1
|
Khalil A, Laguna A, I Mehta T, Gowda PC, Gong AJ, Weinstein RM, Garg T, Ring NY, England RW, George Linguraru M, Jones CK, Weiss CR. Whole-lesion assessment of volume and signal changes after sclerotherapy of extremity venous malformations. Eur J Radiol 2024; 174:111397. [PMID: 38452733 DOI: 10.1016/j.ejrad.2024.111397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/12/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To investigate quantitative changes in MRI signal intensity (SI) and lesion volume that indicate treatment response and correlate these changes with clinical outcomes after percutaneous sclerotherapy (PS) of extremity venous malformations (VMs). METHODS VMs were segmented manually on pre- and post-treatment T2-weighted MRI using 3D Slicer to assess changes in lesion volume and SI. Clinical outcomes were scored on a 7-point Likert scale according to patient perception of symptom improvement; treatment response (success or failure) was determined accordingly. RESULTS Eighty-one patients with VMs underwent 125 PS sessions. Treatment success occurred in 77 patients (95 %). Mean (±SD) changes were -7.9 ± 24 cm3 in lesion volume and -123 ± 162 in SI (both, P <.001). Mean reduction in lesion volume was greater in the success group (-9.4 ± 24 cm3) than in the failure group (21 ± 20 cm3) (P =.006). Overall, lesion volume correlated with treatment response (ρ = -0.3, P =.004). On subgroup analysis, volume change correlated with clinical outcomes in children (ρ = -0.3, P =.03), in sodium tetradecyl sulfate-treated lesions (ρ = -0.5, P =.02), and in foot lesions (ρ = -0.6, P =.04). SI change correlated with clinical outcomes in VMs treated in 1 PS session (ρ = -0.3, P =.01) and in bleomycin-treated lesions (ρ = -0.4, P =.04). CONCLUSIONS Change in lesion volume is a reliable indicator of treatment response. Lesion volume and SI correlate with clinical outcomes in specific subgroups.
Collapse
Affiliation(s)
- Adham Khalil
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Surgery, Medstar Georgetown University Hospital, Washington, DC
| | - Amanda Laguna
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Tej I Mehta
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; United States Air Force Medical Corps, Falls Church, VA, USA
| | - Prateek C Gowda
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna J Gong
- The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Tushar Garg
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Natalie Y Ring
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ryan W England
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marius George Linguraru
- Sheikh Zayed Institute for Pediatric Surgical Innovation, Children's National Hospital, Washington, DC, USA; School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Craig K Jones
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; Department of Computer Science, The Johns Hopkins University, Baltimore, MD, USA; The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, USA.
| | - Clifford R Weiss
- Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA; The Malone Center for Engineering in Healthcare, The Johns Hopkins University, Baltimore, MD, USA
| |
Collapse
|
2
|
England RW, Ring NY, Huh E, Bhagat N, Srinivas A, Akman A, Johnson B, Hong K, Leigh R, Hui FK. Development of Endovascular Thrombectomy Services for Acute Ischemic Stroke via On-Site Training of Interventional Radiologists. J Vasc Interv Radiol 2021; 33:720-721. [PMID: 34871773 DOI: 10.1016/j.jvir.2021.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/30/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ryan W England
- Russell H. Morgan Department of Radiology and Radiological Science.
| | - Natalie Y Ring
- Russell H. Morgan Department of Radiology and Radiological Science
| | - Eric Huh
- Russell H. Morgan Department of Radiology and Radiological Science
| | - Nikhil Bhagat
- Russell H. Morgan Department of Radiology and Radiological Science
| | | | - Andrew Akman
- Russell H. Morgan Department of Radiology and Radiological Science
| | - Brian Johnson
- Russell H. Morgan Department of Radiology and Radiological Science
| | - Kelvin Hong
- Russell H. Morgan Department of Radiology and Radiological Science
| | - Richard Leigh
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD
| | - Ferdinand K Hui
- Russell H. Morgan Department of Radiology and Radiological Science
| |
Collapse
|
3
|
Ring NY, Latif MA, Hafezi-Nejad N, Holly BP, Weiss CR. Prevalence of and Factors Associated with Arterial Aneurysms in Patients with Hereditary Hemorrhagic Telangiectasia: 17-Year Retrospective Series of 418 Patients. J Vasc Interv Radiol 2021; 32:1661-1669. [PMID: 34478850 DOI: 10.1016/j.jvir.2021.08.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/26/2021] [Accepted: 08/22/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE To estimate the prevalence of and identify characteristics associated with the presence of aneurysms in a cohort of patients with hereditary hemorrhagic telangiectasia (HHT). MATERIALS AND METHODS In the study institution's HHT database, 418 patients with a definite HHT diagnosis were identified based on the clinical Curaçao criteria and/or an HHT-associated genetic mutation. Regression modeling was used to evaluate the association between arterial aneurysms and older age, male sex, smoking, alcohol consumption, hypertension, hyperlipidemia, genetic mutations, the presence of arteriovenous malformations (AVMs) unrelated to the aneurysms, and HHT-related genetic mutations. RESULTS Forty-three (10.3%) patients had at least 1 aneurysm. Sixteen (3.8%) patients had multiple aneurysms. Of the variables analyzed, older age (odds ratio [OR] = 1.02; 95% confidence interval [CI]: 1.0-1.1), the presence of anatomically and flow-unrelated AVMs (OR = 3.2; 95% CI: 1.3-8.0), and the presence of activin A receptor type II-like 1 (ACVRL1) mutation (OR = 4.0; 95% CI: 1.5-10) were associated with the presence of at least 1 aneurysm. CONCLUSIONS In this cohort of patients with HHT, the prevalence of intracranial and visceral arterial aneurysms was estimated to be 10.3%. Older age, the presence of unrelated AVMs, and the presence of the ACVRL1 mutation were associated with the presence of arterial aneurysms. Further study is required to assess the clinical importance and risk of rupture of aneurysms in patients with HHT.
Collapse
Affiliation(s)
- Natalie Y Ring
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad A Latif
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology and Biostatistics, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Nima Hafezi-Nejad
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian P Holly
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clifford R Weiss
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
| |
Collapse
|
4
|
Hoffer EK, Shelton TW, Ring NY. Pulmonary Hemorrhage during Irreversible Electroporation of Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:970-972.e1. [PMID: 31126611 DOI: 10.1016/j.jvir.2019.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/08/2019] [Accepted: 02/17/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Eric K Hoffer
- Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03755; Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | | | - Natalie Y Ring
- Department of Radiology, Johns Hopkins Medical Center, Baltimore, Maryland
| |
Collapse
|
5
|
Ring NY, diFlorio‐Alexander RM, Bond JS, Rosenkranz KM, Cervantes E, Sohn JH, Marotti JD. Papillary and sclerosing lesions of the breast detected and biopsied by MRI: Clinical management, upgrade rate, and association with apocrine metaplasia. Breast J 2019; 25:393-400. [DOI: 10.1111/tbj.13238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/05/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Natalie Y. Ring
- Department of Radiology Dartmouth‐Hitchcock Medical Center, Lebanon, NH and Geisel School of Medicine Hanover New Hampshire
| | - Roberta M. diFlorio‐Alexander
- Department of Radiology Dartmouth‐Hitchcock Medical Center, Lebanon, NH and Geisel School of Medicine Hanover New Hampshire
| | - Jesse S. Bond
- Department of Pathology and Laboratory Medicine Dartmouth‐Hitchcock Medical Center, Lebanon, NH, and Geisel School of Medicine Hanover New Hampshire
| | - Kari M. Rosenkranz
- Department of Surgery Dartmouth‐Hitchcock Medical Center, Lebanon, NH and Geisel School of Medicine Hanover New Hampshire
| | - Eduardo Cervantes
- Department of Radiology Dartmouth‐Hitchcock Medical Center, Lebanon, NH and Geisel School of Medicine Hanover New Hampshire
| | - Jae Ho Sohn
- Department of Radiology and Biomedical Imaging University of California, San Francisco San Francisco California
| | - Jonathan D. Marotti
- Department of Pathology and Laboratory Medicine Dartmouth‐Hitchcock Medical Center, Lebanon, NH, and Geisel School of Medicine Hanover New Hampshire
| |
Collapse
|
6
|
Fried JG, Andrew AS, Ring NY, Pastel DA. Changes in Primary Care Health Care Utilization after Inclusion of Epidemiologic Data in Lumbar Spine MR Imaging Reports for Uncomplicated Low Back Pain. Radiology 2018; 287:563-569. [PMID: 29361247 DOI: 10.1148/radiol.2017170722] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine whether inclusion of an epidemiologic statement in radiology reports of lumbar magnetic resonance (MR) imaging influences downstream health care utilization in the primary care population. Materials and Methods Beginning July 1, 2013, a validated epidemiologic statement regarding prevalence of common findings in asymptomatic patients was included in all lumbar MR imaging reports at a tertiary academic medical center. Data were collected from July 1, 2012, through June 30, 2014, and retrospective analysis was completed in September 2016. The electronic medical record was reviewed to capture health care utilization rates in patients for 1 year after index MR imaging. Of 4527 eligible adult patients with low back pain referred for lumbar spine MR imaging during the study period, 375 patients had their studies ordered by in-network primary care providers, did not have findings other than degenerative disease, and had at least one follow-up encounter within the system within 1 year of index MR imaging. In the before-and-after study design, a pre-statement-implementation cohort was compared with a post-statement-implementation cohort by using univariate and multivariate statistical models to evaluate treatment utilization rates in these groups. Results Patients in the statement group were 12% less likely to be referred to a spine specialist (137 of 187 [73%] vs 159 of 188 [85%]; P = .007) and were 7% less likely to undergo repeat imaging (seven of 187 [4%] vs 20 of 188 [11%]; P = .01) compared with patients in the nonstatement group. The intervention was not associated with any change in narcotic prescription (53 of 188 [28%] vs 54 of 187 [29%]; P = .88) or with the rate of low back surgery (24 of 188 [13%] vs 16 of 187 [9%]; P = .19). Conclusion In this study, inclusion of a simple epidemiologic statement in lumbar MR imaging reports was associated with decreased utilization in high-cost domains of low back pain management. © RSNA, 2018.
Collapse
Affiliation(s)
- Jessica G Fried
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein Bldg, Philadelphia, PA 19103 (J.G.F.); Departments of Neurology (A.S.A.) and Radiology (D.A.P.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Geisel School of Medicine, Dartmouth College, Hanover, NH (N.Y.R.)
| | - Angeline S Andrew
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein Bldg, Philadelphia, PA 19103 (J.G.F.); Departments of Neurology (A.S.A.) and Radiology (D.A.P.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Geisel School of Medicine, Dartmouth College, Hanover, NH (N.Y.R.)
| | - Natalie Y Ring
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein Bldg, Philadelphia, PA 19103 (J.G.F.); Departments of Neurology (A.S.A.) and Radiology (D.A.P.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Geisel School of Medicine, Dartmouth College, Hanover, NH (N.Y.R.)
| | - David A Pastel
- From the Department of Radiology, University of Pennsylvania, 3400 Spruce St, 1 Silverstein Bldg, Philadelphia, PA 19103 (J.G.F.); Departments of Neurology (A.S.A.) and Radiology (D.A.P.), Dartmouth-Hitchcock Medical Center, Lebanon, NH; and Geisel School of Medicine, Dartmouth College, Hanover, NH (N.Y.R.)
| |
Collapse
|
7
|
Haider SJ, Na NR, Eskey CJ, Fried JG, Ring NY, Bao MH, Pastel DA. Symptomatic Lumbar Facet Synovial Cysts: Clinical Outcomes Following Percutaneous CT–Guided Cyst Rupture with Intra-articular Steroid Injection. J Vasc Interv Radiol 2017; 28:1083-1089. [PMID: 28549711 DOI: 10.1016/j.jvir.2017.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/20/2017] [Accepted: 04/22/2017] [Indexed: 10/19/2022] Open
|