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Fassia MK, Balasubramanian A, Woo S, Vargas HA, Hricak H, Konukoglu E, Becker AS. Deep Learning Prostate MRI Segmentation Accuracy and Robustness: A Systematic Review. Radiol Artif Intell 2024:e230138. [PMID: 38568094 DOI: 10.1148/ryai.230138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
"Just Accepted" papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence. This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To investigate the accuracy and robustness of prostate segmentation using deep learning across various training data sizes, MRI vendors, prostate zones, and testing methods relative to fellowship-trained diagnostic radiologists. Materials and methods In this systematic review, EMBASE, PubMed, Scopus and Web of Science databases were queried for English-language articles using keywords and related terms for prostate MRI segmentation and deep learning algorithms dated to July 31, 2022. A total of 691 articles from the search query were collected, and subsequently filtered to 48 based on predefined inclusion and exclusion criteria. Multiple characteristics were extracted from selected studies, such as deep learning algorithm performance, MRI vendor, and training dataset features. The primary outcome was comparison of mean Dice similarity coefficient (DSC) for prostate segmentation for deep learning algorithms versus diagnostic radiologists. Results Forty-eight studies were included. The vast majority of published deep learning algorithms for whole prostate gland segmentation (39/42 or 93%) had a DSC at or above expert level (DSC ≥ 0.86). The mean DSC was 0.79 ± 0.06 for peripheral zone, 0.87 ± 0.05 for transition zone, and 0.90 ± 0.04 for whole prostate gland segmentation. For selected studies using one major MRI vendor, the mean DSCs of each were as follows: GE (3/48 studies) 0.92 ± 0.03, Philips (4/48 studies) 0.92 ± 0.02, and Siemens (6/48 studies) 0.91 ± 0.03. Conclusion Deep learning algorithms for prostate MRI segmentation demonstrated comparable accuracy to expert radiologists despite varying parameters, therefore future research should shift toward evaluating segmentation robustness and patient outcomes across diverse clinical settings. ©RSNA, 2024.
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Affiliation(s)
- Mohammad-Kasim Fassia
- From the Departments of Radiology (M.K.F.) and Urology (A.B.), NewYork-Presbyterian Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065-4870; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (S.W., H.A.V., H.H., A.S.B.); and Department of Biomedical Imaging, ETH-Zurich, Zurich Switzerland (E.K.)
| | - Adithiya Balasubramanian
- From the Departments of Radiology (M.K.F.) and Urology (A.B.), NewYork-Presbyterian Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065-4870; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (S.W., H.A.V., H.H., A.S.B.); and Department of Biomedical Imaging, ETH-Zurich, Zurich Switzerland (E.K.)
| | - Sungmin Woo
- From the Departments of Radiology (M.K.F.) and Urology (A.B.), NewYork-Presbyterian Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065-4870; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (S.W., H.A.V., H.H., A.S.B.); and Department of Biomedical Imaging, ETH-Zurich, Zurich Switzerland (E.K.)
| | - Hebert Alberto Vargas
- From the Departments of Radiology (M.K.F.) and Urology (A.B.), NewYork-Presbyterian Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065-4870; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (S.W., H.A.V., H.H., A.S.B.); and Department of Biomedical Imaging, ETH-Zurich, Zurich Switzerland (E.K.)
| | - Hedvig Hricak
- From the Departments of Radiology (M.K.F.) and Urology (A.B.), NewYork-Presbyterian Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065-4870; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (S.W., H.A.V., H.H., A.S.B.); and Department of Biomedical Imaging, ETH-Zurich, Zurich Switzerland (E.K.)
| | - Ender Konukoglu
- From the Departments of Radiology (M.K.F.) and Urology (A.B.), NewYork-Presbyterian Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065-4870; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (S.W., H.A.V., H.H., A.S.B.); and Department of Biomedical Imaging, ETH-Zurich, Zurich Switzerland (E.K.)
| | - Anton S Becker
- From the Departments of Radiology (M.K.F.) and Urology (A.B.), NewYork-Presbyterian Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065-4870; Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (S.W., H.A.V., H.H., A.S.B.); and Department of Biomedical Imaging, ETH-Zurich, Zurich Switzerland (E.K.)
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Becker AS, Das JP, Woo S, Vilela de Oliveira C, Charbel C, Perez-Johnston R, Vargas HA. Body oncologic imaging subspecialty training a curriculum based on the experience in a tertiary cancer center. Eur J Radiol 2024; 173:111396. [PMID: 38428254 PMCID: PMC10989997 DOI: 10.1016/j.ejrad.2024.111396] [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: 01/24/2024] [Revised: 02/19/2024] [Accepted: 02/25/2024] [Indexed: 03/03/2024]
Abstract
PURPOSE To describe the structure of a dedicated body oncologic imaging fellowship program. To summarize the numbers and types of cross-sectional imaging examinations reported by fellows. METHODS The curriculum, training methods, and assessment measures utilized in the program were reviewed and described. An educational retrospective analysis was conducted. Data on the number of examinations interpreted by fellows, breakdown of modalities, and examinations by disease management team (DMT) were collected. RESULTS A total of 38 fellows completed the fellowship program during the study period. The median number of examinations reported per fellow was 2296 [interquartile range: 2148 - 2534], encompassing all oncology-relevant imaging modalities: CT 721 [646-786], MRI 1158 [1016-1309], ultrasound 256 [209-320] and PET/CT 176 [130-202]. The breakdown of examinations by DMT revealed variations in imaging patterns, with MRIs most frequently interpreted for genitourinary, musculoskeletal, and hepatobiliary cancers, and CTs most commonly for general staging or assessment of nonspecific symptoms. CONCLUSION This descriptive analysis may serve as a foundation for the development of similar fellowship programs and the advancement of body oncologic imaging. The volume and diversity of examinations reported by fellows highlights the comprehensive nature of body oncologic imaging.
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Affiliation(s)
- Anton S Becker
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Oncologic Imaging Service, NYU Langone, New York, NY. https://twitter.com/@becker_rad
| | - Jeeban P Das
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Sungmin Woo
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Oncologic Imaging Service, NYU Langone, New York, NY.
| | - Camila Vilela de Oliveira
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Charlotte Charbel
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA.
| | - Rocio Perez-Johnston
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Anschutz Medical Center, University of Colorado, Denver CO.
| | - Hebert Alberto Vargas
- Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Radiology, Oncologic Imaging Service, NYU Langone, New York, NY.
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Woo S, Andrieu PC, Abu-Rustum NR, Broach V, Zivanovic O, Sonoda Y, Chi DS, Aviki E, Ellis A, Carayon P, Hricak H, Vargas HA. Bridging Communication Gaps Between Radiologists, Referring Physicians, and Patients Through Standardized Structured Cancer Imaging Reporting: The Experience with Female Pelvic MRI Assessment Using O-RADS and a Simulated Cohort Patient Group. Acad Radiol 2024; 31:1388-1397. [PMID: 37661555 DOI: 10.1016/j.acra.2023.08.005] [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: 06/27/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to evaluate whether implementing structured reporting based on Ovarian-Adnexal Reporting and Data System (O-RADS) magnetic resonance imaging (MRI) in women with sonographically indeterminate adnexal masses improves communication between radiologists, referrers, and patients/caregivers and enhances diagnostic performance for determining adnexal malignancy. MATERIALS AND METHODS We retrospectively analyzed prospectively issued MRI reports in 2019-2022 performed for characterizing adnexal masses before and after implementing O-RADS MRI; 56 patients/caregivers and nine gynecologic oncologists ("referrers") were surveyed about report interpretability/clarity/satisfaction; responses for pre- and post-implementation reports were compared using Fisher's exact and Chi-squared tests. Diagnostic performance was assessed using receiver operating characteristic curves. RESULTS A total of 123 reports from before and 119 reports from after O-RADS MRI implementation were included. Survey response rates were 35.7% (20/56) for patients/caregivers and 66.7% (6/9) for referrers. For patients/caregivers, O-RADS MRI reports were clearer (p < 0.001) and more satisfactory (p < 0.001) than unstructured reports, but interpretability did not differ significantly (p = 0.14), as 28.0% (28/100) of postimplementation and 38.0% (38/100) of preimplementation reports were considered difficult to interpret. For referrers, O-RADS MRI reports were clearer, more satisfactory, and easier to interpret (p < 0.001); only 1.3% (1/77) were considered difficult to interpret. For differentiating benign from malignant adnexal lesions, O-RADS MRI showed area under the curve of 0.92 (95% confidence interval [CI], 0.85-0.99), sensitivity of 0.81 (95% CI, 0.58-0.95), and specificity of 0.91 (95% CI, 0.83-0.96). Diagnostic performance of reports before implementation could not be calculated due to many different phrases used to describe the likelihood of malignancy. CONCLUSION Implementing standardized structured reporting using O-RADS MRI for characterizing adnexal masses improved clarity and satisfaction for patients/caregivers and referrers. Interpretability improved for referrers but remained limited for patients/caregivers.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.); Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016 (S.W., H.A.V.).
| | - Pamela Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.)
| | - Nadeem R Abu-Rustum
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Vance Broach
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Oliver Zivanovic
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.); Department of Obstetrics and Gynecology, University Hospital Heidelberg, Heidelberg, Germany (O.Z.)
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York (N.R.A.-R., V.B., O.Z., Y.S., D.S.C.)
| | - Emeline Aviki
- Department of Obstetrics and Gynecology, NYU Long Island School of Medicine, Mineola, New York (E.A.)
| | - Annie Ellis
- Patient Family Advisory Council for Quality (PFACQ), Memorial Sloan Kettering Cancer Center, New York, New York (A.E.)
| | - Pascale Carayon
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin (P.C.)
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065 (S.W., P.C.A., H.H.)
| | - Hebert A Vargas
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016 (S.W., H.A.V.)
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Panebianco V, Briganti A, Boellaard TN, Catto J, Comperat E, Efstathiou J, van der Heijden AG, Giannarini G, Girometti R, Mertens L, Takeuchi M, Muglia VF, Narumi Y, Novara G, Pecoraro M, Roupret M, Sanguedolce F, Santini D, Shariat SF, Simone G, Vargas HA, Woo S, Barentsz J, Witjes JA. Clinical application of bladder MRI and the Vesical Imaging-Reporting and Data System. Nat Rev Urol 2024; 21:243-251. [PMID: 38036666 DOI: 10.1038/s41585-023-00830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
Diagnostic work-up and risk stratification in patients with bladder cancer before and after treatment must be refined to optimize management and improve outcomes. MRI has been suggested as a non-invasive technique for bladder cancer staging and assessment of response to systemic therapy. The Vesical Imaging-Reporting And Data System (VI-RADS) was developed to standardize bladder MRI image acquisition, interpretation and reporting and enables accurate prediction of muscle-wall invasion of bladder cancer. MRI is available in many centres but is not yet recommended as a first-line test for bladder cancer owing to a lack of high-quality evidence. Consensus-based evidence on the use of MRI-VI-RADS for bladder cancer care is needed to serve as a benchmark for formulating guidelines and research agendas until further evidence from randomized trials becomes available.
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Affiliation(s)
- Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy.
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Milan, Italy
| | - Thierry N Boellaard
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Eva Comperat
- Department of Pathology, Sorbonne University, Assistance Publique-Hôpitaux de Paris, Hopital Tenon, Paris, France
| | - Jason Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Rossano Girometti
- Institute of Radiology, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Laura Mertens
- Department of Surgical Oncology (Urology), Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Valdair F Muglia
- Department of Medical Images, Radiation Therapy and Oncohematology, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Padua, Italy
| | - Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University of Rome, Rome, Italy
| | - Morgan Roupret
- Department of Urology, Sorbonne University, AP-HP, Pitié Salpétrière Hospital, Paris, France
| | - Francesco Sanguedolce
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Daniele Santini
- Division of Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Latina, Italy
| | - Shahrokh F Shariat
- Department of Urology, Teaching Hospital Motol and 2nd Faculty of Medicine, Charles University Praha, Prague, Czech Republic
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna General Hospital, Vienna, Austria
| | - Giuseppe Simone
- IRCCS "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jelle Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Kim SH, Kim M, Lee H, Woo S, Kim HJ, Koyanagi A, Smith L, Kim MS, Min HK, Min JY, Yon DK. Assisted reproductive techniques and subsequent risk of asthma and allergic rhinitis in offspring: a nationwide birth cohort study in South Korea. Eur Rev Med Pharmacol Sci 2024; 28:2737-2749. [PMID: 38639513 DOI: 10.26355/eurrev_202404_35902] [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] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The relationship between assisted reproductive techniques (ART) and the risk of asthma and allergic rhinitis (AR) is controversial. Thus, we aimed to investigate the relationship between ART and the risk of asthma and AR in a nationwide, large-scale birth cohort. PATIENTS AND METHODS This study utilized the National Health Insurance Service data in South Korea to conduct a nationwide, large-scale, population-based birth cohort. We included all infants born between 2017 and 2018. AR, asthma, food allergies, and atopic dermatitis were defined using the International Classification of Diseases tenth edition codes. Asthma was classified as allergic or non-allergic based on accompanying allergic diseases (AR, food allergy, or atopic dermatitis). Using 1:10 propensity score matching, we compared infants conceived through ART with those conceived naturally (non-ART). After matching, logistic regression was used to compare the hazard ratio for asthma and AR between the two groups. RESULTS We included 543,178 infants [male infants, 280,194 (51.38%)]. After matching, 8,925 and 74,229 infants were selected for the ART and non-ART groups, respectively. The ART group showed a decreased risk of asthma in the offspring [adjusted hazard ratio (aHR), 0.45; 95% confidence interval (CI), 0.41-0.48]. Similarly, for AR, being conceived by ART was associated with a decreased risk of AR (aHR, 0.25; 95% CI, 0.12-0.37). ART offspring showed a decreased risk of asthma and AR in offspring compared to that observed in non-ART offspring. CONCLUSIONS Our study offers important insights for clinicians, researchers, and parents regarding the health outcomes of ART-conceived infants and enhances our understanding of ART's impact on respiratory health.
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Affiliation(s)
- S H Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea.
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Kim TH, Woo S, Lee DH, Do RK, Chernyak V. MRI imaging features for predicting macrotrabecular-massive subtype hepatocellular carcinoma: a systematic review and meta-analysis. Eur Radiol 2024:10.1007/s00330-024-10671-1. [PMID: 38507054 DOI: 10.1007/s00330-024-10671-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/06/2024] [Accepted: 02/14/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To identify significant MRI features associated with macrotrabecular-massive hepatocellular carcinoma (MTM-HCC), and to assess the distribution of Liver Imaging Radiology and Data System (LI-RADS, LR) category assignments. METHODS PubMed and EMBASE were searched up to March 28, 2023. Random-effects model was constructed to calculate pooled diagnostic odds ratios (DORs) and 95% confidence intervals (CIs) for each MRI feature for differentiating MTM-HCC from NMTM-HCC. The pooled proportions of LI-RADS category assignments in MTM-HCC and NMTM-HCC were compared using z-test. RESULTS Ten studies included 1978 patients with 2031 HCCs (426 (20.9%) MTM-HCC and 1605 (79.1%) NMTM-HCC). Six MRI features showed significant association with MTM-HCC: tumor in vein (TIV) (DOR = 2.4 [95% CI, 1.6-3.5]), rim arterial phase hyperenhancement (DOR =2.6 [95% CI, 1.4-5.0]), corona enhancement (DOR = 2.6 [95% CI, 1.4-4.5]), intratumoral arteries (DOR = 2.6 [95% CI, 1.1-6.3]), peritumoral hypointensity on hepatobiliary phase (DOR = 2.2 [95% CI, 1.5-3.3]), and necrosis (DOR = 4.2 [95% CI, 2.0-8.5]). The pooled proportions of LI-RADS categories in MTM-HCC were LR-3, 0% [95% CI, 0-2%]; LR-4, 11% [95% CI, 6-16%]; LR-5, 63% [95% CI, 55-71%]; LR-M, 12% [95% CI, 6-19%]; and LR-TIV, 13% [95% CI, 6-22%]. In NMTM-HCC, the pooled proportions of LI-RADS categories were LR-3, 1% [95% CI, 0-2%]; LR-4, 8% [95% CI, 3-15%]; LR-5, 77% [95% CI, 71-82%]; LR-M, 5% [95% CI, 3-7%]; and LR-TIV, 6% [95% CI, 2-11%]. MTM-HCC had significantly lower proportion of LR-5 and higher proportion of LR-M and LR-TIV categories. CONCLUSIONS Six MRI features showed significant association with MTM-HCC. Additionally, compared to NMTM-HCC, MTM-HCC are more likely to be categorized LR-M and LR-TIV and less likely to be categorized LR-5. CLINICAL RELEVANCE STATEMENT Several MR imaging features can suggest macrotrabecular-massive hepatocellular carcinoma subtype, which can assist in guiding treatment plans and identifying potential candidates for clinical trials of new treatment strategies. KEY POINTS • Macrotrabecular-massive hepatocellular carcinoma is a subtype of HCC characterized by its aggressive nature and unfavorable prognosis. • Tumor in vein, rim arterial phase hyperenhancement, corona enhancement, intratumoral arteries, peritumoral hypointensity on hepatobiliary phase, and necrosis on MRI are indicative of macrotrabecular-massive hepatocellular carcinoma. • Various MRI characteristics can be utilized for the diagnosis of the macrotrabecular-massive hepatocellular carcinoma subtype. This can prove beneficial in guiding treatment decisions and identifying potential candidates for clinical trials involving novel treatment approaches.
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Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, South Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, South Korea
| | - Richard K Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Victoria Chernyak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Charbel C, Causa Andrieu PI, Soliman M, Woo S, Zheng J, Capanu M, Nikolovski I, Vargas HA, Abusamra M, Carlo MI. The Prevalence and Radiologic Features of Renal Cancers Associated with FLCN, BAP1, SDH, and MET Germline Mutations. Radiol Imaging Cancer 2024; 6:e230063. [PMID: 38456787 PMCID: PMC10988346 DOI: 10.1148/rycan.230063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 12/15/2023] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
Purpose To investigate the prevalence of FLCN, BAP1, SDH, and MET mutations in an oncologic cohort and determine the prevalence, clinical features, and imaging features of renal cell carcinoma (RCC) associated with these mutations. Secondarily, to determine the prevalence of encountered benign renal lesions. Materials and Methods From 25 220 patients with cancer who prospectively underwent germline analysis with a panel of more than 70 cancer-predisposing genes from 2015 to 2021, patients with FLCN, BAP1, SDH, or MET mutations were retrospectively identified. Clinical records were reviewed for patient age, sex, race/ethnicity, and renal cancer diagnosis. If RCC was present, baseline CT and MRI examinations were independently assessed by two radiologists. Summary statistics were used to summarize continuous and categorical variables by mutation. Results A total of 79 of 25 220 (0.31%) patients had a germline mutation: FLCN, 17 of 25 220 (0.07%); BAP1, 22 of 25 220 (0.09%); SDH, 39 of 25 220 (0.15%); and MET, one of 25 220 (0.004%). Of these 79 patients, 18 (23%) were diagnosed with RCC (FLCN, four of 17 [24%]; BAP1, four of 22 [18%]; SDH, nine of 39 [23%]; MET, one of one [100%]). Most hereditary RCCs demonstrated ill-defined margins, central nonenhancing area (cystic or necrotic), heterogeneous enhancement, and various other CT and MR radiologic features, overlapping with the radiologic appearance of nonhereditary RCCs. The prevalence of other benign solid renal lesions (other than complex cysts) in patients was up to 11%. Conclusion FLCN, BAP1, SDH, and MET mutations were present in less than 1% of this oncologic cohort. Within the study sample size limits, imaging findings for hereditary RCC overlapped with those of nonhereditary RCC, and the prevalence of other associated benign solid renal lesions (other than complex cysts) was up to 11%. Keywords: Familial Renal Cell Carcinoma, Birt-Hogg-Dubé Syndrome, Carcinoma, Renal Cell, Paragangliomas, Urinary, Kidney © RSNA, 2024.
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Affiliation(s)
| | | | - Mohamed Soliman
- From the Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (C.C.);
Department of Radiology, Mayo Clinic, Rochester, Minn (P.I.C.A.); Department of
Radiology (M.S.), Department of Epidemiology and Biostatistics (J.Z., M.C.), and
Genitourinary Oncology Service (M.I.C.), Memorial Sloan Kettering Cancer Center,
New York, NY; Department of Radiology, NYU Langone Health, New York, NY (S.W.,
H.A.V.); Department of Radiology, Royal North Shore Hospital, St Leonards, New
South Wales, Australia (I.N.); and Department of Radiology, Cleveland Clinic,
Cleveland, Ohio (M.A.)
| | - Sungmin Woo
- From the Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (C.C.);
Department of Radiology, Mayo Clinic, Rochester, Minn (P.I.C.A.); Department of
Radiology (M.S.), Department of Epidemiology and Biostatistics (J.Z., M.C.), and
Genitourinary Oncology Service (M.I.C.), Memorial Sloan Kettering Cancer Center,
New York, NY; Department of Radiology, NYU Langone Health, New York, NY (S.W.,
H.A.V.); Department of Radiology, Royal North Shore Hospital, St Leonards, New
South Wales, Australia (I.N.); and Department of Radiology, Cleveland Clinic,
Cleveland, Ohio (M.A.)
| | - Junting Zheng
- From the Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (C.C.);
Department of Radiology, Mayo Clinic, Rochester, Minn (P.I.C.A.); Department of
Radiology (M.S.), Department of Epidemiology and Biostatistics (J.Z., M.C.), and
Genitourinary Oncology Service (M.I.C.), Memorial Sloan Kettering Cancer Center,
New York, NY; Department of Radiology, NYU Langone Health, New York, NY (S.W.,
H.A.V.); Department of Radiology, Royal North Shore Hospital, St Leonards, New
South Wales, Australia (I.N.); and Department of Radiology, Cleveland Clinic,
Cleveland, Ohio (M.A.)
| | - Marinela Capanu
- From the Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (C.C.);
Department of Radiology, Mayo Clinic, Rochester, Minn (P.I.C.A.); Department of
Radiology (M.S.), Department of Epidemiology and Biostatistics (J.Z., M.C.), and
Genitourinary Oncology Service (M.I.C.), Memorial Sloan Kettering Cancer Center,
New York, NY; Department of Radiology, NYU Langone Health, New York, NY (S.W.,
H.A.V.); Department of Radiology, Royal North Shore Hospital, St Leonards, New
South Wales, Australia (I.N.); and Department of Radiology, Cleveland Clinic,
Cleveland, Ohio (M.A.)
| | - Ines Nikolovski
- From the Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (C.C.);
Department of Radiology, Mayo Clinic, Rochester, Minn (P.I.C.A.); Department of
Radiology (M.S.), Department of Epidemiology and Biostatistics (J.Z., M.C.), and
Genitourinary Oncology Service (M.I.C.), Memorial Sloan Kettering Cancer Center,
New York, NY; Department of Radiology, NYU Langone Health, New York, NY (S.W.,
H.A.V.); Department of Radiology, Royal North Shore Hospital, St Leonards, New
South Wales, Australia (I.N.); and Department of Radiology, Cleveland Clinic,
Cleveland, Ohio (M.A.)
| | - Hebert A. Vargas
- From the Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (C.C.);
Department of Radiology, Mayo Clinic, Rochester, Minn (P.I.C.A.); Department of
Radiology (M.S.), Department of Epidemiology and Biostatistics (J.Z., M.C.), and
Genitourinary Oncology Service (M.I.C.), Memorial Sloan Kettering Cancer Center,
New York, NY; Department of Radiology, NYU Langone Health, New York, NY (S.W.,
H.A.V.); Department of Radiology, Royal North Shore Hospital, St Leonards, New
South Wales, Australia (I.N.); and Department of Radiology, Cleveland Clinic,
Cleveland, Ohio (M.A.)
| | - Murad Abusamra
- From the Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (C.C.);
Department of Radiology, Mayo Clinic, Rochester, Minn (P.I.C.A.); Department of
Radiology (M.S.), Department of Epidemiology and Biostatistics (J.Z., M.C.), and
Genitourinary Oncology Service (M.I.C.), Memorial Sloan Kettering Cancer Center,
New York, NY; Department of Radiology, NYU Langone Health, New York, NY (S.W.,
H.A.V.); Department of Radiology, Royal North Shore Hospital, St Leonards, New
South Wales, Australia (I.N.); and Department of Radiology, Cleveland Clinic,
Cleveland, Ohio (M.A.)
| | - Maria I. Carlo
- From the Department of Radiology, Beth Israel Deaconess Medical
Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (C.C.);
Department of Radiology, Mayo Clinic, Rochester, Minn (P.I.C.A.); Department of
Radiology (M.S.), Department of Epidemiology and Biostatistics (J.Z., M.C.), and
Genitourinary Oncology Service (M.I.C.), Memorial Sloan Kettering Cancer Center,
New York, NY; Department of Radiology, NYU Langone Health, New York, NY (S.W.,
H.A.V.); Department of Radiology, Royal North Shore Hospital, St Leonards, New
South Wales, Australia (I.N.); and Department of Radiology, Cleveland Clinic,
Cleveland, Ohio (M.A.)
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8
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Kim TH, Woo S. How Systematic Review Can Shape Clinical Practice in Radiology. AJR Am J Roentgenol 2024; 222:e2329603. [PMID: 37493323 DOI: 10.2214/ajr.23.29603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Systematic reviews offer radiologists a comprehensive synthesis of all relevant evidence pertaining to a specific question, aiding them in shaping their clinical practices. It is crucial for radiologists to familiarize themselves with the methods used in systematic reviews and meta-analyses and to understand the limitations. By doing so, they can effectively appraise and interpret results, enabling them to make informed decisions based on the evidence provided in systematic reviews and meta-analyses.
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Affiliation(s)
- Tae-Hyung Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, Box 29, New York, NY 10065
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY
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9
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Woo S, Vargas HA. Editorial for "Efficiency and Accuracy Evaluation of Multiple Diffusion-Weighted MRI Techniques Across Different Scanners". J Magn Reson Imaging 2024; 59:323-324. [PMID: 37367223 DOI: 10.1002/jmri.28873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 06/28/2023] Open
Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hebert A Vargas
- Department of Radiology, NYU Langone Health, New York, New York, USA
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10
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Pecoraro M, Dehghanpour A, Das JP, Woo S, Panebianco V. Evaluation of Prostate Cancer Recurrence with MR Imaging and Prostate Imaging for Recurrence Reporting Scoring System. Radiol Clin North Am 2024; 62:135-159. [PMID: 37973239 DOI: 10.1016/j.rcl.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Detection of prostate cancer recurrence after whole-gland treatment with curative intent is critical to identify patients who may benefit from local salvage therapy. Among the different imaging modalities used in clinical practice, MR imaging is the most accurate in identifying local prostate cancer recurrence; indeed, it is an excellent technique for local recurrence detection superior to PET/CT, even at low PSA, but provides no information about extra-pelvic lymph nodes or bone metastasis. In 2021, a group of experts developed the Prostate Imaging for local Recurrence Reporting scoring system to standardize acquisition, interpretation, and reporting of prostate cancer recurrence.
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Affiliation(s)
- Martina Pecoraro
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Policlinico Umberto I, Viale Regina Elena 324, Rome 00161, Italy
| | - Ailin Dehghanpour
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Policlinico Umberto I, Viale Regina Elena 324, Rome 00161, Italy
| | - Jeeban Paul Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Sapienza University, Policlinico Umberto I, Viale Regina Elena 324, Rome 00161, Italy.
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11
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Arita Y, Kwee TC, Woo S, Shigeta K, Ishii R, Okawara N, Edo H, Waseda Y, Vargas HA. Biparametric versus Multiparametric Magnetic Resonance Imaging for Assessing Muscle Invasion in Bladder Urothelial Carcinoma with Variant Histology Using the Vesical Imaging-Reporting and Data System. Eur Urol Focus 2024; 10:131-138. [PMID: 37633790 DOI: 10.1016/j.euf.2023.08.004] [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: 05/10/2023] [Revised: 06/27/2023] [Accepted: 08/11/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND The diagnostic performance of contrast medium-free biparametric magnetic resonance imaging (bpMRI; combining T2-weighted imaging [T2WI] and diffusion-weighted imaging [DWI]) for evaluating variant-histology urothelial carcinoma (VUC) remains unknown. OBJECTIVE To compare the diagnostic performance of bpMRI and multiparametric MRI (mpMRI; combining T2WI, DWI, and dynamic contrast-enhanced MRI]) for assessing muscle invasion of VUC. DESIGN, SETTING, AND PARTICIPANTS This multi-institution retrospective analysis included 118 patients with pathologically verified VUC who underwent bladder mpMRI before transurethral bladder tumor resection between 2010 and 2019. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Three board-certified radiologists separately evaluated two sets of images, set 1 (bpMRI) and set 2 (mpMRI), in accordance with the Vesical Imaging Reporting and Data System (VI-RADS). The histopathology results were utilized as a reference standard. Receiver operating characteristic curve analysis, Z test, and Wald test were used to assess diagnostic abilities. RESULTS AND LIMITATIONS Sixty-six (55.9%) and 52 (44.1%) of the 118 patients with VUC included in the analysis (mean age, 71 ± 10 yr; 88 men) had muscle-invasive bladder cancer (MIBC) and non-MIBC, respectively. For the diagnosis of MIBC, the areas under the curve for bpMRI were significantly smaller than those for mpMRI (0.870-0.884 vs 0.902-0.923, p < 0.05). The sensitivity of bpMRI was significantly lower than that of mpMRI for all readers with a VI-RADS cutoff score of 4 (65.2-66.7% vs 77.3-80.3%, p < 0.05). The specificity of bpMRI and mpMRI did not differ significantly for all readers (88.5-90.4 vs 88.5-92.3, p > 0.05). A limitation of the study is the limited sample size because of the rarity of VUC. CONCLUSIONS In patients with VUC, on applying VI-RADS, the diagnostic results of bpMRI were inferior to those of mpMRI for evaluating muscle invasion. Therefore, mpMRI-based methods are recommended for evaluating muscle invasiveness of VUC. PATIENT SUMMARY Contrast medium-free biparametric magnetic resonance imaging (bpMRI)-based Vesical Imaging Reporting and Data System (VI-RADS) can accurately diagnose pure urothelial carcinomas, similar to conventional multiparametric magnetic resonance imaging-based VI-RADS. However, bpMRI-based VI-RADS may misdiagnose muscle invasiveness of urothelial carcinoma with variant histology, particularly when its cutoff score is 4.
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Affiliation(s)
- Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Radiology, Keio University School of Medicine, Tokyo, Japan.
| | - Thomas C Kwee
- Department of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Sungmin Woo
- Department of Radiology, NYU Langone Health, New York, NY, USA
| | - Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryota Ishii
- Department of Biostatistics, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Naoko Okawara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Hiromi Edo
- Department of Radiology, National Defence Medical College, Saitama, Japan
| | - Yuma Waseda
- Department of Urology, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
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12
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Woo S, Becker AS, Das JP, Ghafoor S, Arita Y, Benfante N, Gangai N, Teo MY, Goh AC, Vargas HA. Evaluating residual tumor after neoadjuvant chemotherapy for muscle-invasive urothelial bladder cancer: diagnostic performance and outcomes using biparametric vs. multiparametric MRI. Cancer Imaging 2023; 23:110. [PMID: 37964386 PMCID: PMC10644594 DOI: 10.1186/s40644-023-00632-0] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Neoadjuvant chemotherapy (NAC) before radical cystectomy is standard of care in patients with muscle-invasive bladder cancer (MIBC). Response assessment after NAC is important but suboptimal using CT. We assessed MRI without vs. with intravenous contrast (biparametric [BP] vs. multiparametric [MP]) for identifying residual disease on cystectomy and explored its prognostic role. METHODS Consecutive MIBC patients that underwent NAC, MRI, and cystectomy between January 2000-November 2022 were identified. Two radiologists reviewed BP-MRI (T2 + DWI) and MP-MRI (T2 + DWI + DCE) for residual tumor. Diagnostic performances were compared using receiver operating characteristic curve analysis. Kaplan-Meier curves and Cox proportional-hazards models were used to evaluate association with disease-free survival (DFS). RESULTS 61 patients (36 men and 25 women; median age 65 years, interquartile range 59-72) were included. After NAC, no residual disease was detected on pathology in 19 (31.1%) patients. BP-MRI was more accurate than MP-MRI for detecting residual disease after NAC: area under the curve = 0.75 (95% confidence interval (CI), 0.62-0.85) vs. 0.58 (95% CI, 0.45-0.70; p = 0.043). Sensitivity were identical (65.1%; 95% CI, 49.1-79.0) but specificity was higher in BP-MRI compared with MP-MRI for determining residual disease: 77.8% (95% CI, 52.4-93.6) vs. 38.9% (95% CI, 17.3-64.3), respectively. Positive BP-MRI and residual disease on pathology were both associated with worse DFS: hazard ratio (HR) = 4.01 (95% CI, 1.70-9.46; p = 0.002) and HR = 5.13 (95% CI, 2.66-17.13; p = 0.008), respectively. Concordance between MRI and pathology results was significantly associated with DFS. Concordant positive (MRI+/pathology+) patients showed worse DFS than concordant negative (MRI-/pathology-) patients (HR = 8.75, 95% CI, 2.02-37.82; p = 0.004) and compared to the discordant group (MRI+/pathology- or MRI-/pathology+) with HR = 3.48 (95% CI, 1.39-8.71; p = 0.014). CONCLUSION BP-MRI was more accurate than MP-MRI for identifying residual disease after NAC. A negative BP-MRI was associated with better outcomes, providing complementary information to pathological assessment of cystectomy specimens.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA.
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
| | - Jeeban P Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, Zürich, CH-8091, Switzerland
| | - Yuki Arita
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Min Yuen Teo
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Alvin C Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
- Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY, 10016, USA
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13
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Wong BZY, Causa Andrieu PI, Sonoda Y, Chi DS, Aviki EM, Vargas HA, Woo S. Improving risk stratification of indeterminate adnexal masses on MRI: What imaging features help predict malignancy in O-RADS MRI 4 lesions? Eur J Radiol 2023; 168:111122. [PMID: 37806193 DOI: 10.1016/j.ejrad.2023.111122] [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: 07/06/2023] [Revised: 09/07/2023] [Accepted: 09/27/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE Ovarian-Adnexal Reporting and Data System (O-RADS) MRI uses a 5-point scale to establish malignancy risk in sonographically-indeterminate adnexal masses. The management of O-RADS MRI score 4 lesions is challenging, as the prevalence of malignancy is widely variable (5-90%). We assessed imaging features that may sub-stratify O-RADS MRI 4 lesions into malignant and benign subgroups. METHOD Retrospective single-institution study of women with O-RADS MRI score of 4 adnexal masses between April 2021-August 2022. Imaging findings were assessed independently by 2 radiologists according to the O-RADS lexicon white paper. MRI and clinical findingswere compared between malignant and benign adnexal masses, and inter-reader agreement was calculated. RESULTS Seventy-four women (median age 52 years, IQR 36-61) were included. On pathology, 41 (55.4%) adnexal masses were malignant. Patients with malignant masses were younger (p = 0.02) with higher CA-125 levels (p = 0.03). Size of solid tissue was greater in malignant masses (p = 0.01-0.04). Papillary projections and larger solid portion were more common in malignant lesions; irregular septations and predominantly solid composition were more frequent in benign lesions (p < 0.01). Solid tissue of malignant lesions was more often hyperintense on T2-weighted and diffusion-weighted imaging (p ≤ 0.03). Other imaging findings were not significantly different (p = 0.09-0.77). Inter-reader agreement was excellent-good for most features (ICC = 0. 662-0.950; k = 0. 650-0.860). CONCLUSION Various MRI and clinical features differed between malignant and benign O-RADS MRI score 4 adnexal masses. O-RADS MRI 4 lesions may be sub-stratified (high vs low risk) based on solid tissue characteristics and CA-125 levels.
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Affiliation(s)
- Bernadette Z Y Wong
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Pamela I Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Emeline M Aviki
- Department of Obstetrics and Gynecology, NYU Langone Health, Mineola, NY 11501, USA
| | - Hebert A Vargas
- Department of Radiology, NYU Langone Health, New York, NY 10016, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology, NYU Langone Health, New York, NY 10016, USA.
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Becker AS, Das JP, Woo S, Perez-Johnston R, Vargas HA. Improving Radiology Oncologic Imaging Trainee Case Diversity through Automatic Examination Assignment: Retrospective Study from a Tertiary Cancer Center. Radiol Imaging Cancer 2023; 5:e230035. [PMID: 37889137 DOI: 10.1148/rycan.230035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
In a retrospective single-center study, the authors assessed the efficacy of an automated imaging examination assignment system for enhancing the diversity of subspecialty examinations reported by oncologic imaging fellows. The study aimed to mitigate traditional biases of manual case selection and ensure equitable exposure to various case types. Methods included evaluating the proportion of "uncommon" to "common" cases reported by fellows before and after system implementation and measuring the weekly Shannon Diversity Index to determine case distribution equity. The proportion of reported uncommon cases more than doubled from 8.6% to 17.7% in total, at the cost of a concurrent 9.0% decrease in common cases from 91.3% to 82.3%. The weekly Shannon Diversity Index per fellow increased significantly from 0.66 (95% CI: 0.65, 0.67) to 0.74 (95% CI: 0.72, 0.75; P < .001), confirming a more balanced case distribution among fellows after introduction of the automatic assignment. © RSNA, 2023 Keywords: Computer Applications, Education, Fellows, Informatics, MRI, Oncologic Imaging.
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Affiliation(s)
- Anton S Becker
- From the Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (A.S.B., J.P.D., S.W., R.P.J., H.A.V.); and Department of Radiology, NYU Langone Medical Center, New York, NY (A.S.B., S.W., H.A.V.)
| | - Jeeban P Das
- From the Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (A.S.B., J.P.D., S.W., R.P.J., H.A.V.); and Department of Radiology, NYU Langone Medical Center, New York, NY (A.S.B., S.W., H.A.V.)
| | - Sungmin Woo
- From the Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (A.S.B., J.P.D., S.W., R.P.J., H.A.V.); and Department of Radiology, NYU Langone Medical Center, New York, NY (A.S.B., S.W., H.A.V.)
| | - Rocio Perez-Johnston
- From the Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (A.S.B., J.P.D., S.W., R.P.J., H.A.V.); and Department of Radiology, NYU Langone Medical Center, New York, NY (A.S.B., S.W., H.A.V.)
| | - Hebert Alberto Vargas
- From the Department of Radiology, Body Imaging Service, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 (A.S.B., J.P.D., S.W., R.P.J., H.A.V.); and Department of Radiology, NYU Langone Medical Center, New York, NY (A.S.B., S.W., H.A.V.)
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15
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Woo S. Editorial Comment: PRECISE-The Precisely Right Thing to Use When Interpreting Prostate MRI for Active Surveillance? AJR Am J Roentgenol 2023; 221:660. [PMID: 37404085 DOI: 10.2214/ajr.23.29852] [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: 07/06/2023]
Affiliation(s)
- Sungmin Woo
- NYU Langone Health, New York, NY, , @swoo_rad
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16
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Soliman MM, Kim TH, Cheng M, McKenney AS, Fassia MK, Lamparello NA, Lee JM, Vargas HA, Woo S. Mentorship in Radiology Research: A Guide for Mentors and Mentees. Radiol Imaging Cancer 2023; 5:e230176. [PMID: 37975804 DOI: 10.1148/rycan.230176] [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: 11/19/2023]
Affiliation(s)
- Mohamed M Soliman
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
| | - Tae-Hyung Kim
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
| | - Monica Cheng
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
| | - Anna Sophia McKenney
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
| | - Mohammad-Kasim Fassia
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
| | - Nicole A Lamparello
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
| | - Jeong Min Lee
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
| | - Hebert A Vargas
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
| | - Sungmin Woo
- From the Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY (M.M.S., A.S.M., M.K.F., N.A.L.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY (T.H.K.); Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Mass (M.C.); Department of Radiology, Seoul National University Hospital, Seoul, Korea (J.M.L.); Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Seoul, Korea (J.M.L.); and Department of Radiology, NYU Langone Health, 660 1st Avenue, New York, NY 10016 (H.A.V., S.W.)
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Tan N, Pollock JR, Margolis DJA, Padhani AR, Tempany C, Woo S, Gorin MA. Management of Patients With a Negative Multiparametric Prostate MRI Examination: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023. [PMID: 37877601 DOI: 10.2214/ajr.23.29969] [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: 10/26/2023]
Abstract
Multiparametric prostate MRI (mpMRI) aids risk stratification of patients with elevated PSA levels. While most clinically significant prostate cancers are detected by mpMRI, insignificant cancers are less evident. Thus, multiple international prostate cancer guidelines now endorse routine use of prostate MRI as a secondary screening test before prostate biopsy. Nonetheless, management of patients with negative mpMRI results (defined as PI-RADS category 1 or 2) remains unclear. This AJR Expert Panel Narrative Review summarizes the available literature on patients with an elevated screening PSA level and a negative prostate mpMRI, and provides guidance for these patients' management. Systematic biopsy should not be routinely performed after a negative mpMRI in patients at average risk but should be considered in patients at high risk. In patients who undergo PSA screening rather than systematic biopsy after negative mpMRI, clear triggers should be established for when to perform a repeat MRI. Patients with negative MRI followed by negative biopsy should follow their healthcare practitioners' preferred guidelines concerning subsequent PSA screening for the patient's risk level. Insufficient high-level data exist to support routine use of adjunctive serum or urine biomarkers, artificial intelligence, or PSMA PET to determine the need for prostate biopsy after negative mpMRI.
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Affiliation(s)
- Nelly Tan
- Mayo Clinic Department of Radiology, Phoenix, AZ, USA
| | | | | | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Rickmansworth Road, Middlesex, UK
| | - Clare Tempany
- Department of Radiology, Brigham & Women's Hospital Boston MA
| | - Sungmin Woo
- Department of Radiology, New York University Langone Health, New York, NY, USA
| | - Michael A Gorin
- Milton and Carroll Petrie Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
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Becker AS, Giganti F, Purysko AS, Fainberg J, Vargas HA, Woo S. Taking PI-QUAL beyond the prostate: Towards a standardized radiological image quality score (RI-QUAL). Eur J Radiol 2023; 165:110955. [PMID: 37421773 PMCID: PMC10404469 DOI: 10.1016/j.ejrad.2023.110955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/25/2023] [Accepted: 06/29/2023] [Indexed: 07/10/2023]
Abstract
PURPOSE To compare the interreader agreement of a novel quality score, called the Radiological Image Quality Score (RI-QUAL), to a slighly modified version of the existing Prostate Imaging Quality (mPI-QUAL) score for magnetic resonance imaging (MRI) of the prostate. METHODS A total of 43 consecutive scans were evaluated by two subspecialized radiologists who assigned scores using both the RI-QUAL and mPI-QUAL methods. The interreader agreement was analyzed using three statistical methods: concordance correlation coefficient (CCC), intraclass correlation coefficient (ICC), and Cohen's kappa. Time needed to arrive at a quality judgment was measured and compared using the Wilcoxon signed rank test. RESULTS The interreader agreement for RI-QUAL and mPI-QUAL scores was comparable, as evidenced by the high CCC (0.76 vs. 0.77, p = 0.93), ICC (0.86 vs. 0.87, p = 0.93), and moderate Cohen's kappa (0.61 vs. 0.64, p = 0.85) values. Moreover, RI-QUAL assessment was faster than mPI-QUAL (19 vs. 40 s, p = 0.001). CONCLUSION RI-QUAL is a new quality score that has comparable interreader agreement to the mPI-QUAL score, but with the potential to be applied to different MRI protocols and even different modalities. Like PI-QUAL, RI-QUAL may also facilitate communication about quality to referring physicians, as it provides a standardized and easily interpretable score. Further studies are warranted to validate the usefulness of RI-QUAL in larger patient cohorts and for other imaging modalities.
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Affiliation(s)
- Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Radiology, NYU Langone, New York, NY, United States.
| | - Francesco Giganti
- Department of Radiology, University College London Hospital NHS Foundation Trust, London, UK; Division of Surgery & Interventional Science, University College London, London, UK
| | - Andrei S Purysko
- Department of Radiology, Abdominal Imaging Section, Cleveland Clinic, Cleveland, OH, United States
| | - Jonathan Fainberg
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States; Department of Radiology, NYU Langone, New York, NY, United States
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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Akin O, Woo S, Oto A, Allen BC, Avery R, Barker SJ, Gerena M, Halpern DJ, Gettle LM, Rosenthal SA, Taneja SS, Turkbey B, Whitworth P, Nikolaidis P. ACR Appropriateness Criteria® Pretreatment Detection, Surveillance, and Staging of Prostate Cancer: 2022 Update. J Am Coll Radiol 2023; 20:S187-S210. [PMID: 37236742 DOI: 10.1016/j.jacr.2023.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Prostate cancer is second leading cause of death from malignancy after lung cancer in American men. The primary goal during pretreatment evaluation of prostate cancer is disease detection, localization, establishing disease extent (both local and distant), and evaluating aggressiveness, which are the driving factors of patient outcomes such as recurrence and survival. Prostate cancer is typically diagnosed after the recognizing elevated serum prostate-specific antigen level or abnormal digital rectal examination. Tissue diagnosis is obtained by transrectal ultrasound-guided biopsy or MRI-targeted biopsy, commonly with multiparametric MRI without or with intravenous contrast, which has recently been established as standard of care for detecting, localizing, and assessing local extent of prostate cancer. Although bone scintigraphy and CT are still typically used to detect bone and nodal metastases in patients with intermediate- or high-risk prostate cancer, novel advanced imaging modalities including prostatespecific membrane antigen PET/CT and whole-body MRI are being more frequently utilized for this purpose with improved detection rates. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Sungmin Woo
- Research Author, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice-Chair, Duke University Medical Center, Durham, North Carolina
| | - Ryan Avery
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Commission on Nuclear Medicine and Molecular Imaging
| | - Samantha J Barker
- University of Minnesota, Minneapolis, Minnesota; Director of Ultrasound M Health Fairview
| | | | - David J Halpern
- Duke University Medical Center, Durham, North Carolina, Primary care physician
| | | | - Seth A Rosenthal
- Sutter Medical Group, Sacramento, California; Commission on Radiation Oncology; Member, RTOG Foundation Board of Directors
| | - Samir S Taneja
- NYU Clinical Cancer Center, New York, New York; American Urological Association
| | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Pat Whitworth
- Thomas F. Frist, Jr College of Medicine, Belmont University, Nashville, Tennessee
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Barnett E, Woo S, Perk TG, Munian-Govindan R, Lokre O, Gajar RN, Erazo T, Carbone E, Morris MJ, Vargas HA, Scher HI. Automated analysis of FDG-PET/CT imaging to monitor heterogeneous disease response in metastatic castration-resistant prostate cancer. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.251] [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: 03/15/2023] Open
Abstract
251 Background: The heterogeneity of individual sites of disease in prostate cancer is well recognized and increases over time as the therapies administered promote divergent evolution. In clinical practice, this is often depicted in radiology reports as a mixed response, wherein some lesions improve and others progress or emerge, for which individualizing management is challenging. The problem is exacerbated in patients with high volume disease by the inability to concisely and effectively assess overall disease status which may mask the presence of emerging resistance that could benefit from early intervention and/or a change in therapy. Methods: Thirty-one sets of serial baseline and on-treatment FDG-PET/CT images done for the clinical management of patients with progressing mCRPC were analyzed using TRAQinform IQ software (AIQ Solutions). Individual regions of interest (ROI) identified and tracked across imaging time-points were analyzed for a range of features. The univariate prognostic weight of each feature was assessed with Cox regression models. Imaging features from single timepoints, heterogeneity of response features, and PSA values/dynamics were input into the separate TRAQinform Profile software, which was calculated to predict either time on treatment or overall survival using 3-fold cross-validation of a random survival forest. Individual case reviews were performed on select patients including TRAQinform IQ analytics, PSA trends, radiology reports, and physician notes to evaluate the potential additive benefit of the TRAQinform IQ output. Results: In general, imaging features were more strongly correlated with overall survival than PSA dynamics. After iterative feature selection, only imaging features were selected for TRAQinform Profile scores. In the case of predicting OS, the most important features were baseline total lesion glycolysis (TLG), and the number of new/progressing lesions. Patients with high TRAQinform Profile scores had shorter median survival times than those with low scores (630 vs 1326 days, p<0.01, c-index = 0.744). Of particular value was the finding that the software could identify indicators of oligo-progression for which directed radiotherapy could be considered. Also detected were early indications of widespread disease progression represented as changes in total SUV uptake and TRAQinform Profile scores, which could indicate that the patient was no longer benefitting from treatment and a change in therapy was needed. Conclusions: In pilot analysis, the TRAQinform Profile scores generated from baseline and early on-treatment FDG-PET images had treatment-agnostic prognostic value in mCRPC. Further validation is on-going. The TRAQinform IQ software can aid in identifying the presence of resistant lesions in the setting of otherwise grossly stable disease as determined by the treating physician.
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Affiliation(s)
- Ethan Barnett
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sungmin Woo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | - Ria N Gajar
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Tatiana Erazo
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Emily Carbone
- Memorial Sloan Kettering Cancer Center, New York, NY
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Cheng M, Duzgol C, Kim TH, Ghafoor S, Becker AS, Causa Andrieu PI, Gangai N, Jiang H, Hakimi AA, Vargas HA, Woo S. Sarcomatoid renal cell carcinoma: MRI features and their association with survival. Cancer Imaging 2023; 23:16. [PMID: 36793052 PMCID: PMC9930281 DOI: 10.1186/s40644-023-00535-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
OBJECTIVE To evaluate MRI features of sarcomatoid renal cell carcinoma (RCC) and their association with survival. METHODS This retrospective single-center study included 59 patients with sarcomatoid RCC who underwent MRI before nephrectomy during July 2003-December 2019. Three radiologists reviewed MRI findings of tumor size, non-enhancing areas, lymphadenopathy, and volume (and percentage) of T2 low signal intensity areas (T2LIA). Clinicopathological factors of age, gender, ethnicity, baseline metastatic status, pathological details (subtype and extent of sarcomatoid differentiation), treatment type, and follow-up were extracted. Survival was estimated using Kaplan-Meier method and Cox proportional-hazards regression model was used to identify factors associated with survival. RESULTS Forty-one males and eighteen females (median age 62 years; interquartile range 51-68) were included. T2LIAs were present in 43 (72.9%) patients. At univariate analysis, clinicopathological factors associated with shorter survival were: greater tumor size (> 10 cm; HR [hazard ratio] = 2.44, 95% CI 1.15-5.21; p = 0.02), metastatic lymph nodes (present; HR = 2.10, 95% CI 1.01-4.37; p = 0.04), extent of sarcomatoid differentiation (non-focal; HR = 3.30, 95% CI 1.55-7.01; p < 0.01), subtypes other than clear cell, papillary, or chromophobe (HR = 3.25, 95% CI 1.28-8.20; p = 0.01), and metastasis at baseline (HR = 5.04, 95% CI 2.40-10.59; p < 0.01). MRI features associated with shorter survival were: lymphadenopathy (HR = 2.24, 95% CI 1.16-4.71; p = 0.01) and volume of T2LIA (> 3.2 mL, HR = 4.22, 95% CI 1.92-9.29); p < 0.01). At multivariate analysis, metastatic disease (HR = 6.89, 95% CI 2.79-16.97; p < 0.01), other subtypes (HR = 9.50, 95% CI 2.81-32.13; p < 0.01), and greater volume of T2LIA (HR = 2.51, 95% CI 1.04-6.05; p = 0.04) remained independently associated with worse survival. CONCLUSION T2LIAs were present in approximately two thirds of sarcomatoid RCCs. Volume of T2LIA along with clinicopathological factors were associated with survival.
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Affiliation(s)
- Monica Cheng
- grid.51462.340000 0001 2171 9952Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA ,grid.38142.3c000000041936754XDepartment of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Cihan Duzgol
- grid.51462.340000 0001 2171 9952Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA ,grid.461527.30000 0004 0383 4123Department of Radiology, Lowell General Hospital, 295 Varnum Avenue, Lowell, MA 01854, USA
| | - Tae-Hyung Kim
- grid.51462.340000 0001 2171 9952Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Soleen Ghafoor
- grid.412004.30000 0004 0478 9977Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Anton S. Becker
- grid.51462.340000 0001 2171 9952Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Pamela I. Causa Andrieu
- grid.51462.340000 0001 2171 9952Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Natalie Gangai
- grid.51462.340000 0001 2171 9952Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Hui Jiang
- grid.51462.340000 0001 2171 9952Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Abraham A. Hakimi
- grid.51462.340000 0001 2171 9952Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Hebert A. Vargas
- grid.51462.340000 0001 2171 9952Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065 USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
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Tan Y, Woo S, Yong Y, Wong M, Ajith J, Ng L. Adopting machine vision augmentation to detect detrusor instability in overactive bladder: A frontier of artificial intelligence application in functional urology. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00733-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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23
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Cheng M, Causa Andrieu P, Kim TH, Gangai N, Sonoda Y, Hricak H, Lakhman Y, Vargas HA, Woo S. Fat-containing adnexal masses on MRI: solid tissue volume and fat distribution as a guide for O-RADS Score assignment. Abdom Radiol (NY) 2023; 48:358-366. [PMID: 36173552 DOI: 10.1007/s00261-022-03688-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To explore ways to improve O-RADS MRI scoring for fat-containing adnexal masses, by investigating methods for quantifying solid tissue volume and fat distribution and evaluating their associations with malignancy. METHODS This retrospective, single-center study included patients with fat-containing adnexal masses on MRI during 2008-2021. Two radiologists independently reviewed overall size (Sizeoverall), size of any solid tissue (Sizeanysolid), size of solid tissue that was not Rokitansky nodule (Sizenon-Rokitansky), and fat distribution. Wilcoxon test, Fisher-exact test, and ROC curve analysis were performed. Reference standard was pathology or follow-up > 24 months. RESULTS 188 women (median age 35 years) with 163 benign and 25 malignant lesions were included. Sizeoverall (R1, 9.9 cm vs 5.9 cm; R2, 12.4 cm vs 6.0 cm), Sizeanysolid (R1, 5.1 cm vs 1.2 cm; R2, 3.2 cm vs 0.0 cm), Sizenon-Rokitansky (R1, 5.1 cm vs 0.0 cm; R2, 3.1 cm vs 0.0 cm), and fat distribution differed significantly between malignant and benign lesions (p < 0.01). Area under ROC curve was greatest using Sizenon-Rokitansky (R1, 0.83; R2, 0.86) vs Sizeoverall (R1, 0.78; R2, 0.81) or Sizeanysolid (R1, 0.79; R2, 0.81), though differences were non-significant (p = 0.48-0.93). Cutoffs for Sizenon-Rokitansky (R1, ≥ 1.2 cm; R2, ≥ 1.0 cm) yielded sensitivity and specificity of 0.72 and 0.93 (R1) and 0.76 and 0.95 (R2). Among immature teratomas, 85.7% displayed scattered fat. CONCLUSION Overall size, size of (any or non-Rokitansky-nodule) solid tissue, and fat distribution differed between benign and malignant fat-containing adnexal masses. Incorporating these would constitute simple and practical approaches to refining O-RADS MRI scoring.
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Affiliation(s)
- Monica Cheng
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Pamela Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tae-Hyung Kim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Department of Surgery, Gynecology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hebert A Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Vickers AJ, Woo S. Decision curve analysis in the evaluation of radiology research. Eur Radiol 2022; 32:5787-5789. [PMID: 35348862 DOI: 10.1007/s00330-022-08685-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 485 Lexington Ave, 2nd Floor, New York, NY, 10017, USA.
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Becker AS, Das JP, Woo S, Elnajjar P, Chaim J, Erinjeri JP, Hricak H, Vargas HA. Programmatic Implementation of a Custom Subspecialized Oncologic Imaging Workflow Manager at a Tertiary Cancer Center. JCO Clin Cancer Inform 2022; 6:e2200066. [PMID: 36084275 PMCID: PMC9848557 DOI: 10.1200/cci.22.00066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
PURPOSE To evaluate whether a custom programmatic workflow manager reduces reporting turnaround times (TATs) from a body oncologic imaging workflow at a tertiary cancer center. METHODS A custom software program was developed and implemented in the programming language R. Other aspects of the workflow were left unchanged. TATs were measured over a 12-month period (June-May). The same prior 12-month period served as a historical control. Median TATs of magnetic resonance imaging (MRI) and computed tomography (CT) examinations were compared with a Wilcoxon test. A chi-square test was used to compare the numbers of examinations reported within 24 hours and after 72 hours as well as the proportions of examinations assigned according to individual radiologist preferences. RESULTS For all MRI and CT examinations (124,507 in 2019/2020 and 138,601 in 2020/2021), the median TAT decreased from 4 (interquartile range: 1-22 hours) to 3 hours (1-17 hours). Reports completed within 24 hours increased from 78% (124,127) to 89% (138,601). For MRI, TAT decreased from 22 (5-49 hours) to 8 hours (2-21 hours), and reports completed within 24 hours increased from 55% (14,211) to 80% (23,744). For CT, TAT decreased from 3 (1-19 hours) to 2 hours (1-13 hours), and reports completed within 24 hours increased from 84% (82,342) to 92% (99,922). Delayed reports (with a TAT > 72 hours) decreased from 17.0% (4,176) to 2.2% (649) for MRI and from 2.5% (2,500) to 0.7% (745) for CT. All differences were statistically significant (P < .001). CONCLUSION The custom workflow management software program significantly decreased MRI and CT report TATs.
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Affiliation(s)
- Anton S. Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jeeban P. Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Pierre Elnajjar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joshua Chaim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph P. Erinjeri
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
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Silva AE, Lyu A, Leat SJ, Khan S, Labreche T, Chan JCH, Li Q, Woo GC, Woo S, Cheong AMY, Thompson B. A differential effect of visual cortex tDCS on reading of English and Chinese in patients with central vision loss. Brain Stimul 2022; 15:1215-1217. [PMID: 36044975 DOI: 10.1016/j.brs.2022.08.016] [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: 07/23/2022] [Revised: 08/13/2022] [Accepted: 08/23/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- A E Silva
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada.
| | - A Lyu
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - S J Leat
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
| | - S Khan
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - T Labreche
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
| | - J C H Chan
- Department of Ophthalmology, The University of Hong Kong, Hong Kong
| | - Q Li
- Department of Ophthalmology, The University of Hong Kong, Hong Kong, China
| | - G C Woo
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
| | - S Woo
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada
| | - A M Y Cheong
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China.
| | - B Thompson
- School of Optometry and Vision Science, University of Waterloo, Ontario, Canada; Centre for Eye and Vision Research, 17W Science Park, Hong Kong, China
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Fernandes MC, Yildirim O, Woo S, Vargas HA, Hricak H. The role of MRI in prostate cancer: current and future directions. MAGMA 2022; 35:503-521. [PMID: 35294642 PMCID: PMC9378354 DOI: 10.1007/s10334-022-01006-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/16/2022] [Accepted: 03/03/2022] [Indexed: 06/14/2023]
Abstract
There has been an increasing role of magnetic resonance imaging (MRI) in the management of prostate cancer. MRI already plays an essential role in the detection and staging, with the introduction of functional MRI sequences. Recent advancements in radiomics and artificial intelligence are being tested to potentially improve detection, assessment of aggressiveness, and provide usefulness as a prognostic marker. MRI can improve pretreatment risk stratification and therefore selection of and follow-up of patients for active surveillance. MRI can also assist in guiding targeted biopsy, treatment planning and follow-up after treatment to assess local recurrence. MRI has gained importance in the evaluation of metastatic disease with emerging technology including whole-body MRI and integrated positron emission tomography/MRI, allowing for not only better detection but also quantification. The main goal of this article is to review the most recent advances on MRI in prostate cancer and provide insights into its potential clinical roles from the radiologist's perspective. In each of the sections, specific roles of MRI tailored to each clinical setting are discussed along with its strengths and weakness including already established material related to MRI and the introduction of recent advancements on MRI.
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Affiliation(s)
- Maria Clara Fernandes
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Onur Yildirim
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA.
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY, 10065, USA
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Das JP, Woo S, Ghafoor S, Andrieu PC, Ulaner GA, Donahue TF, Goh AC, Vargas HA. Value of MRI in evaluating urachal carcinoma: A single center retrospective study. Urol Oncol 2022; 40:345.e9-345.e17. [DOI: 10.1016/j.urolonc.2022.02.017] [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: 10/07/2021] [Revised: 02/07/2022] [Accepted: 02/26/2022] [Indexed: 11/25/2022]
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Lee H, Ko T, Park J, Kim H, Woo S. P-233 Deep ensembles-based AI as a tool to support embryo grading and clinical pregnancy prediction. Hum Reprod 2022. [DOI: 10.1093/humrep/deac106.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
Can deep learning accurately evaluate embryo grades and predict clinical pregnancy while providing relevant clinical evidence, not just results from a black box?
Summary answer
The sophisticated ensemble method can improve the predictive performance for embryo grades and clinical pregnancy, while providing clinically relevant evidence.
What is known already
Previous studies have shown that AI can predict the IVF outcomes by analyzing the images of embryos. In many literature, AI outperformed human because AI could identify features human eyes could not easily detect. However, clinicians have been cautious to adopt the AI technology due to the black box nature of AI algorithms. In this study, we increased the predictive power of AI as well as providing evidence of the prediction by using deep ensembles and Grad-CAM images.
Study design, size, duration
We performed a retrospective study of single static images of 727 Day 5 blastocysts from 270 patients who underwent single embryo transfer at a single in vitro fertilization (IVF) clinic between January 2015 and March 2021. The images were collected from standard optical light microscopes and matched with metadata such as embryo grades and pregnancy outcomes.
Participants/materials, setting, methods
Two different models were designed: an automatic embryo grading model and a pregnancy prediction model. Embryologists labeled a day 5 embryo “GEM,” a good embryo if 4AA/AB or above in the Gardner system and pregnancy was defined as the presence of a fetal heartbeat (FHB). Deep ensembles were applied by training four convolutional neural networks (CNNs) and Grad-CAM images were extracted from the last layer and reviewed by experts.
Main results and the role of chance
Under several single CNNs, the highest AUROCs of the embryo grading model and the pregnancy prediction model were 0.80 and 0.67, respectively. After applying deep ensembles, the AUROCs of the two models increased to 0.84 and 0.72, respectively. When the F1-score for the positive cases were maximized by adjusting the threshold of ensembles, accuracy, sensitivity and specificity of the embryo grading model were 88.1%, 92.9% and 62.5% respectively. For the pregnancy prediction model, accuracy, sensitivity and specificity were 66.3%, 77.1% and 55.6% respectively. The accuracy of GEM predicting pregnancy for the embryologists and the embryo grading AI model was 47.3% and 59.2%, respectively. It is noteworthy that the AI pregnancy prediction model outperformed the embryologists while successfully auto-grading embryos, a strong evidence that AI considered more features for prediction than what was used for grading. It was also noted from the review of the Grad-CAM images that the both AI models were focusing on the ICM, TE and hatching. Although their area of focus was the same, the pregnancy prediction model was able to make better predictions than the embryologists and the embryo grading model.
Limitations, reasons for caution
This study has limitations as it is a retrospective study performed on embryo images from a single IVF center. In addition, including other variables such as clinical data may enhance the models.
Wider implications of the findings
We showed that deep learning can automatically grade embryos and more accurately predict pregnancy than embryologists. Furthermore, the embryologists confirmed the model was looking at key features like ICM, TE and hatching. Sharing such evidence with clinicians can be a necessary step for AI to be adopted for clinical practice.
Trial registration number
not applicable
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Affiliation(s)
- H.J Lee
- Kai Health, Chief Executive Officer , Seoul, Korea- South
- Seoul National University, Obstetrics and Gynecology , Seoul, Korea- South
| | - T Ko
- The Catholic University of Korea, Department of Medical Informatics , Seoul, Korea- South
| | - J.H Park
- Miraewaheemang hospital, IVF clinic , Seoul, Korea- South
| | - H.M Kim
- The Catholic University of Korea, Department of Medical Informatics , Seoul, Korea- South
| | - S Woo
- Kai Health, Artificial intelligence , Seoul, Korea- South
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Lee C, Leung MC, Tang YK, Ho C, Wan MC, Woo S, Lee ML, Ng KH, So H, Lee MY, Ying SKY, Leung MH, Wong PY, Mok CC. POS0779 STANDARDIZED MORTALITY RATIO AND RISK FACTORS FOR DEATH IN SOUTHERN CHINESE PATIENTS WITH THE ANTIPHOSPHOLIPID SYNDROME (APS). Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
ObjectivesTo report the mortality rate and risk factors for death in southern Chinese patients with the antiphospholipid syndrome (APS)MethodsThe HKAPS registry was established in early 2020 by the Hong Kong Society of Rheumatology to study the outcomes of Chinese patients with APS treated in public hospitals in Hong Kong. Patients aged ≥18 years were identified by the Hospital Authority Clinical Data retrieval system using the ICD-10 diagnostic code of APS. The medical history and APS diagnosis was verified by sub-investigators in different hospitals using the 2006 modified consensus criteria for the APS. Eligible patients were classified into definite APS or probable APS, which was further categorized into primary (without underlying rheumatic diseases) and secondary types. The treatment and outcome (recurrence and mortality) of the patients was studied by Kaplan-Meier analysis and risk factors for recurrence of thrombosis and mortality were studied by Cox regression.Results428 APS patients were studied - 282 fulfilled the 2006 criteria for APS while 146 patients had probable APS (anti-phospholipid [aPL] antibodies positive once or with non-criteria manifestations). All were ethnic Chinese. The mean age at diagnosis was 44.1±15.6 years and the female to male ratio was 3.4:1. APS was primary in 211 patients and secondary to concomitant rheumatic diseases in 217 patients (SLE in 89.9%). 369(86.4%) patients had thromboembolic manifestations, 85(19.9%) had obstetric morbidities and 20(4.7%) had both. In patients with secondary APS, 23% thrombotic or obstetric manifestations occurred before diagnosis of the rheumatic diseases. Lupus anticoagulant (LAC), moderate/high titers of IgG anticardiolipin and anti-β2glycoprotein-1 antibodies was present in 326(76.1%), 242(56.5%) and 29(6.7%) patients, respectively. 137(32%) patients were double positive while 19(4.4%) patient was triple positive for these aPL antibodies. Among the thromboembolic manifestations, arterial thrombosis (n=201) was more common than venous thrombosis (n=186). The following treatment regimens were used: warfarin (63.6%), aspirin plus subcutaneous heparin (6.8%), aspirin plus warfarin (3%), aspirin alone (17.8%) and direct oral anticoagulant (DOAC) (2.8%). Bleeding complications developed in 77(18%) patients.After a mean follow-up of 8.0±14.1 years, recurrence of thromboembolic or obstetric complications occurred in 83(19.4%) and 14(3.3%) patients, respectively (1 patient had recurrence of both thrombosis and obstetric complications). Cox regression did not reveal any factors significantly associated with recurrence of thrombosis. A total of 67(15.7%) patients succumbed (median time to death 7.3 years). The causes of death were vascular in 29.9% (intracranial haemorrhage [35%], myocardial infarction [30%], limb ischemia [10%], ischemic stroke[10%], bowel ischemia[5%]) and non-vascular in 70.1% of patients (infection [59.6%], malignancy [10.6%], SLE activity [6.4%], pulmonary arterial hypertension [2.1%], organ failure [6.4%] and others). The cumulative risk of mortality over time was 6.4% at 5 years and 11.9% at 10 years. The age and sex adjusted standardized mortality ratio (SMR) of our APS patients relative to the general population was 18.2(14.2-23.0). In patients with thrombotic APS, mortality was associated with older age (≥60 years) (HR 2.57[1.34-4.95]) and the presence of LAC (HR 2.01[1.07-3.75]), adjusted for age, sex and vascular risk factors that included hypertension, diabetes mellitus, dyslipidaemia, smoking and atrial fibrillation.ConclusionAPS in southern Chinese is relatively uncommon and most cases were associated with SLE. In contrast to the Caucasians, venous thrombosis related to APS is less frequent. Over 8 years, recurrence of thrombotic events is uncommon. The mortality of APS in our Chinese patients was increased, with older age and the presence of LAC being independent risk factors.Disclosure of InterestsNone declared
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Affiliation(s)
- Hebert Alberto Vargas
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Sungmin Woo
- From the Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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Woo S, Ghafoor S, Das JP, Gangai N, Goh AC, Vargas HA. Plasmacytoid urothelial carcinoma of the bladder: MRI features and their association with survival. Urol Oncol 2022; 40:108.e1-108.e10. [PMID: 34750054 PMCID: PMC8885786 DOI: 10.1016/j.urolonc.2021.09.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 08/20/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Plasmacytoid urothelial carcinomas (PUC) of the bladder are rare variants known for diffuse and infiltrative spread, however their magnetic resonance imaging (MRI) features are not well established. We aimed to evaluate MRI features of PUC of the bladder and their association with survival. METHODS AND MATERIALS This retrospective single-center study included 41 patients with pathologically-proven bladder PUC of the bladder that underwent pre-treatment MRI between January 2000 and March 2020. Two radiologists reviewed MRIs independently followed by consensus with a third radiologist. On MRI, tumor extent, size, Vesical Imaging-Reporting and Data System (VI-RADS) scores (≥4, muscle-invasive; 5, extravesical extension [EVE]), pelvic peritoneal spread (PPS), hydronephrosis, pelvic adenopathy and clinicopathological factors of age, gender, pathological stage, and treatment type were extracted. Kaplan-Meier curves and Cox proportional-hazards models were used to evaluate association with survival. RESULTS Thirty-two men and 9 women (median age 70 years, IQR 64-76) were included. Most were muscle-invasive (n = 30 [73.2%]). On MRI, most tumors were diffuse (n = 28 [68.3%]), >5 cm (n = 30 [73.2%]), VI-RADS 4 to 5 (n = 36 [87.8%]) with features of EVE and (n = 31 [75.6%]) and PPS (n = 25 [61.0%]). Variables associated with survival were: Larger tumors (>5 cm; hazard ratio [HR] = 5.0; 95% confidence interval [CI] 1.6-15.5; P < 0.01), diffuse extent (HR = 4.0; 95% CI 1.4-11.2; P = 0.01), EVE (HR = 4.5; 95% CI 1.5-13.6; P < 0.01), PPS (HR = 3.0; 95% CI 1.2-7.4; P = 0.01), hydronephrosis (HR = 13.7; 95% CI 3.1-60.9; P < 0.01), pathologic stage (≥pT3 vs. pT1; HR = 5.6; 95% CI 1.3-22.0; P = 0.02), and margin positivity (HR = 4.4 [95% CI 1.2-16.4], P = 0.03). CONCLUSION PUCs of the bladder are commonly large, diffuse VI-RADS score 4 to 5 tumors with MRI features of EVE and PPS. These features and pathological stage were associated with survival.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Rämistrasse 100, CH-8091 Zürich, Switzerland
| | - Jeeban P. Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
| | - Alvin C. Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY
| | - H. Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA
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Park HY, Suh CH, Woo S, Kim PH, Kim KW. Quality Reporting of Systematic Review and Meta-Analysis According to PRISMA 2020 Guidelines: Results from Recently Published Papers in the Korean Journal of Radiology. Korean J Radiol 2022; 23:355-369. [PMID: 35213097 PMCID: PMC8876652 DOI: 10.3348/kjr.2021.0808] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the completeness of the reporting of systematic reviews and meta-analyses published in a general radiology journal using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. MATERIALS AND METHODS Twenty-four articles (systematic review and meta-analysis, n = 18; systematic review only, n = 6) published between August 2009 and September 2021 in the Korean Journal of Radiology were analyzed. Completeness of the reporting of main texts and abstracts were evaluated using the PRISMA 2020 statement. For each item in the statement, the proportion of studies that met the guidelines' recommendation was calculated and items that were satisfied by fewer than 80% of the studies were identified. The review process was conducted by two independent reviewers. RESULTS Of the 42 items (including sub-items) in the PRISMA 2020 statement for main text, 24 were satisfied by fewer than 80% of the included articles. The 24 items were grouped into eight domains: 1) assessment of the eligibility of potential articles, 2) assessment of the risk of bias, 3) synthesis of results, 4) additional analysis of study heterogeneity, 5) assessment of non-reporting bias, 6) assessment of the certainty of evidence, 7) provision of limitations of the study, and 8) additional information, such as protocol registration. Of the 12 items in the abstract checklists, eight were incorporated in fewer than 80% of the included publications. CONCLUSION Several items included in the PRISMA 2020 checklist were overlooked in systematic review and meta-analysis articles published in the Korean Journal of Radiology. Based on these results, we suggest a double-check list for improving the quality of systematic reviews and meta-analyses. Authors and reviewers should familiarize themselves with the PRISMA 2020 statement and check whether the recommended items are fully satisfied prior to publication.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ruppert LM, Cohn ED, Keegan NM, Bacharach A, Woo S, Gillis T, Scher HI. Spine Pain and Metastatic Prostate Cancer: Defining the Contribution of Nonmalignant Etiologies. JCO Oncol Pract 2022; 18:e938-e947. [PMID: 35175783 DOI: 10.1200/op.21.00816] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In patients with metastatic prostate cancer (MPC), the contribution of nonmalignant etiologies to morbidity is often overlooked. METHODS We retrospectively reviewed the documented specialist assessments of back pain in men with MPC in a joint medical oncology and physiatry clinic at our tertiary cancer care center. Data on cancer disease extent, hormonal status, sites of spread, pain characteristics, physiatric examination findings, imaging, and recommended management were reviewed, extracted, and codified. For those with back pain at a site of known disease, pain etiology was classified as malignant, nonmalignant, or mixed. RESULTS Ninety-three men were collaboratively assessed for back pain, 24 (26%) with a biochemical recurrence and 69 (74%) with MPC of whom 53 (77%) reported pain in an area of known spinal metastases including 35 (66%) metastatic castration-resistant disease and 34 (64%) a precancer history of back pain. The presenting pain symptoms of the 53 patients were activity-related in 22 (42%), radicular in eight (15%), transitional movement-related in seven (13%), biologic in five (9%), and multifactorial in 11 (21%). Overall, pain was deemed malignant in 20 (38%; five castration-sensitive, 15 metastatic castration resistant prostate cancer), nonmalignant in 12 (23%; four castration-sensitive, eight CRPC), and of mixed etiology in 21 (40%; nine castration-sensitive, 12 CRPC). CONCLUSION Nonmalignant etiologies contributed significantly to back pain at sites of metastatic spread for 33/53 (62%) patients with MPC assessed by medical oncology and physiatry. We recommend multidisciplinary care for patients with MPC and back pain to address nonmalignant etiologies that contribute to functional compromise.
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Affiliation(s)
- Lisa Marie Ruppert
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY
| | - Erica Dayan Cohn
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Niamh M Keegan
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Abigail Bacharach
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Theresa Gillis
- Rehabilitation Medicine Service, Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY
| | - Howard I Scher
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY.,Department of Medicine, Weill Cornell Medicine, New York, NY
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Kim TH, Woo S, Han S, Suh CH, Do RKG, Lee JM. Risk Factors for Hypervascularization in Hepatobiliary Phase Hypointense Nodules without Arterial Phase Hyperenhancement: A Systematic Review and Meta-analysis. Acad Radiol 2022; 29:198-210. [PMID: 32962925 PMCID: PMC9115668 DOI: 10.1016/j.acra.2020.08.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/16/2020] [Accepted: 08/20/2020] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVES To perform a systematic review and meta-analysis to determine risk factors for hypervascularization in hepatobiliary phase (HBP) hypointense nodules without arterial phase hyperenhancement (APHE) in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS Pubmed and EMBASE databases were searched up to May 7, 2020. Studies which evaluated radiologic and clinical risk factors for hypervascularization in HBP hypointense nodules without APHE were included. Hazard ratios were meta-analytically pooled using random-effects model. Methodological quality of included studies was assessed using Quality in Prognostic Studies (QUIPS) tool. RESULTS Sixteen studies with 934 patients were included. HBP hypointense nodules without APHE with baseline size greater than 10 mm, T2 hyperintensity, and restricted diffusion showed risk for hypervascularization with pooled HRs of 2.95 (95% confidence interval [CI], 1.94-4.20), 4.21 (95% CI, 1.15-15.40), 5.83 (95% CI, 1.42-23.95), respectively. Previous HCC history contributed to hypervascularization of the nodules with hazard ratio of 2.06 (95% CI, 1.23-3.44). T1 hyperintensity, intralesional fat, Child-Pugh Class B, sex, alfa-fetoprotein, hepatitis B or C infection were not significant risk factors for hypervascularization (p ≥0.05). Study quality was generally moderate. CONCLUSION HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI with baseline size greater than 10 mm, T2 hyperintensity, restricted diffusion and previous hepatocellular carcinoma history pose higher risk for hypervascularization. Proper patient management in patients with HBP hypointense nodules without APHE on gadoxetic acid-enhanced MRI may need to be tailored according to these risk factors.
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Ghafoor S, Becker AS, Woo S, Causa Andrieu PI, Stocker D, Gangai N, Hricak H, Vargas HA. Comparison of PI-RADS Versions 2.0 and 2.1 for MRI-based Calculation of the Prostate Volume. Acad Radiol 2021; 28:1548-1556. [PMID: 32814644 DOI: 10.1016/j.acra.2020.07.027] [Citation(s) in RCA: 6] [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: 06/24/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/25/2023]
Abstract
RATIONALE AND OBJECTIVES Prostate gland volume (PGV) should be routinely included in MRI reports of the prostate. The recently updated Prostate Imaging Reporting and Data System (PI-RADS) version 2.1 includes a change in the recommended measurement method for PGV compared to version 2.0. The purpose of this study was to evaluate the agreement of MRI-based PGV calculations with the volumetric manual slice-by-slice prostate segmentation as a reference standard using the linear measurements per PI-RADS versions 2.0 and 2.1. Furthermore, to assess inter-reader agreement for the different measurement approaches, determine the influence of an enlarged transition zone on measurement accuracy and to assess the value of the bullet formula for PGV calculation. MATERIALS AND METHODS Ninety-five consecutive treatment-naive patients undergoing prostate MRI were retrospectively analyzed. Prostates were manually contoured and segmented on axial T2-weighted images. Four different radiologists independently measured the prostate in three dimensions according to PI-RADS v2.0 and v2.1, respectively. MRI-based PGV was calculated using the ellipsoid and bullet formulas. Calculated volumes were compared to the reference manual segmentations using Wilcoxon signed-rank test. Inter-reader agreement was calculated using intraclass correlation coefficient (ICC). RESULTS Inter-reader agreement was excellent for the ellipsoid and bullet formulas using PI-RADS v2.0 (ICC 0.985 and 0.987) and v2.1 (ICC 0.990 and 0.994), respectively. The median difference from the reference standard using the ellipsoid formula derived PGV was 0.4 mL (interquartile range, -3.9 to 5.1 mL) for PI-RADS v2.0 (p = 0.393) and 2.6 mL (interquartile range, -1.6 to 7.3 mL) for v2.1 (p < 0.001) with a median difference of 2.2 mL. The bullet formula overestimated PGV by a median of 13.3 mL using PI-RADS v2.0 (p < 0.001) and 16.0 mL using v2.1 (p < 0.001). In the presence of an enlarged transition zone the PGV tended to be higher than the reference standard for PI-RADS v2.0 (median difference of 4.7 mL; p = 0.018) and for v2.1 (median difference of 5.7 mL, p < 0.001) using the ellipsoid formula. CONCLUSION Inter-reader agreement was excellent for the calculated PGV for both methods. PI-RADS v2.0 measurements with the ellipsoid formula yielded the most accurate volume estimates. The differences between PI-RADS v2.0 and v2.1 were statistically significant although small in absolute numbers but may be of relevance in specific clinical scenarios like prostate-specific antigen density calculation. These findings validate the use of the ellipsoid formula and highlight that the bullet formula should not be used for prostate volume estimation due to systematic overestimation.
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Affiliation(s)
- Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Pamela I Causa Andrieu
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Daniel Stocker
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Andrieu PC, Woo S, Kim TH, Kertowidjojo E, Hodgson A, Sun S. New imaging modalities to distinguish rare uterine mesenchymal cancers from benign uterine lesions. Curr Opin Oncol 2021; 33:464-475. [PMID: 34172593 PMCID: PMC8376762 DOI: 10.1097/cco.0000000000000758] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE OF REVIEW Uterine sarcomas are rare and are often challenging to differentiate on imaging from benign mimics, such as leiomyoma. As functional MRI techniques have improved and new adjuncts, such as machine learning and texture analysis, are now being investigated, it is helpful to be aware of the current literature on imaging features that may sometimes allow for preoperative distinction. RECENT FINDINGS MRI, with both conventional and functional imaging, is the modality of choice for evaluating uterine mesenchymal tumors, especially in differentiating uterine leiomyosarcoma from leiomyoma through validated diagnostic algorithms. MRI is sometimes helpful in differentiating high-grade stromal sarcoma from low-grade stromal sarcoma or differentiating endometrial stromal sarcoma from endometrial carcinoma. However, imaging remains nonspecific for evaluating rarer neoplasms, such as uterine tumor resembling ovarian sex cord tumor or perivascular epithelioid cell tumor, primarily because of the small number and power of relevant studies. SUMMARY Through advances in MRI techniques and novel investigational imaging adjuncts, such as machine learning and texture analysis, imaging differentiation of malignant from benign uterine mesenchymal tumors has improved and could help reduce morbidity relating to misdiagnosis or diagnostic delays.
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Affiliation(s)
| | - Sungmin Woo
- Department of Radiology. Memorial Sloan Kettering Cancer Center
| | - Tae-Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Naval Pohang Hospital, Pohang, Korea
| | | | | | - Simon Sun
- Department of Radiology. Hospital for Special Surgery
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Han S, Lee HS, Woo S, Kim TH, Yoo C, Ryoo BY, Ryu JS. Prognostic Value of 18F-FDG PET in Neuroendocrine Neoplasm: A Systematic Review and Meta-analysis. Clin Nucl Med 2021; 46:723-731. [PMID: 34028406 DOI: 10.1097/rlu.0000000000003682] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Accurate assessment of the prognosis is critical for the rational treatment of neuroendocrine neoplasms (NENs). We performed a systematic review and meta-analysis of the prognostic value of 18F-FDG PET for NENs. PATIENTS AND METHODS PubMed and Embase databases were searched up to September 2020 for studies that evaluated 18F-FDG PET as prognostic factors in patients with NENs with overall survival (OS) and event-free survival (EFS) as outcomes. Hazards ratios (HRs) comparing high and low FDG uptakes were pooled using the DerSimonian-Laird method. Publication bias was assessed and adjusted for using the trim-and-fill method. Metaregression and subgroup analyses were performed to explore the cause of heterogeneity. RESULTS Twenty-three studies (1799 patients) were included. The overall pooled HRs of high FDG uptake on EFS and OS were 2.84 (95% confidence interval [CI], 2.21-3.64) and 3.50 (95% CI, 2.42-4.12), respectively. Publication biases were present regarding both EFS and OS (P = 0.0342 and 0.0009, respectively). After adjustment, effect sizes remained significant for EFS and OS (adjusted HR, 2.26 [95% CI, 1.76-2.89]; 3.16 [95% CI, 2.42-4.12]). In metaregression analyses, the proportion of grade 3 tumors positively correlated with the HR of OS (adjusted P = 0.0422). CONCLUSIONS 18F-FDG PET is a significant prognostic factor in patients with NENs. 18F-FDG PET might be a useful prognostic biomarker in conjunction with the histologic grade and can help select the optimal treatment.
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Affiliation(s)
- Sangwon Han
- From the Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
| | - Hyo Sang Lee
- Department of Nuclear Medicine, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, South Korea
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Changhoon Yoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Baek-Yeol Ryoo
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Sook Ryu
- From the Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul
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Woo S, Araji A, El Amine MA, Gangai N, Acquafredda E, Price AP, Trippett TM, Hricak H, Vargas HA, Behr GG. Emergency room imaging in pediatric patients with cancer: analysis of the spectrum and frequency of imaging modalities and findings in a tertiary cancer center and their relationship with survival. Cancer Imaging 2021; 21:51. [PMID: 34454626 PMCID: PMC8400759 DOI: 10.1186/s40644-021-00421-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To assess the spectrum and frequency of modalities used for emergency room (ER) imaging and their findings in pediatric cancer patients and assess their relationship with survival. METHODS Consecutive pediatric cancer patients that underwent imaging during an ER visit at our tertiary cancer center over a 5-year period were retrospectively analyzed. Imaging findings were considered positive when they were relevant to the ER presenting complaint. Imaging positivity was correlated with inpatient admission. Overall survival (OS) was assessed with Kaplan-Meier curves and uni- and multi-variate Cox proportional hazards model was used to identify significant factors associated with OS. RESULTS Two hundred sixty-one patients (135 males and 126 females; median age 11 years [interquartile range 5-16 years] with 348 visits and a total of 406 imaging studies were included. Common chief complaints were related to the chest (100 [28.7 %]) and fever (99 [28.4 %]). ER imaging was positive in 207 visits (59.5 %), commonly revealing increased metastases (50 [14.4 %]), pneumonia (47 [13.5 %]), and other lung problems (12 [2.9 %]). Positive ER imaging was associated with inpatient admission (69.3 % [133/192] vs. 40.4 % [63/156], p < 0.01). Multivariate survival analysis showed that positive ER imaging (hazard ratio [HR] = 2.35 [95% CI 1.44-3.83, p < 0.01), admission (HR = 1.86 [95% CI 1.17-3.00], p < 0.01), number of ER visits (HR = 3.08 [95% CI 1.62-5.83], p < 0.01 for ≥ 3 visits) were associated with poorer survival. CONCLUSIONS Imaging was able to delineate the cause for ER visits in children with cancer in over half of the cases. Positive ER imaging was associated with admission and worse survival.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA.
| | - Abdallah Araji
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA
| | - Mohammad Ali El Amine
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA
| | - Natalie Gangai
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA
| | - Elizabeth Acquafredda
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA
| | - Anita P Price
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA
| | - Tanya M Trippett
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA
| | - Gerald G Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, 10065, New York, NY, USA
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Mok CC, Lee C, Leung MC, Tang YK, Ho C, Woo S, Lee ML, Wan MC, Lee MY. POS0773 CLINICAL PRESENTATION AND OUTCOMES OF THE ANTIPHOSPHOLIPID SYNDROME (APS) IN SOUTHERN CHINESE PATIENTS: THE HONG KONG APS REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:To report the clinical presentation and outcomes of the APS in Hong Kong Chinese patients.Methods:The HKAPS registry was established in early 2020 by the Hong Kong Society of Rheumatology to study the outcomes of Chinese patients with APS treated in public hospitals in Hong Kong. Patients aged ≥18 years were identified by the Hospital Authority Clinical Data retrieval system using the ICD-10 diagnostic code of APS. The medical history and APS diagnosis was verified by sub-investigators in different hospitals using the 2006 modified consensus criteria for the APS. Eligible patients were classified into definite APS or probable APS, which was further categorized into primary (without underlying rheumatic diseases) and secondary types. The presentation, treatment and outcomes of these patients were summarized.Results:232 APS patients (76.3% women) were identified. All were ethnic Chinese. A total of 160 patients fulfilled the 2006 criteria for APS (definite APS) while 72 patients had probable APS (anti-phospholipid [aPL] antibodies positive once or with non-criteria manifestations). In those with definite APS, the mean age at diagnosis was 44.9±15.8 years and the female to male ratio was 3.1:1. APS was primary in 82 patients while 78 patients had concomitant rheumatic diseases (SLE in 95% of patients). 130(81%) patients had thromboembolic manifestations, 20(13%) had obstetric morbidities and 10(6%) had both. In patients with secondary APS, 23% thrombotic or obstetric manifestations occurred before diagnosis of the rheumatic diseases (ie. evolved from primary APS). Lupus anticoagulant was present in 81(51%) patients, moderate/high titers of anti-cardiolipin were present in 90(56%) patients and anti-β2glycoprotein-1 was present in 6(4%) patients. Sixteen (10%) patients were double positive while 1 patient was triple positive for these aPL antibodies. Among the thromboembolic manifestations, arterial thrombosis (n=84) (ischemic stroke 77%, myocardial infarction 4.8%, peripheral vascular disease with limb/digital gangrene 2.4%, retinal artery 2.4%, splenic artery 1.2%, bowel infarct 1.2%) was more common than venous thrombosis (n=73) (calf vein thrombosis ± pulmonary embolism 86%, cerebral veins 2.7%, inferior vena cava/iliac veins 6.8%, retinal vein 2.7%, splenic vein 1.4%). The following treatment regimens were used in our APS patients: warfarin (71%), aspirin plus subcutaneous heparin (4%), aspirin + warfarin (3.1%), aspirin alone (17%) and the direct oral anticoagulant (DOAC) (5%). Bleeding complications developed in 35(22%) patients. Over a mean follow-up of 9.9±7.0years, recurrence of thromboembolic or obstetric manifestations recurred in 39(24%) and 6(4%) patients, respectively. A total of 29(18%) patients succumbed (median time to death: 6.4 years) and the causes of death were: pneumonia (24%), septicemia (17%), intracranial hemorrhage (14%), myocardial infarction (10%), ischemic stroke (3%), bowel infarct (3%), pulmonary hypertension (6.9%) and sudden death with unknown causes (14%).Conclusion:APS in southern Chinese is relatively uncommon and most cases were associated with SLE. In contrast with the Caucasians, venous thrombosis related to APS is less frequent than arterial thrombosis in Chinese patients. With long-term anticoagulation treatment, the outcome is satisfactory with relatively low rates of recurrence and mortality. Expansion of the sample size to study factors associated with recurrence and mortality by involving more hospitals is in progress.Disclosure of Interests:None declared
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Causa Andrieu PI, Woo S, Rios-Doria E, Sonoda Y, Ghafoor S. The role of imaging in pelvic exenteration for gynecological cancers. Br J Radiol 2021; 94:20201460. [PMID: 33960814 DOI: 10.1259/bjr.20201460] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pelvic exenteration (PE) is one of the most challenging gynecologic oncologic surgeries and is an overriding term for different procedures that entail radical en bloc resection of the female reproductive organs and removal of additional adjacent affected pelvic organs (bladder, rectum, anus, etc.) with concomitant surgical reconstruction to restore bodily functions. Multimodality cross-sectional imaging with MRI, PET/CT, and CT plays an integral part in treatment decision-making, not only for the appropriate patient selection but also for surveillance after surgery. The purpose of this review is to provide a brief background on pelvic exenteration in gynecologic cancers and to familiarize the reader with the critical radiological aspects in the evaluation of patients for this complex procedure. The focus of this review will be on how imaging can aid in treatment planning and guide management.
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Affiliation(s)
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Eric Rios-Doria
- Department of Gynecological Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Yukio Sonoda
- Department of Gynecological Surgery, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Soleen Ghafoor
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
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Han S, Woo S, Kim YI, Lee JL, Wibmer AG, Schoder H, Ryu JS, Vargas HA. Concordance between Response Assessment Using Prostate-Specific Membrane Antigen PET and Serum Prostate-Specific Antigen Levels after Systemic Treatment in Patients with Metastatic Castration Resistant Prostate Cancer: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2021; 11:diagnostics11040663. [PMID: 33917006 PMCID: PMC8067707 DOI: 10.3390/diagnostics11040663] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/10/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/16/2022] Open
Abstract
Prostate-specific membrane antigen positron emission tomography (PSMA PET) has recently gained interest as a promising tool for treatment response evaluation in metastatic castration-resistant prostate cancer (CRPC). We performed a systematic review and meta-analysis assessing the concordance between response evaluation using PSMA PET and serum prostate-specific antigen (PSA) level after systemic treatment and the association between PSMA PET and overall survival in metastatic CRPC patients. PubMed, Embase, and Cochrane library databases were searched until August 2020. Studies that reported the concordance between PSMA PET and PSA response were included. PSMA PET and PSA response evaluation were dichotomized into response vs. non-response to construct two-by-two contingency tables; an ≥30% increase in PSMA PET according to PET Response Criteria in Solid Tumors 1.0 and as an increase in serum PSA level of ≥25% as per Prostate Cancer Working Group 3 guidelines were defined as non-response. The percent agreement rates were pooled using random-effect model. Ten studies (268 patients) were included. The concordance rates ranged 0.50–0.84 with a pooled proportion of 0.73 (95% confidence interval 0.67–0.79). Patients were treated with 177Lu-PSMA therapy in five, chemotherapy in three, 223Ra in one, and more than one type in one study. Various PET parameters were used: the most widely evaluated was PSMA tumor volume (PSMA-TV). Similar proportions were found across different therapeutic agents, PET response parameters, and regarding directionality of discordance (PSA response/PSMA non-response vs. PSMA response/PSA non-response). Two studies reported that a decrease in PSMA-TV was associated with better overall survival. PSMA PET and PSA response assessments were discordant in nearly a fourth of metastatic CRPC patients. Further studies are warranted to establish the clinical meaning of this discordance and define appropriate management for such clinical situation.
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Affiliation(s)
- Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.H.); (Y.-i.K.); (J.-S.R.)
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.G.W.); (H.S.); (H.A.V.)
- Correspondence: ; Tel.: +1-646-888-5119; Fax: +1-212-717-3234
| | - Yong-il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.H.); (Y.-i.K.); (J.-S.R.)
| | - Jae-Lyun Lee
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;
| | - Andreas G. Wibmer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.G.W.); (H.S.); (H.A.V.)
| | - Heiko Schoder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.G.W.); (H.S.); (H.A.V.)
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea; (S.H.); (Y.-i.K.); (J.-S.R.)
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (A.G.W.); (H.S.); (H.A.V.)
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Han S, Kim YI, Woo S, Kim TH, Ryu JS. Prognostic and predictive values of interim 18F-FDG PET during neoadjuvant chemoradiotherapy for esophageal cancer: a systematic review and meta-analysis. Ann Nucl Med 2021; 35:447-457. [PMID: 33471289 DOI: 10.1007/s12149-021-01583-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/07/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE To determine the prognostic and predictive value of early metabolic response assessed by a change in standardized uptake value (SUV) on interim 18F-FDG PET in patients with esophageal cancer undergoing neoadjuvant chemoradiotherapy. METHODS PubMed and Embase were searched up until 10 September, 2020, for studies evaluating a change in SUV on interim 18F-FDG PET for predicting a pathologic response, progression-free survival (PFS), or overall survival (OS) in patients with esophageal cancer. The sensitivity and specificity for predicting a pathologic response were pooled using bivariate and hierarchical summary receiver operating characteristic (HSROC) models. Meta-analytic pooled hazard ratios (HRs) and their 95% confidence intervals (CIs) were derived using a random-effects model. RESULTS A total of 11 studies (695 patients) were included in the meta-analysis. For nine studies assessing predictive accuracy, the pooled sensitivity and specificity of an early metabolic response for predicting a pathologic response were 0.80 (95% CI 0.61-0.91) and 0.54 (95% CI 0.45-0.63), respectively. The area under the HSROC curve was 0.64 (95% CI 0.60-0.68). Across the nine studies assessing prognostic value, an early metabolic response determined by interim PET showed pooled HRs for predicting PFS and OS of 0.44 (95% CI, 0.30-0.63) and 0.42 (95% CI, 0.31-0.56), respectively. CONCLUSION Change in SUV on interim 18F-FDG PET had significant prognostic value and moderate predictive value for a pathologic response in esophageal cancer treated with neoadjuvant chemoradiotherapy. Interim 18F-FDG PET may help prognostic stratification and guide treatment planning in oncologic practice.
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Affiliation(s)
- Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Yong-Il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea.
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tae-Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
- Department of Radiology, Naval Pohang Hospital, Pohang, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
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Yang J, Kim H, Shin K, Nam Y, Heo HJ, Kim GH, Hwang BY, Kim J, Woo S, Choi HS, Ko DS, Lee D, Kim YH. Molecular insights into the development of hepatic metastases in colorectal cancer: a metastasis prediction study. Eur Rev Med Pharmacol Sci 2020; 24:12701-12708. [PMID: 33378017 DOI: 10.26355/eurrev_202012_24168] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Colorectal cancer is presently the third most commonly diagnosed cancer in the United States. In this study, we identified molecular differences between hepatic and non-hepatic metastases in colorectal cancer and evaluated their prognostic significance. MATERIALS AND METHODS We downloaded primary data from the NCBI Gene Expression Omnibus (GSE6988, GSE62321, GSE50760, and GSE28722). To identify the molecular differences, we used the Significance Analysis of Microarray method. We selected nine prognostic genes (SYTL2, PTPLAD1, CDS1, RNF138, PIGR, WDR78, MYO7B, TSPAN3, and ATP5F1) with hepatic metastasis prediction score in colorectal cancer (hereafter referred to as LASSO Score). We confirmed the prognostic significance of the LASSO Score by using Kaplan-Meier survival analysis, multivariate analysis, the time-dependent area under the curve (AUC) of Uno's C-index, and the AUC of the receiver operating characteristic curve at 1-5 years. RESULTS Survival analysis revealed that a high LASSO Score is associated with a poor prognosis in colorectal cancer patients with hepatic metastases (p = 0). Analysis of C-indices and AUC values from the receiver operating characteristic curve further supported this prediction by the LASSO Score. Multivariate analysis confirmed the prognostic significance of the LASSO Score (p = 1.13e-06). CONCLUSIONS This study reveals the biological mechanisms underlying hepatic metastases in colorectal cancer and will help in developing targeted therapies for colorectal cancer.
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Affiliation(s)
- J Yang
- Department of Premedicine, School of Medicine, Pusan National University, Yangsan, South Korea.
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Schieda N, van der Pol CB, Walker D, Tsampalieros AK, Maralani PJ, Woo S, Davenport MS. Adverse Events to the Gadolinium-based Contrast Agent Gadoxetic Acid: Systematic Review and Meta-Analysis. Radiology 2020; 297:565-572. [DOI: 10.1148/radiol.2020200073] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Kim TH, Woo S, Han S, Suh CH, Ghafoor S, Hricak H, Vargas HA. The Diagnostic Performance of the Length of Tumor Capsular Contact on MRI for Detecting Prostate Cancer Extraprostatic Extension: A Systematic Review and Meta-Analysis. Korean J Radiol 2020; 21:684-694. [PMID: 32410407 PMCID: PMC7231615 DOI: 10.3348/kjr.2019.0842] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/06/2020] [Accepted: 02/09/2020] [Indexed: 01/23/2023] Open
Affiliation(s)
- Tae Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Naval Pohang Hospital, Pohang, Korea
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Sangwon Han
- Department of Nuclear Medicine, Armed Forces Daejeon Hospital, Daejeon, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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Woo S, Panebianco V, Narumi Y, Giudice FD, Muglia VF, Takeuchi M, Ghafoor S, Bochner BH, Goh AC, Hricak H, Catto JWF, Vargas HA. Corrigendum to 'Diagnostic Performance of Vesical Imaging Reporting and Data System for the Prediction of Muscle-invasive Bladder Cancer: A Systematic Review and Meta-analysis' [European Urology Oncology 3 (2020) 306-315]. Eur Urol Oncol 2020; 3:S2588-9311(20)30168-1. [PMID: 34756363 DOI: 10.1016/j.euo.2020.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Valeria Panebianco
- Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Yoshifumi Narumi
- Departments of Radiology and Health Science, Kyoto Tachibana University, Kyoto, Japan
| | - Francesco Del Giudice
- Department of Radiological, Oncological and Anatomopathological Sciences, "Sapienza" Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Valdair F Muglia
- Imaging Division, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Bernard H Bochner
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alvin C Goh
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
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Woo S, Ghafoor S, Becker AS, Han S, Wibmer AG, Hricak H, Burger IA, Schöder H, Vargas HA. Prostate-specific membrane antigen positron emission tomography (PSMA-PET) for local staging of prostate cancer: a systematic review and meta-analysis. Eur J Hybrid Imaging 2020; 4:16. [PMID: 34191215 PMCID: PMC8218057 DOI: 10.1186/s41824-020-00085-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022] Open
Abstract
Purpose Prostate-specific membrane antigen positron emission tomography (PSMA-PET) has shown promise for detecting nodal and distant prostate cancer (PCa) metastases. However, its performance for local tumor staging is not as well established. The purpose of this study was to review the diagnostic performance of PSMA-PET for determining seminal vesical invasion (SVI) and extraprostatic extension (EPE). Methods Pubmed and Embase databases were searched until January 12, 2020. Studies assessing accuracy of PSMA-PET in determining SVI and EPE were included. Study quality was evaluated with the revised Quality Assessment of Diagnostic Accuracy Studies-2 tool. Pooled sensitivity and specificity were calculated using hierarchical summary receiver operating characteristics modeling. Heterogeneity was explored using meta-regression analyses for anatomical imaging component (MRI vs CT) and by testing for a threshold effect. Results Twelve studies (615 patients) were included. Pooled sensitivity and specificity were 0.68 (95% CI 0.53-0.81) and 0.94 (95% CI 0.90-0.96) for SVI and 0.72 (95% CI 0.56-0.84) and 0.87 (95% CI 0.72-0.94) for EPE. Meta-regression analyses showed that for SVI, PET/MRI demonstrated greater sensitivity than PET/CT (0.87 [95% CI 0.75-0.98] vs 0.60 [95% CI 0.47-0.74]; p = 0.02 for joint model) while specificity was comparable (0.91 [95% CI 0.84-0.97] vs. 0.96 [95% CI 0.93-0.99]) but not for EPE (p = 0.08). A threshold effect was present for studies assessing EPE (correlation coefficient = 0.563 [95% CI, −0.234-0.908] between sensitivity and false-positive rate). Conclusion PSMA-PET has moderate sensitivity and excellent specificity for assessing local tumor extent in patients with PCa. PET/MRI showed potential for greater sensitivity than PET/CT in assessing SVI.
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Affiliation(s)
- Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Anton S Becker
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Korea
| | - Andreas G Wibmer
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Irene A Burger
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Zürich, Switzerland.,Department of Nuclear Medicine, Kantonsspital Baden, Baden, Switzerland
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Han S, Woo S, Kim YI, Yoon DH, Ryu JS. Prognostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in newly diagnosed multiple myeloma: a systematic review and meta-analysis. Eur Radiol 2020; 31:152-162. [PMID: 32809165 DOI: 10.1007/s00330-020-07177-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/18/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We performed a systematic review and meta-analysis on the prognostic values of 18F-FDG PET/CT in patients with newly diagnosed multiple myeloma (MM). METHODS PubMed and Embase were searched until July 10, 2019, for studies that reported the prognostic significance of 18F-FDG PET in patients with newly diagnosed MM, with overall (OS) and progression-free survival (PFS) included as outcomes. Hazard ratios (HRs) and their 95% confidence intervals (CIs) were meta-analytically pooled using a random-effects model. RESULTS Fifteen studies (1670 patients) were included for qualitative synthesis. Among multiple PET parameters, the presence of extramedullary disease (EMD), more than three focal lesions (FLs), and high FDG uptake were widely evaluated and significantly associated with shorter OS and PFS in most of the included studies. Among 11 studies included in quantitative synthesis, the overall HRs of EMD, more than three FLs, and high FDG uptake on PFS were 2.12 (95% CI, 1.52-2.96), 2.38 (95% CI, 1.84-3.07), and 2.02 (95% CI, 1.51-2.68), respectively. The pooled HRs of those three parameters on OS were 2.37 (95% CI, 1.77-3.16), 3.29 (95% CI, 2.38-4.56), and 2.28 (95% CI, 1.67-3.13). No statistical differences were found across parameters for either PFS (p = 0.6822) or OS (p = 0.2147). CONCLUSIONS Pretreatment 18F-FDG PET/CT is a significant predictor for disease progression and survival in patients with MM. It may be a useful prognostic biomarker capable of accurate risk stratification and application in clinical decision-making for newly diagnosed MM. KEY POINTS • There remain unmet clinical needs for reliable prognostic biomarkers in patients with newly diagnosed multiple myeloma. • This meta-analysis shows that the presence of extramedullary disease, more than three focal lesions, and high FDG uptake from baseline 18F-FDG PET are significant prognostic factors. • These imaging biomarkers might help the accurate stratification of patient prognosis which is required for choosing an appropriate therapeutic strategy in clinical practice.
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Affiliation(s)
- Sangwon Han
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yong-Il Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Dok Hyun Yoon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
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Nam H, Kim J, Woo S, Park S, Lee H, Jang H, Park† K, Suh† S. 0971 Mother’s Parenting Style As A Moderator In The Relationship Between Temperament And Sleep Problems In Children With Obesity. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Based on past studies, a child’s temperament and parenting style greatly affect a child’s sleep. However, there are limited studies that have investigated how parenting styles and a child’s temperament interact and affect the child’s sleep in obese children. Thus, this study investigated parenting styles as a moderator in the relationship between temperament and sleep in obese children.
Methods
Seventy-seven obese children (male=66.2%, average BMI = 27.35±2.78) participated in the study. The mean age of the participants was 10.82(± 1.00) years. The primary caregiver (mother) of the participants completed the Junior Temperament and Character Inventory (J-TCI), and Parents as Social Context Questionnaire (K-PSCQ), and Children’s Sleep Habits Questionnaire (CSHQ). Among the different subscales, only Novelty Seeking (NS) and Reward Dependence (RD) were used for analysis among Junior Temperament and Character Inventory (J-TCI) components.
Results
In this sample, 66 children (85.7%) reported significant levels of sleep problems based on the CSHQ. Novelty seeking (NS) and reward dependence (RD) significantly predicted sleep problems (B=-.771, p<.05, B=-.683, p<.01). Additionally, mother’s negative parenting style moderated the relationship between NS and the child’s sleep problem [B=.03, 95% CI=.007, .049] and the relationship between RD and the child’s sleep problem [B=.031, 95% CI=.013, .049]. The more negative mother’s parenting style, the higher the child’s NS or RD scores had a negative effect on sleep.
Conclusion
The results of this study show that obese children experience high levels of sleep disturbance. Additionally, the mother’s negative parenting style moderated the relationship between temperament and sleep problems in obese children. The results suggest that sleep interventions for obese children should include the mother, especially in children with high novelty seeking and reward dependence.
Support
This work was supported by Korea Centers for Disease Control and Prevention & Korea National Research Institute of Health (2019020660E-00)
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Affiliation(s)
- H Nam
- SUNGSHIN WOMEN’S UNIVERSITY, Seoul, KOREA, REPUBLIC OF
| | - J Kim
- SUNGSHIN WOMEN’S UNIVERSITY, Seoul, KOREA, REPUBLIC OF
| | - S Woo
- Department of Medical Science, Hallym University School of Medicine, Chuncheon, KOREA, REPUBLIC OF
| | - S Park
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk, KOREA, REPUBLIC OF
| | - H Lee
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk, KOREA, REPUBLIC OF
| | - H Jang
- Center for Biomedical Sciences, Korea National Institute of Health, Cheongju, Chungbuk, KOREA, REPUBLIC OF
| | - K Park†
- Department of Family Medicine, Hallym University Sacred Heart Hospital, Hallym University School of Medicine, Anayng, KOREA, REPUBLIC OF
| | - S Suh†
- SUNGSHIN WOMEN’S UNIVERSITY, Seoul, KOREA, REPUBLIC OF
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