nahum Goldberg
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Shaul D, Grieb B, Lev‐Cohain N, Sosna J, Gomori JM, Katz‐Brull R. Accumulation of 3-aminopropylphosphonate in the ex vivo brain observed by phosphorus-31 nuclear magnetic resonance. NMR Biomed 2022; 35:e4721. [PMID: 35229366 PMCID: PMC9540894 DOI: 10.1002/nbm.4721] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
3-aminopropylphosphonate (3-APP) is known for its use as an exogenous indicator of extracellular volume and pH in phosphorus-31 nuclear magnetic resonance (31 P NMR) studies. We used 3-APP for estimating the extracellular volume in NMR studies of several ex vivo preparations including retrograde perfused mouse heart (n = 4), mouse liver slices (n = 2), xenograft breast cancer tumors (n = 7, MCF7), and rat brain slices (n = 4). In the former three preparations, the 3-APP signal was stable in lineshape and intensity for hours and the chemical shift of the signal in the presence of the biological sample was the same as in the perfusion medium without the biological sample. However, in studies of brain slices, the 3-APP signal appeared split into two, with an upfield component (0.7 ± 0.1 ppm to the left) increasing with time and showing a wider linewidth (66.7 ± 12.6 vs. 39.1 ± 7.6 Hz, the latter is of the perfusion medium signal). This finding suggests that 3-APP inadvertently accumulated in brain slices, most likely as a membrane bound form. This observation limits the use of 3-APP as an inert biochemical indicator in brain preparations and should be taken into account when using 3-APP in vivo.
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Affiliation(s)
- David Shaul
- Department of Radiology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
- The Wohl Institute for Translational MedicineJerusalemIsrael
| | - Benjamin Grieb
- Department of Radiology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
- Department of Psychiatry and Psychotherapie I (Weissenau), ZfP SuedwuerttembergUlm UniversityRavensburgGermany
| | - Naama Lev‐Cohain
- Department of Radiology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
| | - J. Moshe Gomori
- Department of Radiology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
| | - Rachel Katz‐Brull
- Department of Radiology, Hadassah Medical CenterHebrew University of Jerusalem, The Faculty of MedicineJerusalemIsrael
- The Wohl Institute for Translational MedicineJerusalemIsrael
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Sosna J. Photon-counting Detector CT: Initial Analysis of Virtual Noncontrast Imaging. Radiology 2022; 305:116-117. [PMID: 35670720 DOI: 10.1148/radiol.221173] [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: 11/11/2022]
Affiliation(s)
- Jacob Sosna
- From the Department of Radiology, Hebrew University School of Medicine, Hadassah Medical Center, Jerusalem, Israel 91120
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18
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Halevy D, Simanovsky N, Lev-Cohain N, Sosna J, Hiller N, Duvdevani M, Gofrit ON, Hidas G. Correction to: Parenchymal echotexture changes as a predictor of viability in testicular torsion. Emerg Radiol 2022; 29:621. [PMID: 35381873 DOI: 10.1007/s10140-022-02043-3] [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: 10/18/2022]
Affiliation(s)
- Dan Halevy
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel.
| | - Natalia Simanovsky
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
| | - Namma Lev-Cohain
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
| | - Nurith Hiller
- Department of Radiology, Hadassah University Hospital, Jerusalem, Israel
| | | | - Ofer N Gofrit
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
| | - Guy Hidas
- Department of Urology, Hadassah University Hospital, Jerusalem, Israel
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19
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Saban M, Sosna J, Singer C, Vaknin S, Myers V, Shaham D, Assaf J, Hershko A, Feder-Bubis P, Wilf-Miron R, Luxenburg O. Clinical decision support system recommendations: how often do radiologists and clinicians accept them? Eur Radiol 2022; 32:4218-4224. [PMID: 35024948 DOI: 10.1007/s00330-021-08479-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 10/06/2021] [Revised: 11/01/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the acceptance and reliability of clinical decision support system (CDSS) imaging referral scores (ESR iGuide). METHODS A pilot study was conducted in a tertiary hospital. Four different experts were invited to rate 40 simulated clinical cases on a 5-level scale, for the level of agreement with the ESR iGuide's recommended procedures. In cases of disagreement, physicians were asked to indicate the reason. Descriptive measures were calculated for the level of agreement. We also explored the degree of agreement between four different specialists, and examined the cases in which clinicians disagreed with ESR iGuide best practice recommendations. RESULTS The mean rating of the four experts for the 40 clinical simulated cases was 4.17 ± 0.65, median 4.25 (on a scale of 1-5). All four raters totally agreed with the system recommendation in 75% of cases. No significant relationship was found between the degree of agreement and the number of indications and the patient's age or gender. In an optimistic scenario, using a binary agree/disagree variable, the Overall Percentage Agreement for the rating of the 40 simulated cases between the four experts was 77.28%. There were a total of 20 disagreements out of 160 cases with the ESR iGuide, of which 7 were among the two radiologists. CONCLUSIONS CDSS can be an effective tool for guiding the selection of appropriate imaging examinations, thus cutting costs due to unnecessary imaging scans. Since this is a pilot study, further research on a larger scale, preferably at national level, is required. KEY POINTS • The average of the mean rating of the four experts was 4.17 ± 0.65, median 4.25, on a scale of 1-5 where 5 represents total agreement with the CDSS tool. • In an optimistic scenario, using a binary agree/disagree variable, the Overall Percentage Agreement between the four experts was 77.28%. • Radiologists had fewer disagreements with the recommendations of the CDSS tool than other physicians, indicating a better fit of the support system to radiology experts' perspective.
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Affiliation(s)
- Mor Saban
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel.
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Clara Singer
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Sharona Vaknin
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Vicki Myers
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel
| | - Dorit Shaham
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Assaf
- Emergency Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Alon Hershko
- Internal Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Paula Feder-Bubis
- Department of Health Systems Management, Ben-Gurion University of the Negev, Beersheba, Israel
| | - Rachel Wilf-Miron
- The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, 526210, Ramat Gan, Israel.,School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Luxenburg
- Medical Technology, Health Information and Research Directorate, Ministry of Health, Jerusalem, Israel
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20
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Kahn C, Leichter I, Lederman R, Sosna J, Duvdevani M, Yeshua T. Quantitative assessment of renal obstruction in multi-phase CTU using automatic 3D segmentation of the renal parenchyma and renal pelvis: A proof of concept. Eur J Radiol Open 2022; 9:100458. [DOI: 10.1016/j.ejro.2022.100458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 11/27/2022] Open
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21
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Talmon A, Tal Y, Moss J, Hershkowitz I, Shaham D, Sosna J, Hershko AY. Clinical impact of allergy and pre-medication in CT studies with low-osmolality intravenous iodinated contrast media. Clin Radiol 2021; 77:210-215. [PMID: 34973806 DOI: 10.1016/j.crad.2021.12.009] [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: 06/23/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022]
Abstract
AIM To evaluate the occurrence and severity of allergic reactions to iodinated contrast media (ICM), including associated risk factors and the impact of pre-medication. MATERIALS AND METHODS Data on patients who had experienced allergic reactions during outpatient computed tomography (CT) examinations between January 2014 and September 2018 were analysed retrospectively. Response severity was assessed according to validated criteria. A control group was selected among individuals who underwent CT during the study period and did not experience allergic reactions. RESULTS Screening of 36,920 CT studies revealed 74 (0.2%) individuals with systemic reactions to ICM. No significant differences in patient characteristics were found among patients who experienced mild (n=54), moderate (n=17), or severe (n=4) reactions. Previous ICM allergy was reported in 10 patients (13.3%). Patients with a history of ICM allergy had mild (9/10) or moderate (1/10) reactions, with one individual showing decreased intensity of the allergic response compared to a previous event. Within the control group, four patients (4%) had previous ICM allergy. In these individuals, lack of allergic reactions could not be attributed to pre-medication. All patients with severe reactions did not have a prior history of ICM allergy. CONCLUSION Severe allergic reactions to ICM are rare, lack significant risk factors, and do not appear to be impacted by pre-medication. The findings presented herein highlight the need for prospective work that will re-evaluate the yield of pre-medication protocols.
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Affiliation(s)
- A Talmon
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Y Tal
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - J Moss
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - I Hershkowitz
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - D Shaham
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - J Sosna
- Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - A Y Hershko
- Allergy and Clinical Immunology Unit, Department of Medicine, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Israel.
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22
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Sosna J. Deep Learning for Automated Normal Liver Volume Estimation. Radiology 2021; 302:343-344. [PMID: 34698573 DOI: 10.1148/radiol.2021212010] [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: 11/11/2022]
Affiliation(s)
- Jacob Sosna
- From the Department of Radiology, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel 91120
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23
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Levy S, Goldberg SN, Roth I, Shochat M, Sosna J, Leichter I, Flacke S. Clinical evaluation of a robotic system for precise CT-guided percutaneous procedures. Abdom Radiol (NY) 2021; 46:5007-5016. [PMID: 34146132 DOI: 10.1007/s00261-021-03175-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/07/2021] [Accepted: 06/09/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To assess accuracy and compare protocols for CT-guided needle insertion for clinical biopsies using a hands-free robotic system, balancing system accuracy with duration of procedure and radiation dose. METHODS Thirty-two percutaneous abdominal and pelvic biopsies were performed and analyzed at two centers (Center 1 n = 11; Center 2 n = 21) as part of an ongoing prospective, multi-center study. CT datasets were obtained for planning and controlled placement of 17 g needles using a patient-mounted, CT-guided robotic system. Planning included target selection, skin entry point, and predetermined checkpoints. Additional CT imaging was performed at checkpoints to confirm needle location and permit stepwise correction of the trajectory. Center 1 used a more conservative approach with multiple checkpoints, whereas Center 2 used fewer checkpoints. Scanning and needle advancement were performed under respiratory gating. Accuracy, radiation dose, and steering duration were compared. RESULTS Overall accuracy was 1.6 ± 1.5 mm (1.9 ± 1.2 mm Center 1; 1.5 ± 1.6 mm Center 2; p = 0.55). Mean distance to target was 86.2 ± 27.1 mm (p = 0.18 between centers). Center 1 used 4.6 ± 0.8 checkpoints, whereas Center 2 used 1.8 ± 0.6 checkpoints (p < 0.001). Effective radiation doses were lower for Center 1 than for Center 2 (22.2 ± 12.6 mSv vs. 11.7 ± 4.3 mSv; p = 0.002). Likewise, steering duration (from planning to target) was significantly reduced in relation to the number of checkpoints from 43.8 ± 15.9 min for Center 1 to 30.5 ± 10.2 min for Center 2 (p = 0.008). CONCLUSIONS Accurate needle targeting with < 2 mm error can be achieved in patients when using a CT-guided robotic system. Judicious selection of the number of checkpoints may substantially reduce procedure time and radiation dose without sacrificing accuracy.
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24
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Benson AA, Aviran E, Yaari S, Lev-Cohain N, Sosna J, Oren R, Israeli E. Clinical and Radiologic Characteristics of Intra-Abdominal Fistulizing Crohn's Disease. Digestion 2021; 101:667-673. [PMID: 31291622 DOI: 10.1159/000501514] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Few studies describe the radiological and laboratory characteristics of patients with Crohn's disease (CD) with intra-abdominal fistulae. OBJECTIVES We aimed to describe a cohort of CD patients with intra-abdominal fistulae and determine characteristics associated with complex fistulae. METHODS Data were gathered from medical records and imaging studies of patients. Evaluation included type of fistula, number of fistulae, and radiological characteristics. RESULTS A total of 205 fistulae in 132 patients were identified with an average patient age of 31 (±12) years. The average time from CD diagnosis to fistula development was 7 years. The most common type of fistula was entero-enteric (53%). Patients with an extra-intestinal fistula presented with an average of 1.96 fistulae, compared with an average of 1.28 fistulae for those with a fistula limited to the bowel (p =0.01). Except for the number of fistula no other significant differences were observed in radiological characteristics of patients who were diagnosed with a fistula at time of CD diagnosis compared to those diagnosed with a fistula later. CONCLUSIONS The most common CD-associated intra-abdominal fistulae are entero-enteric and entero-colonic fistulae. An extra-intestinal fistula and diagnosis of a fistula subsequent to diagnosis of CD were associated with an increased number of fistulae per patient.
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Affiliation(s)
- Ariel A Benson
- Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel,
| | - Eyal Aviran
- Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Shaul Yaari
- Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Naama Lev-Cohain
- Department of Radiology and Medical Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology and Medical Imaging, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Ran Oren
- Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Eran Israeli
- Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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25
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Shaul D, Grieb B, Sapir G, Uppala S, Sosna J, Gomori JM, Katz-Brull R. The metabolic representation of ischemia in rat brain slices: A hyperpolarized 13 C magnetic resonance study. NMR Biomed 2021; 34:e4509. [PMID: 33774865 DOI: 10.1002/nbm.4509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 06/12/2023]
Abstract
The ischemic penumbra in stroke is not clearly defined by today's available imaging tools. This study aimed to develop a model system and noninvasive biomarkers of ischemic brain tissue for an examination that might potentially be performed in humans, very quickly, in the course of stroke triage. Perfused rat brain slices were used as a model system and 31 P spectroscopy verified that the slices were able to recover from an ischemic insult of about 3.5 min of perfusion arrest. This was indicated as a return to physiological pH and adenosine triphosphate levels. Instantaneous changes in lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) activities were monitored and quantified by the metabolic conversions of hyperpolarized [1-13 C]pyruvate to [1-13 C]lactate and [13 C]bicarbonate, respectively, using 13 C spectroscopy. In a control group (n = 8), hyperpolarized [1-13 C]pyruvate was administered during continuous perfusion of the slices. In the ischemia group (n = 5), the perfusion was arrested 30 s prior to administration of hyperpolarized [1-13 C]pyruvate and perfusion was not resumed throughout the measurement time (approximately 3.5 min). Following about 110 s of the ischemic insult, LDH activity increased by 80.4 ± 13.5% and PDH activity decreased by 47.8 ± 25.3%. In the control group, the mean LDH/PDH ratio was 16.6 ± 3.3, and in the ischemia group, the LDH/PDH ratio reached an average value of 38.7 ± 16.9. The results suggest that monitoring the activity of LDH and PDH, and their relative activities, using hyperpolarized [1-13 C]pyruvate, could serve as an imaging biomarker to characterize the changes in the ischemic penumbra.
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Affiliation(s)
- David Shaul
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Benjamin Grieb
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
- Department of Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ravensburg, Germany
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sivaranjan Uppala
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
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Sosna J, Pyatigorskaya N, Krestin G, Denton E, Stanislav K, Morozov S, Kumamaru KK, Jankharia B, Mildenberger P, Forster B, Schouman-Clayes E, Bradey A, Akata D, Brkljacic B, Grassi R, Plako A, Papanagiotou H, Maksimović R, Lexa F. International survey on residency programs in radiology: similarities and differences among 17 countries. Clin Imaging 2021; 79:230-234. [PMID: 34119915 DOI: 10.1016/j.clinimag.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE With the initiative of the ACR International Economics Committee, a multinational survey was conducted to evaluate radiology residency programs around the world. METHODS A 31-question survey was developed. It included: economic issues, program size and length, resident's activities during daytime and call, academic aspects including syllabus and examinations. Data was tabulated using the forementioned thematic framework and was qualitatively analyzed. RESULTS Responses were received from all 17 countries that were invited to participate (France, Netherlands, Israel, UK, Russia, USA, Japan, India, Germany, Canada, Turkey, Croatia, Serbia, Italy, Ireland, Hungary, and Greece). Residency length varied between 2 and 5 years. The certificate of residency completion is provided by a local hospital [4/17 (23%)], University [6/17 (36%)], National Board [6/17 (36%)], and Ministry of Health [1/17 (6%)]. There was variability among the number of residency programs and residents per program ranging from 15 to 300 programs per nation with a 1-700 residents in each one respectively. Salaries varied significantly and ranged from 8000 to 75,000 USD equivalent. Exams are an integral part of training in all surveyed countries. Length of call varied between 5 and 26 h and the number of monthly calls ranged from 3 to 6. The future of radiology was judged as growing in [12/17 (70%)] countries and stagnant in [5/17 (30%)] countries. DISCUSSION Radiology residency programs worldwide have many similarities. The differences are in the structure of the residency programs. Stagnation and uncertainties need to be addressed to ensure the continued development of the next generation of radiologists. SUMMARY STATEMENT There are many similarities in the academic aims and approach to education and training of radiology residency programs worldwide. The differences are in the structure of the residency programs and payments to individual residents.
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Affiliation(s)
- Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel.
| | - Nadya Pyatigorskaya
- Department of Radiology Pitié-Salpêtrière, Sorbonne Universités, UPMC Univ Paris 6, Paris, France; Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Gabriel Krestin
- Department of Radiology Pitié-Salpêtrière, Sorbonne Universités, UPMC Univ Paris 6, Paris, France
| | - Erika Denton
- Department of Radiology, Norfolk & Norwich University Hospital, UK
| | - Kim Stanislav
- Radiology Research and Practical Centre, Moscow, Russia
| | | | | | | | - Peter Mildenberger
- Department of Radiology, Universitätsmedizin Mainz Klinik und Poliklinik Radiologie, Mainz, Germany
| | - Bruce Forster
- Department of Radiology, University of British Columbia, Faculty of Medicine, Vancouver, Canada
| | | | - Adrian Bradey
- Department of Radiology, Mercy University Hospital, Cork, Ireland
| | - Deniz Akata
- Department of Radiology, Hacettepe University, Ankara, Turkey
| | - Boris Brkljacic
- Department of Radiology, Dubrava Hospital, University of Zagreb, Croatia
| | - Roberto Grassi
- Department of Radiology, Università della Campania Luigi Vanvitelli, Naples, Italy
| | - Andras Plako
- Department of Radiology, University of Szeged, Hungary
| | | | | | - Frank Lexa
- The Radiology Leadership Institute and Chair of the Commission on Leadership and Practice Development of the American College of Radiology, Reston, VA, United States of America
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Husseini JS, Amorim BJ, Torrado-Carvajal A, Prabhu V, Groshar D, Umutlu L, Herrmann K, Cañamaque LG, Garzón JRG, Palmer WE, Heidari P, Shih TTF, Sosna J, Matushita C, Cerci J, Queiroz M, Muglia VF, Nogueira-Barbosa MH, Borra RJH, Kwee TC, Glaudemans AWJM, Evangelista L, Salvatore M, Cuocolo A, Soricelli A, Herold C, Laghi A, Mayerhoefer M, Mahmood U, Catana C, Daldrup-Link HE, Rosen B, Catalano OA. An international expert opinion statement on the utility of PET/MR for imaging of skeletal metastases. Eur J Nucl Med Mol Imaging 2021; 48:1522-1537. [PMID: 33619599 PMCID: PMC8240455 DOI: 10.1007/s00259-021-05198-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/10/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND MR is an important imaging modality for evaluating musculoskeletal malignancies owing to its high soft tissue contrast and its ability to acquire multiparametric information. PET provides quantitative molecular and physiologic information and is a critical tool in the diagnosis and staging of several malignancies. PET/MR, which can take advantage of its constituent modalities, is uniquely suited for evaluating skeletal metastases. We reviewed the current evidence of PET/MR in assessing for skeletal metastases and provided recommendations for its use. METHODS We searched for the peer reviewed literature related to the usage of PET/MR in the settings of osseous metastases. In addition, expert opinions, practices, and protocols of major research institutions performing research on PET/MR of skeletal metastases were considered. RESULTS Peer-reviewed published literature was included. Nuclear medicine and radiology experts, including those from 13 major PET/MR centers, shared the gained expertise on PET/MR use for evaluating skeletal metastases and contributed to a consensus expert opinion statement. [18F]-FDG and non [18F]-FDG PET/MR may provide key advantages over PET/CT in the evaluation for osseous metastases in several primary malignancies. CONCLUSION PET/MR should be considered for staging of malignancies where there is a high likelihood of osseous metastatic disease based on the characteristics of the primary malignancy, hight clinical suspicious and in case, where the presence of osseous metastases will have an impact on patient management. Appropriate choice of tumor-specific radiopharmaceuticals, as well as stringent adherence to PET and MR protocols, should be employed.
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Affiliation(s)
- Jad S Husseini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Bárbara Juarez Amorim
- Division of Nuclear Medicine, Department of Radiology, School of Medical Sciences,, State University of Campinas, Campinas, Brazil
| | - Angel Torrado-Carvajal
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Medical Image Analysis and Biometry Laboratory, Universidad Rey Juan Carlos, Madrid, Spain
| | - Vinay Prabhu
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - David Groshar
- Department of Nuclear Medicine, Assuta Medical Center, Tel Aviv, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, Essen, Germany
| | - Lina García Cañamaque
- Department of Nuclear Medicine, Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | | | - William E Palmer
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Tiffany Ting-Fang Shih
- Department of Radiology and Medical Imaging, National Taiwan University College of Medicine and Hospital, Taipei City, Taiwan
| | - Jacob Sosna
- Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Cristina Matushita
- Department of Nuclear Medicine, Hospital São Lucas of Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliano Cerci
- Department of Nuclear Medicine, Quanta Diagnóstico Nuclear, Curitiba, Brazil
| | - Marcelo Queiroz
- Department of Radiology and Oncology, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valdair Francisco Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, Hospital Clinicas, University of São Paulo, Ribeirão Prêto, Brazil
| | - Marcello H Nogueira-Barbosa
- Department of Medical Imaging, Hematology and Clinical Oncology, Ribeirão Preto Medical School. University of São Paulo (USP), Ribeirão Prêto, Brazil
| | - Ronald J H Borra
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Thomas C Kwee
- Medical Imaging Center, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura Evangelista
- Department of Clinical and Experimental Medicine, University of Padova, Padua, Italy
| | - Marco Salvatore
- Department of Radiology and Nuclear Medicine, Università Suor Orsola Benincasa di Napoli, Naples, Italy
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
| | - Alberto Cuocolo
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Andrea Soricelli
- Department of Radiology and Nuclear Medicine, Institute for Hospitalization and Healthcare (IRCCS) SDN, Istituto di Ricerca, Naples, Italy
- Department of Movement and Wellness Sciences, Parthenope University of Naples, Naples, Italy
| | - Christian Herold
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Andrea Laghi
- Department of Radiology, University of Rome "La Sapienza", Rome, Italy
| | - Marius Mayerhoefer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Umar Mahmood
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Ciprian Catana
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Bruce Rosen
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
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Lev-Cohain N, Sosna J, Meir Y, Dar G, Shussman N, Leichter I, Caplan N, Goldberg SN. Dual energy CT in acute appendicitis: value of low mono-energy. Clin Imaging 2021; 77:213-218. [PMID: 33992882 DOI: 10.1016/j.clinimag.2021.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To assess the potential role of low monoenergetic images in the evaluation of acute appendicitis. METHODS A retrospective study of 42 patients with pathology proven acute appendicitis underwent contrast-enhanced-CT conducted on a single-source-DECT before surgery. Attenuation, SNR, and CNR were calculated on both monoenergetic and conventional images and compared to 24 abdominal CT-scans with normal appendix. Representative conventional and monoenergetic images were randomized and presented side-by-side to three abdominal radiologists to determine preferred images for detecting inflammation. Additionally, six individual acute inflammatory characteristics were graded on a 1-5 scale to determine factors contributing to differences between conventional and monoenergetic images by 2 abdominal radiologists. Paired t-tests, Wilcoxon and McNemar tests, and intra-observer error statistics were performed. RESULTS For the inflamed appendixes monoenergetic images had overall increased attenuation (average ratio 1.7; P < 0.05), signal-to-noise-ratio (6.7 ± 3.1 vs 4.2 ± 1.6; P < 0.001) and contrast-to-noise-ratio (12.1 ± 3 vs 9 ± 2.1; P < 0.001). Moreover, this increase was not found in normal appendixes (P < 0.001 vs p = 0.28-0.44). Subjectively, radiologists showed significant preferences towards monoenergetic images (P < 0.001), with inter-reader agreement of 0.84. Two parameters, diffuse bowel wall and mucosal enhancement, received significantly higher scores on monoenergetic images (average 4.3 vs. 3.0; P < 0.001 and 2.8 vs. 2.3 P < 0.03 respectively, with interobserver agreements of 62% and 52%). CONCLUSION Increased bowel wall conspicuity from enhanced attenuation, SNR, and CNR on low monenergetic CT images results in a significant preference by radiologists for these images when assessing acute inflamed appendixes. Thus, close inspection of low monoenergetic images may improve the visualization of acute inflammatory bowel processes.
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Affiliation(s)
- Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel.
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Yuval Meir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Gili Dar
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Noam Shussman
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Isaac Leichter
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - Nadia Caplan
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem 91120, Israel
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Sapir G, Shaul D, Lev-Cohain N, Sosna J, Gomori MJ, Katz-Brull R. LDH and PDH Activities in the Ischemic Brain and the Effect of Reperfusion-An Ex Vivo MR Study in Rat Brain Slices Using Hyperpolarized [1- 13C]Pyruvate. Metabolites 2021; 11:210. [PMID: 33808434 PMCID: PMC8066106 DOI: 10.3390/metabo11040210] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 12/11/2022] Open
Abstract
Ischemic stroke is a leading cause for neurologic disability worldwide, for which reperfusion is the only available treatment. Neuroimaging in stroke guides treatment, and therefore determines the clinical outcome. However, there are currently no imaging biomarkers for the status of the ischemic brain tissue. Such biomarkers could potentially be useful for guiding treatment in patients presenting with ischemic stroke. Hyperpolarized 13C MR of [1-13C]pyruvate is a clinically translatable method used to characterize tissue metabolism non-invasively in a relevant timescale. The aim of this study was to utilize hyperpolarized [1-13C]pyruvate to investigate the metabolic consequences of an ischemic insult immediately during reperfusion and upon recovery of the brain tissue. The rates of lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) were quantified by monitoring the rates of [1-13C]lactate and [13C]bicarbonate production from hyperpolarized [1-13C]pyruvate. 31P NMR of the perfused brain slices showed that this system is suitable for studying ischemia and recovery following reperfusion. This was indicated by the levels of the high-energy phosphates (tissue viability) and the chemical shift of the inorganic phosphate signal (tissue pH). Acidification, which was observed during the ischemic insult, has returned to baseline level following reperfusion. The LDH/PDH activity ratio increased following ischemia, from 47.0 ± 12.7 in the control group (n = 6) to 217.4 ± 121.3 in the ischemia-reperfusion group (n = 6). Following the recovery period (ca. 1.5 h), this value had returned to its pre-ischemia (baseline) level, suggesting the LDH/PDH enzyme activity ratio may be used as a potential indicator for the status of the ischemic and recovering brain.
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Affiliation(s)
- Gal Sapir
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - David Shaul
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - Moshe J. Gomori
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9112001, Israel; (G.S.); (D.S.); (N.L.-C.); (J.S.); (M.J.G.)
- The Wohl Institute for Translational Medicine, Jerusalem 9112001, Israel
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Dick J, Darras KE, Lexa FJ, Denton E, Ehara S, Galloway H, Jankharia B, Kassing P, Kumamaru KK, Mildenberger P, Morozov S, Pyatigorskaya N, Song B, Sosna J, van Buchem M, Forster BB. An International Survey of Quality and Safety Programs in Radiology. Can Assoc Radiol J 2021; 72:135-141. [PMID: 32066249 DOI: 10.1177/0846537119899195] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of this study was to determine the status of radiology quality improvement programs in a variety of selected nations worldwide. METHODS A survey was developed by select members of the International Economics Committee of the American College of Radiology on quality programs and was distributed to committee members. Members responded on behalf of their country. The 51-question survey asked about 12 different quality initiatives which were grouped into 4 themes: departments, users, equipment, and outcomes. Respondents reported whether a designated type of quality initiative was used in their country and answered subsequent questions further characterizing it. RESULTS The response rate was 100% and represented Australia, Canada, China, England, France, Germany, India, Israel, Japan, the Netherlands, Russia, and the United States. The most frequently reported quality initiatives were imaging appropriateness (91.7%) and disease registries (91.7%), followed by key performance indicators (83.3%) and morbidity and mortality rounds (83.3%). Peer review, equipment accreditation, radiation dose monitoring, and structured reporting were reported by 75.0% of respondents, followed by 58.3% of respondents for quality audits and critical incident reporting. The least frequently reported initiatives included Lean/Kaizen exercises and physician performance assessments, implemented by 25.0% of respondents. CONCLUSION There is considerable diversity in the quality programs used throughout the world, despite some influence by national and international organizations, from whom further guidance could increase uniformity and optimize patient care in radiology.
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Affiliation(s)
- Jeremy Dick
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn E Darras
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank J Lexa
- Department of Medical Imaging, 12216University of Arizona College of Medicine, Tucson, AZ, USA
- The Radiology Leadership Institute and Commission on Leadership and Practice Development, 72672American College of Radiology, Tucson, AZ, USA
| | - Erika Denton
- Norfolk & Norwich University Hospital, Norwich, Norfolk, United Kingdom
| | - Shigeru Ehara
- Department of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, Tohoku, Japan
| | | | | | - Pam Kassing
- 72672American College of Radiology, Reston, VA, USA
| | | | - Peter Mildenberger
- Department of Radiology, 9182University Medical Center Mainz, Mainz, Germany
| | | | - Nadya Pyatigorskaya
- Department of Neuroradiology, 27063Sorbonne University, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Bin Song
- West China Hospital, 12530Sichuan University, Chengdu, Sichuan, China
| | - Jacob Sosna
- Department of Radiology, 58884Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Marcus van Buchem
- Department of Radiology, 4501Leiden University Medical Center, Leiden, the Netherlands
| | - Bruce B Forster
- University of British Columbia, Vancouver, British Columbia, Canada
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Shaul D, Azar A, Sapir G, Uppala S, Nardi-Schreiber A, Gamliel A, Sosna J, Gomori JM, Katz-Brull R. Correlation between lactate dehydrogenase/pyruvate dehydrogenase activities ratio and tissue pH in the perfused mouse heart: A potential noninvasive indicator of cardiac pH provided by hyperpolarized magnetic resonance. NMR Biomed 2021; 34:e4444. [PMID: 33258527 DOI: 10.1002/nbm.4444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 10/05/2020] [Accepted: 10/24/2020] [Indexed: 06/12/2023]
Abstract
Cardiovascular diseases account for more than 30% of all deaths worldwide and many could be ameliorated with early diagnosis. Current cardiac imaging modalities can assess blood flow, heart anatomy and mechanical function. However, for early diagnosis and improved treatment, further functional biomarkers are needed. One such functional biomarker could be the myocardium pH. Although tissue pH is already determinable via MR techniques, and has been since the early 1990s, it remains elusive to use practically. The objective of this study was to explore the possibility to evaluate cardiac pH noninvasively, using in-cell enzymatic rates of hyperpolarized [1-13 C]pyruvate metabolism (ie, moles of product produced per unit time) determined directly in real time using magnetic resonance spectroscopy in a perfused mouse heart model. As a gold standard for tissue pH we used 31 P spectroscopy and the chemical shift of the inorganic phosphate (Pi) signal. The nonhomogenous pH distribution of the perfused heart was analyzed using a multi-parametric analysis of this signal, thus taking into account the heterogeneous nature of this characteristic. As opposed to the signal ratio of hyperpolarized [13 C]bicarbonate to [13 CO2 ], which has shown correlation to pH in other studies, we investigated here the ratio of two intracellular enzymatic rates: lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH), by way of determining the production rates of [1-13 C]lactate and [13 C]bicarbonate, respectively. The enzyme activities determined here are intracellular, while the pH determined using the Pi signal may contain an extracellular component, which could not be ruled out. Nevertheless, we report a strong correlation between the tissue pH and the LDH/PDH activities ratio. This work may pave the way for using the LDH/PDH activities ratio as an indicator of cardiac intracellular pH in vivo, in an MRI examination.
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Affiliation(s)
- David Shaul
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Assad Azar
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sivaranjan Uppala
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Atara Nardi-Schreiber
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Ayelet Gamliel
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
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Sosna J. The Value of Virtual Unenhanced Dual-Energy CT for Renal Mass and Hematuria Evaluation. Radiology 2021; 298:620-621. [PMID: 33475468 DOI: 10.1148/radiol.2021203947] [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: 11/11/2022]
Affiliation(s)
- Jacob Sosna
- From the Department of Radiology, Hebrew University School of Medicine, Hadassah Medical Center, Jerusalem, Israel 91120
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Ziv O, Goldberg SN, Nissenbaum Y, Sosna J, Weiss N, Azhari H. In vivo noninvasive three-dimensional (3D) assessment of microwave thermal ablation zone using non-contrast-enhanced x-ray CT. Med Phys 2020; 47:4721-4734. [PMID: 32745257 DOI: 10.1002/mp.14428] [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: 01/23/2020] [Revised: 07/20/2020] [Accepted: 07/22/2020] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To develop an image processing methodology for noninvasive three-dimensional (3D) quantification of microwave thermal ablation zones in vivo using x-ray computed tomography (CT) imaging without injection of a contrast enhancing material. METHODS Six microwave (MW) thermal ablation procedures were performed in three pigs. The ablations were performed with a constant heating duration of 8 min and power level of 30 W. During the procedure images from sixty 1 mm thick slices were acquired every 30 s. At the end of all ablation procedures for each pig, a contrast-enhanced scan was acquired for reference. Special algorithms for addressing challenges stemming from the 3D in vivo setup and processing the acquired images were prepared. The algorithms first rearranged the data to account for the oblique needle orientation and for breathing motion. Then, the gray level variance changes were analyzed, and optical flow analysis was applied to the treated volume in order to obtain the ablation contours and reconstruct the ablation zone in 3D. The analysis also included a special correction algorithm for eliminating artifacts caused by proximal major blood vessels and blood flow. Finally, 3D reference reconstructions from the contrast-enhanced scan were obtained for quantitative comparison. RESULTS For four ablations located >3 mm from a large blood vessel, the mean dice similarity coefficient (DSC) and the mean absolute radial discrepancy between the contours obtained from the reference contrast-enhanced images and the contours produced by the algorithm were 0.82 ± 0.03 and 1.92 ± 1.47 mm, respectively. In two cases of ablation adjacent to large blood vessels, the average DSC and discrepancy were: 0.67 ± 0.6 and 2.96 ± 2.15 mm, respectively. The addition of the special correction algorithm utilizing blood vessels mapping improved the mean DSC and the mean absolute discrepancy to 0.85 ± 0.02 and 1.19 ± 1.00 mm, respectively. CONCLUSIONS The developed algorithms provide highly accurate detailed contours in vivo (average error < 2.5 mm) and cope well with the challenges listed above. Clinical implementation of the developed methodology could potentially provide real time noninvasive 3D accurate monitoring of MW thermal ablation in-vivo, provided that the radiation dose can be reduced.
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Affiliation(s)
- Omri Ziv
- Department of Biomedical Engineering, Technion - IIT, Haifa, 32000, Israel
| | - S Nahum Goldberg
- Department of Radiology, Hadassah Medical Center, Hebrew University, Jerusalem, 91120, Israel.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Yitzhak Nissenbaum
- Department of Radiology, Hadassah Medical Center, Hebrew University, Jerusalem, 91120, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University, Jerusalem, 91120, Israel.,Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
| | - Noam Weiss
- Department of Biomedical Engineering, Technion - IIT, Haifa, 32000, Israel
| | - Haim Azhari
- Department of Biomedical Engineering, Technion - IIT, Haifa, 32000, Israel
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Bluemke DA, Sosna J. Peer-reviewed Publications in 2020: Still Needed? Radiology 2020; 295:495. [DOI: 10.1148/radiol.2020204006] [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: 11/11/2022]
Affiliation(s)
- David A. Bluemke
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B.); Department of Radiology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B.); Department of Radiology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel
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35
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Affiliation(s)
- David A. Bluemke
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B.); Department of Radiology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- From the Department of Radiology, University of Wisconsin Madison School of Medicine and Public Health, 600 Highland Dr, Madison, WI 53792 (D.A.B.); Department of Radiology, Hadassah Medical Center, Hebrew University Faculty of Medicine, Jerusalem, Israel
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36
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Harris T, Gamliel A, Nardi-Schreiber A, Sosna J, Gomori JM, Katz-Brull R. The Effect of Gadolinium Doping in [ 13 C 6 , 2 H 7 ]Glucose Formulations on 13 C Dynamic Nuclear Polarization at 3.35 T. Chemphyschem 2020; 21:251-256. [PMID: 31922367 DOI: 10.1002/cphc.201900946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 12/10/2019] [Indexed: 12/27/2022]
Abstract
The promise of hyperpolarized glucose as a non-radioactive imaging agent capable of reporting on multiple metabolic routes has led to recent advances in its dissolution-DNP (dDNP) driven polarization using UV-light induced radicals and trityl radicals at high field (6.7 T) and 1.1 K. However, most preclinical dDNP polarizers operate at the field of 3.35 T and 1.4-1.5 K. Minute amounts of Gd3+ complexes have shown large improvements in solid-state polarization, which can be translated to improved hyperpolarization in solution. However, this Gd3+ effect seems to depend on magnetic field strength, metal ion concentration, and sample formulation. The effect of varying Gd3+ concentrations at 3.35 T has been described for 13 C-labeled pyruvic acid and acetate. However, it has not been studied for other compounds at this field. The results presented here suggest that Gd3+ doping can lead to various concentration and temperature dependent effects on the polarization of [13 C6 ,2 H7 ]glucose, not necessarily similar to the effects observed in pyruvic acid or acetate in size or direction. The maximal polarization for [13 C6 ,2 H7 ]glucose appears to be at a Gd3+ concentration of 2 mM, when irradiating for more than 2 h at the negative maximum of the DNP intensity profile. Surprisingly, for shorter irradiation times, higher polarization levels were determined at 1.50 K compared to 1.45 K, at a [Gd3+ ]=1.3 mM. This was explained by the build-up time constant and maximum at these temperatures.
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Affiliation(s)
- Talia Harris
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Ayelet Gamliel
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Atara Nardi-Schreiber
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, Faculty of Medicine, Jerusalem, Israel
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Harris T, Uppala S, Lev-Cohain N, Adler-Levy Y, Shaul D, Nardi-Schreiber A, Sapir G, Azar A, Gamliel A, Sosna J, Gomori JM, Katz-Brull R. Hyperpolarized product selective saturating-excitations for determination of changes in metabolic reaction rates in real-time. NMR Biomed 2020; 33:e4189. [PMID: 31793111 DOI: 10.1002/nbm.4189] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 08/04/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
Investigation of hyperpolarized substrate metabolism has been showing utility in real-time determination of in-cell and in vivo enzymatic activities. Intracellular reaction rates may vary during the course of a measurement, even on the very short time scales of visibility on hyperpolarized MR, due to many factors such as the availability of the substrate and co-factors in the intracellular space. Despite this potential variation, the kinetic analysis of hyperpolarized signals typically assumes that the same rate constant (and in many cases, the same rate) applies throughout the course of the reaction as observed via the build-up and decay of the hyperpolarized signals. We demonstrate here an acquisition approach that can null the need for such an assumption and enable the detection of instantaneous changes in the rate of the reaction during an ex vivo hyperpolarized investigation, (i.e. in the course of the decay of one hyperpolarized substrate dose administered to a viable tissue sample ex vivo). This approach utilizes hyperpolarized product selective saturating-excitation pulses. Similar pulses have been previously utilized in vivo for spectroscopic imaging. However, we show here favorable consequences to kinetic rate determinations in the preparations used. We implement this acquisition strategy for studies on perfused tissue slices and develop a theory that explains why this particular approach enables the determination of changes in enzymatic rates that are monitored via the chemical conversions of hyperpolarized substrates. Real-time changes in intracellular reaction rates are demonstrated in perfused brain, liver, and xenograft breast cancer tissue slices and provide another potential differentiation parameter for tissue characterization.
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Affiliation(s)
- Talia Harris
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sivaranjan Uppala
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Yael Adler-Levy
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - David Shaul
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Atara Nardi-Schreiber
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Assad Azar
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Ayelet Gamliel
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
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Uppala S, Gamliel A, Sapir G, Sosna J, Gomori JM, Katz-Brull R. Observation of glucose-6-phosphate anomeric exchange in real-time using dDNP hyperpolarised NMR. RSC Adv 2020; 10:41197-41201. [PMID: 35519178 PMCID: PMC9057779 DOI: 10.1039/d0ra08022e] [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: 09/19/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022] Open
Abstract
A hyperpolarised-NMR acquisition approach that is sensitive to the process of glucose-6-phosphate anomerization is presented.
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Affiliation(s)
- Sivaranjan Uppala
- Department of Radiology
- Hadassah Medical Center
- Hebrew University of Jerusalem
- The Faculty of Medicine
- Jerusalem
| | - Ayelet Gamliel
- Department of Radiology
- Hadassah Medical Center
- Hebrew University of Jerusalem
- The Faculty of Medicine
- Jerusalem
| | - Gal Sapir
- Department of Radiology
- Hadassah Medical Center
- Hebrew University of Jerusalem
- The Faculty of Medicine
- Jerusalem
| | - Jacob Sosna
- Department of Radiology
- Hadassah Medical Center
- Hebrew University of Jerusalem
- The Faculty of Medicine
- Jerusalem
| | - J. Moshe Gomori
- Department of Radiology
- Hadassah Medical Center
- Hebrew University of Jerusalem
- The Faculty of Medicine
- Jerusalem
| | - Rachel Katz-Brull
- Department of Radiology
- Hadassah Medical Center
- Hebrew University of Jerusalem
- The Faculty of Medicine
- Jerusalem
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Sapir G, Harris T, Uppala S, Nardi-Schreiber A, Sosna J, Gomori JM, Katz-Brull R. [ 13C 6,D 8]2-deoxyglucose phosphorylation by hexokinase shows selectivity for the β-anomer. Sci Rep 2019; 9:19683. [PMID: 31873121 PMCID: PMC6928223 DOI: 10.1038/s41598-019-56063-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/06/2019] [Indexed: 12/27/2022] Open
Abstract
A non-radioactive 2-deoxyglucose (2DG) analog has been developed here for hyperpolarized magnetic resonance investigations. The analog, [13C6,D8]2DG, showed 13% polarization in solution (27,000-fold signal enhancement at the C1 site), following a dissolution-DNP hyperpolarization process. The phosphorylation of this analog by yeast hexokinase (yHK) was monitored in real-time with a temporal resolution of 1 s. We show that yHK selectively utilizes the β anomer of the 2DG analog, thus revealing a surprising anomeric specificity of this reaction. Such anomeric selectivity was not observed for the reaction of yHK or bacterial glucokinase with a hyperpolarized glucose analog. yHK is highly similar to the human HK-2, which is overexpressed in malignancy. Thus, the current finding may shed a new light on a fundamental enzyme activity which is utilized in the most widespread molecular imaging technology for cancer detection - positron-emission tomography with 18F-2DG.
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Affiliation(s)
- Gal Sapir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Talia Harris
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sivaranjan Uppala
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Atara Nardi-Schreiber
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel.
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Uppala S, Gamliel A, Harris T, Sosna J, Gomori JM, Jerschow A, Katz‐Brull R. 1
H‐decoupling and Isotopic Labeling for the Measurement of the Longitudinal Relaxation Time of Hyperpolarized
13
C‐Methylenes in Choline Analogs. Isr J Chem 2019. [DOI: 10.1002/ijch.201900016] [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: 11/06/2022]
Affiliation(s)
- Sivaranjan Uppala
- Department of Radiology, Hadassah Medical Center Hebrew University of Jerusalem, The Faculty of Medicine Jerusalem Israel
| | - Ayelet Gamliel
- Department of Radiology, Hadassah Medical Center Hebrew University of Jerusalem, The Faculty of Medicine Jerusalem Israel
| | - Talia Harris
- Department of Radiology, Hadassah Medical Center Hebrew University of Jerusalem, The Faculty of Medicine Jerusalem Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center Hebrew University of Jerusalem, The Faculty of Medicine Jerusalem Israel
| | - J. Moshe Gomori
- Department of Radiology, Hadassah Medical Center Hebrew University of Jerusalem, The Faculty of Medicine Jerusalem Israel
| | - Alexej Jerschow
- Department of Chemistry New York University New York, NY USA
| | - Rachel Katz‐Brull
- Department of Radiology, Hadassah Medical Center Hebrew University of Jerusalem, The Faculty of Medicine Jerusalem Israel
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Affiliation(s)
- Jacob Sosna
- From the Department of Radiology, Hadassah Hebrew University Medical Center, Jerusalem, Israel 91120
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Hirshoren N, Damti S, Weinberger J, Meirovitz A, Sosna J, Eliashar R, Eliahou R. Diffusion weighted magnetic resonance imaging of pre and post treatment nasopharyngeal carcinoma. Surg Oncol 2019; 30:122-125. [DOI: 10.1016/j.suronc.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 06/28/2019] [Accepted: 07/22/2019] [Indexed: 12/20/2022]
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Katz Y, Dahan G, Sosna J, Shelef I, Cherniavsky E, Yosibash Z. Scanner influence on the mechanical response of QCT-based finite element analysis of long bones. J Biomech 2019; 86:149-159. [DOI: 10.1016/j.jbiomech.2019.01.049] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 01/03/2019] [Accepted: 01/30/2019] [Indexed: 01/30/2023]
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Lev-Cohain N, Sapir G, Harris T, Azar A, Gamliel A, Nardi-Schreiber A, Uppala S, Sosna J, Gomori JM, Katz-Brull R. Real-time ALT and LDH activities determined in viable precision-cut mouse liver slices using hyperpolarized [1- 13 C]pyruvate-Implications for studies on biopsied liver tissues. NMR Biomed 2019; 32:e4043. [PMID: 30575159 DOI: 10.1002/nbm.4043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 06/09/2023]
Abstract
Precision-cut liver slices (PCLS) are widely used in liver research as they provide a liver model with all liver cell types in their natural architecture. The purpose of this study was to demonstrate the use of PCLS for hyperpolarized metabolic investigation in a mouse model, for potential future application in liver biopsy cores. Fresh normal liver was harvested from six mice. 500 μm PCLS were prepared and placed in a 10 mm NMR tube in an NMR spectrometer and perfused continuously. 31 P spectra were acquired to evaluate the presence of adenosine triphosphate (ATP) and validate viability in all samples. Hyperpolarized [1-13 C]pyruvate was flushed into the NMR tube in the spectrometer. Consecutive 13 C NMR spectra were acquired immediately after the injection using both non-selective (five injections, two livers) and selective RF excitation (six injections, three livers). The 31 P spectra showed the characteristic signals of ATP, confirming the viability of the PCLS for more than 2.5 h in the spectrometer. After each of the [1-13 C]pyruvate injections, both [1-13 C]lactate and [1-13 C]alanine signals were detected. Selective RF excitation aimed at both [1-13 C]lactate and [1-13 C]alanine enabled better visualization and quantification of the metabolic activity. Using this acquisition approach only the newly formed metabolites are observed upon excitation, and their intensities relative to those of hyperpolarized pyruvate enable quantification of metabolite production rates. This rate of lactate and alanine production appeared to be constant throughout the measurement time, with alanine production about 2.3 times higher than lactate. In summary, the viability of PCLS in an NMR spectrometer was demonstrated and hyperpolarized [1-13 C]pyruvate metabolism was recorded. This study opens up the possibility of evaluating alanine aminotransferase (ALT) and lactate dehydrogenase (LDH) activities in human liver biopsies, while preserving the tissue architecture and viability. In healthy, well-perfused liver slices the ratio of ALT to LDH activity is about 2.3.
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Affiliation(s)
- Naama Lev-Cohain
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Talia Harris
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Assad Azar
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Ayelet Gamliel
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Atara Nardi-Schreiber
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sivaranjan Uppala
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
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Gamliel A, Uppala S, Sapir G, Harris T, Nardi-Schreiber A, Shaul D, Sosna J, Gomori JM, Katz-Brull R. Hyperpolarized [ 15N]nitrate as a potential long lived hyperpolarized contrast agent for MRI. J Magn Reson 2019; 299:188-195. [PMID: 30660069 DOI: 10.1016/j.jmr.2019.01.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 12/31/2018] [Accepted: 01/03/2019] [Indexed: 06/09/2023]
Abstract
Reports on gadolinium deposits in the body and brains of adults and children who underwent contrast-enhanced MRI examinations warrant development of new, metal free, contrast agents for MRI. Nitrate is an abundant ion in mammalian biochemistry and sodium nitrate can be safely injected intravenously. We show that hyperpolarized [15N]nitrate can potentially be used as an MR tracer. The 15N site of hyperpolarized [15N]nitrate showed a T1 of more than 100 s in aqueous solutions, which was prolonged to more than 170 s below 20 °C. Capitalizing on this effect for polarization storage we obtained a visibility window of 9 min in blood. Conversion to [15N]nitrite, the bioactive reduced form of nitrate, was not observed in human blood and human saliva in this time frame. Thus, [15N]nitrate may serve as a long-lived hyperpolarized tracer for MR. Due to its ionic nature, the immediate applications appear to be perfusion and tissue retention imaging.
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Affiliation(s)
- Ayelet Gamliel
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Sivaranjan Uppala
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Gal Sapir
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Talia Harris
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Atara Nardi-Schreiber
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - David Shaul
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Jacob Sosna
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - J Moshe Gomori
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel
| | - Rachel Katz-Brull
- Department of Radiology, Hadassah Medical Center, Hebrew University of Jerusalem, The Faculty of Medicine, Jerusalem, Israel.
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Sosna J, Kettanie A, Fraifeld S, Bar-Ziv J, Carel RS. Prevalence of polyps ≥6 mm on follow-up CT colonography in a cohort with no significant colon polyps at baseline. Clin Imaging 2019; 55:1-7. [PMID: 30690226 DOI: 10.1016/j.clinimag.2019.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/25/2018] [Revised: 01/14/2019] [Accepted: 01/15/2019] [Indexed: 12/13/2022]
Abstract
AIM Assess the prevalence of neoplasia ≥6 mm at repeat CT colonoscopy (CTC) in individuals with no significant lesions at baseline. METHODS Individuals aged ≥18 years, with/without CRC risk factors, with no polyps ≥6 mm on baseline CTC (negative baseline) who underwent repeat CTC in a large HMO from 2001 to 2011 were retrospectively identified. Studies were reviewed by board-certified radiologists with experience interpreting CTC. Demographic details, CRC risk factors, and the number, size, and location of incident lesions were noted. Findings were classified using the C-RADS scale. Lesion prevalence at CTC-2 was determined, and study interval and risk characteristics of patients with- and without findings were compared. RESULTS Our study included 636 individuals (369 men [58.0%]; mean age 59.9 years) with negative baseline CTC who underwent repeat CTC after a mean 4.6 year interval (SD 1.6 years). At baseline, 469/636 (73.7%) were at average risk for CRC; 418 remained at average risk for CTC-2 with 51 (8.0%) developing new risk factors in the interval between studies. At CTC-2, 47 participants (7.4%) presented 52 significant neoplasia: 35 polyps 6-9 mm, 14 polyps ≥10 mm, and 3 masses in 3/636 participants (0.47%). 2/3 masses, 6/14 polyps ≥10 mm (42.9%), and 12/25 polyps 6-9 mm (48.0%) were in individuals with risk factors for CRC. Histopathology was available for 12/52 lesions (23.1%): 8 tubular adenomas, 2 villous adenomas, 1 hamartomatous polyp, 1 case of normal tissue. CONCLUSION A mean 4.6 years after negative-baseline CTC, neoplasia ≥6 mm were seen in 7.4% of participants, including masses in 0.47%, supporting recommendations for a 5-year study interval.
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Affiliation(s)
- Jacob Sosna
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel; Department of Radiology, Beth Israel Deaconess Medical Center, Harvard School of Medicine, Boston, MA 02215, USA; MOR Institute for Medical Data, Bnei Brak 51377, Israel.
| | - Amir Kettanie
- Hebrew University-Hadassah School of Medicine, Jerusalem 91120, Israel
| | - Shifra Fraifeld
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel
| | - Jacob Bar-Ziv
- Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120l, Israel; University of Haifa, School of Public Health, Faculty of Social Welfare & Health Sciences, Haifa 34988, Israel.
| | - Rafael S Carel
- MOR Institute for Medical Data, Bnei Brak 51377, Israel; University of Haifa, School of Public Health, Faculty of Social Welfare & Health Sciences, Haifa 34988, Israel.
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Joskowicz L, Cohen D, Caplan N, Sosna J. Automatic segmentation variability estimation with segmentation priors. Med Image Anal 2018; 50:54-64. [DOI: 10.1016/j.media.2018.08.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 07/29/2018] [Accepted: 08/24/2018] [Indexed: 11/16/2022]
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Nardi-Schreiber A, Gamliel A, Harris T, Sapir G, Sosna J, Gomori JM, Katz-Brull R. Author Correction: Biochemical phosphates observed using hyperpolarized 31P in physiological aqueous solutions. Nat Commun 2018; 9:2078. [PMID: 29789613 PMCID: PMC5964175 DOI: 10.1038/s41467-018-04538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Affiliation(s)
- Jacob Sosna
- From the Department of Radiology, Hadassah Medical Center, Hebrew University, Ein Kerem, POB 12000, Jerusalem, Israel
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Nardi-Schreiber A, Sapir G, Gamliel A, Kakhlon O, Sosna J, Gomori JM, Meiner V, Lossos A, Katz-Brull R. Defective ATP breakdown activity related to an ENTPD1 gene mutation demonstrated using 31P NMR spectroscopy. Chem Commun (Camb) 2018; 53:9121-9124. [PMID: 28759073 DOI: 10.1039/c7cc00426e] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The ecto-nucleoside triphosphate diphosphohydrolase-1 (E-NTPDase-1, CD39) enzyme is responsible for the breakdown of extracellular ATP to ADP and then to AMP by a two-step process. Defective CD39 activity has been described in a variety of medical conditions including malignancy and rheumatic diseases and has been proved to be of major diagnostic and clinical importance. Here we show for the first time that a 31P NMR spectroscopy methodology enables the quantification of these two steps in a single blood sample. We have applied this assay to determine the E-NTPDase activity on human mononuclear cells taken from two siblings affected by a stop-codon mutation in the ENTPD1 gene, their obligatory heterozygous parents, and healthy volunteers. The affected subjects presented low ATP breakdown activity, mainly expressed as low AMP production.
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