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Isharwal S, Mithqal A, Wu Y, Tandon YK. Fat Containing Inguinal Canal Mass: Thinking Beyond Inguinal Hernia. Am J Med Sci 2024:S0002-9629(24)01166-2. [PMID: 38608724 DOI: 10.1016/j.amjms.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/14/2024]
Affiliation(s)
- Sumit Isharwal
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA.
| | - Ayman Mithqal
- Department of Radiology, University of Virginia, Charlottesville, Virginia, USA
| | - Yubo Wu
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
| | - Yasmeen K Tandon
- Department of Radiology, Mayo Clinic, Jacksonville, Florida, USA
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2
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Isharwal S, Khot R, Wu Y, Berger BM, Tandon YK. Serous borderline ovarian epithelial type tumor of the testis. Int Urol Nephrol 2024:10.1007/s11255-024-04001-z. [PMID: 38411792 DOI: 10.1007/s11255-024-04001-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 02/28/2024]
Affiliation(s)
- Sumit Isharwal
- Department of Urology, University of Virginia, Charlottesville, VA, 22908-0422, USA.
| | - Rachita Khot
- Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | - Yubo Wu
- Department of Pathology, University of Virginia, Charlottesville, VA, USA
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Wei W, Zhou H, He H, Lin H, Tandon YK, Jaykel TJ, Chen X, Wang PY, Liu SY, Wang F. Right middle pulmonary vein classification by 3D-CT reconstruction and its clinical significance. J Thorac Dis 2023; 15:6868-6878. [PMID: 38249860 PMCID: PMC10797407 DOI: 10.21037/jtd-23-1560] [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: 10/07/2023] [Accepted: 12/01/2023] [Indexed: 01/23/2024]
Abstract
Background A profound understanding of the type of right middle lobe (RML) vein return is crucial for thoracic surgeons to ensure safe anatomic lung resection. In this study, the type of venous return in the RML and its clinical significance were analyzed using the 3D computed tomography (3D-CT) reconstruction technique. Methods This retrospective study analyzed the patients who underwent anatomical lobectomy or anatomical lung segment resection with preoperative 3D-CT reconstruction at the Department of Thoracic Oncology Surgery, Fujian Cancer Hospital from January 2020 to October 2022. The exclusion criteria were as follows: (I) blurred CT images and inadequate IQQA 3D reconstruction for clear visualization of bronchial and vascular subsegmental branches; (II) patients with a previous history of right middle lobectomy; (III) incomplete medical records. Results This study included 608 eligible cases, 245 males (40.30%) and 363 females (59.70%), with an average age of 58.61 years. We identified four major types of RML venous return, including 407 cases (66.94%) of central vein type, 123 cases (20.23%) of isolated vein type, 11 cases (1.81%) of basal vein type, and 67 cases (11.02%) of combined vein type. Furthermore, the central venous type comprised four subtypes: 191 cases (27.3%) had one branch, 165 cases (27.14%) had two branches, 43 cases (7.07%) had three branches, and 8 cases (1.32%) had more than three branches. The combined venous type includes four subtypes: combination type A (n=37 cases, 6.09%), combination type B (n=7 cases, 1.15%), combination type C (n=21 cases, 3.45%), and combination type D (n=2 cases, 0.33%). Conclusions Based on 3D-CT reconstruction, numerous types of venous return in the RML were found, highlighting the significance of 3D-CT reconstruction for thoracic surgeons. It plays a crucial role in understanding the type of RML venous return prior to surgery, providing invaluable information to ensure surgical safety and success.
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Affiliation(s)
- Wenwei Wei
- Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China
- Fujian Key Laboratory of Translational Cancer Medicine, Fuzhou, China
- Fujian Provincial Key Laboratory of Tumor Biotherapy, Fuzhou, China
| | - Hang Zhou
- Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Hao He
- Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Hui Lin
- Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | | | | | - Xiaofeng Chen
- Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Pei-Yuan Wang
- Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Shuo-Yan Liu
- Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China
| | - Feng Wang
- Department of Thoracic Oncology Surgery, Fujian Cancer Hospital, Clinical Oncology School of Fujian Medical University, Fuzhou, China
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Isharwal S, Tandon YK. Active surveillance for large renal angiomyolipoma. Am J Med Sci 2023; 366:e51-e52. [PMID: 37156460 DOI: 10.1016/j.amjms.2023.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 01/17/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Affiliation(s)
- Sumit Isharwal
- Department of Urology, University of Virginia, Charlottesville, VA 22908-0422, USA.
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5
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Isharwal S, Ayers E, Khot R, Gupta S, Devitt M, Tandon YK. An Unusual Renal Mass: Thinking Beyond Renal Cell Carcinoma. Urology 2023; 176:e5-e7. [PMID: 36948360 DOI: 10.1016/j.urology.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/15/2023] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Sumit Isharwal
- Department of Urology, University of Virginia, Charlottesville, VA.
| | - Emily Ayers
- Department of Medicine, University of Virginia, Charlottesville, VA
| | - Rachita Khot
- Department of Radiology, University of Virginia, Charlottesville, VA
| | - Srishti Gupta
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Michael Devitt
- Department of Medicine, University of Virginia, Charlottesville, VA
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6
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Isharwal S, Khot R, Gupta S, Tandon YK. Testicular cavernous hemangioma masquerading as testicular malignancy. J Clin Ultrasound 2023; 51:898-900. [PMID: 36385617 DOI: 10.1002/jcu.23399] [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] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/09/2022] [Accepted: 11/10/2022] [Indexed: 06/02/2023]
Abstract
Cavernous hemangiomas are benign tumors of vascular origin that can develop in any part of the body. However, its occurrence in the testis is rare. To the best of our knowledge, we are reporting the first case of a patient with cavernous hemangioma with concern for an extracapsular extension on ultrasound imaging.
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Affiliation(s)
- Sumit Isharwal
- Department of Urology, University of Virginia, Charlottesville, Virginia, USA
| | - Rachita Khot
- Department of Radiology, University of Virginia, Charlottesville, Virginia, USA
| | - Srishti Gupta
- Department of Pathology, University of Virginia, Charlottesville, Virginia, USA
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7
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Moura MC, Baqir M, Tandon YK, Samec MJ, Hines AS, Reichard KK, Mangaonkar AA, Go RS, Warrington KJ, Patnaik MM, Koster MJ, Ryu JH. Pulmonary manifestations in VEXAS syndrome. Respir Med 2023; 213:107245. [PMID: 37062498 DOI: 10.1016/j.rmed.2023.107245] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome is a recently recognized multisystem disorder caused by somatic mutations in the UBA1 gene. METHODS A retrospective cohort study was conducted on all patients with VEXAS syndrome evaluated at our institution from June 2020 through May 2022. Medical records and chest imaging studies were reviewed. RESULTS We identified 45 subjects with median age of 68 years (range, 57-89), all men. Prior to VEXAS diagnosis, most patients had been diagnosed with various hematologic, rheumatologic, and dermatologic disorders. Most patients (84%) demonstrated canonical UBA1 methionine-41 (p.Met41) somatic mutations in hematopoietic cells. Fever (82%), skin lesions (91%), and respiratory symptoms (93%) were common presenting features. Chest CT manifested abnormalities in 91% of patients including parenchymal opacities in 25 (74%), most commonly ground-glass opacities (47%), along with mediastinal lymphadenopathy (29%), airway abnormalities (29%), and pleural effusion (24%). Pulmonary function test results available in 18 (40%) patients demonstrated mild restrictive impairment or normal results. Bronchoalveolar lavage and lung biopsy performed in a minority of patients demonstrated neutrophilic alveolitis and parenchymal inflammation, respectively. All patients received glucocorticoid therapy with at least partial response, but relapses were common and other immunosuppressive agents were employed in most patients. Pulmonary involvement appeared to improve in patients who received tocilizumab and JAK inhibitors. CONCLUSION The pulmonary manifestations in VEXAS are relatively nonspecific and nonsevere, occur in the context of systemic inflammation and are responsive to escalation in glucocorticoid dosing.
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Affiliation(s)
- Marta Casal Moura
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Yasmeen K Tandon
- Department of Radiology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Matthew J Samec
- Division of Rheumatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Alexander S Hines
- Division of Dermatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Kaaren K Reichard
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Abhishek A Mangaonkar
- Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Ronald S Go
- Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mrinal M Patnaik
- Division of Hematology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Mathew J Koster
- Division of Rheumatology, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Isharwal S, Gupta S, Tandon YK, Krupski TL. Air Outlining the Renal System. Am J Med 2023; 136:e98-e99. [PMID: 36740209 DOI: 10.1016/j.amjmed.2023.01.020] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 02/05/2023]
Affiliation(s)
- Sumit Isharwal
- Department of Urology, University of Virginia, Charlottesville, VA.
| | - Srishti Gupta
- Department of Pathology, University of Virginia, Charlottesville, VA
| | | | - Tracey L Krupski
- Department of Urology, University of Virginia, Charlottesville, VA
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Kennady EH, Tandon YK, Mithqal A, Isharwal S. A rare presentation of unilateral periureteral renal lymphangiomatosis. J Clin Imaging Sci 2022; 12:65. [PMID: 36601601 PMCID: PMC9805599 DOI: 10.25259/jcis_125_2022] [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: 10/17/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Renal lymphangiomatosis is a rare developmental malformation of the perirenal lymphatic system. We report a unique case with unilateral massive periureteral involvement in addition to intrarenal and peripelvic lymphangiomatosis. Although this is a rare entity, it should be considered in patients with peripelvic or periureteric cystic lesions as it may affect appropriate management and follow-up. This case report reviews the imaging features of this entity and a comprehensive literature review and discussion about the entity will be provided.
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Affiliation(s)
- Emmett H. Kennady
- Department of Urology, University of Virginia, Charlottesville, Virginia, United States
| | - Yasmeen K. Tandon
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, United States
| | - Ayman Mithqal
- Department of Radiology, University of Virginia, Charlottesville, Virginia, United States
| | - Sumit Isharwal
- Department of Urology, University of Virginia, Charlottesville, Virginia, United States,Corresponding author: Sumit Isharwal, Department of Urology, University of Virginia, Charlottesville, Virginia, United States.
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10
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Kirby KM, Ren L, Daly TR, Tandon YK, Bartholmai BJ, Schueler BA, Long Z. Impact of flexible noise control (FNC) image processing parameters on portable chest radiography. J Appl Clin Med Phys 2022; 23:e13812. [PMID: 36321326 PMCID: PMC9797169 DOI: 10.1002/acm2.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/28/2022] [Indexed: 12/29/2022] Open
Abstract
There is a lack of understanding in the performance of flexible noise control (FNC) processing, which is used in digital radiography on a scanner vendor and has four parameters each involving multiple options. The aim of this study was to investigate the impact of FNC on portable chest imaging. An anthropomorphic chest phantom was imaged using a clinical chest program with 85 kV and five radiation dose levels at 40″ source-to-image distance with software-based scatter reduction method. All images were processed without and with FNC. Noise analysis was performed in two regions of interest (ROI) on subtracted noise-only images, and line profiles were generated through a lung-rib interface. In addition, noise power spectra (NPS) analysis was performed in solid water phantoms of 10 and 20 cm thicknesses, using the same acquisition program and a range of dose levels. Last, feedback on retrospectively deidentified, reprocessed, and randomized clinical images from 20 portable chest exams was gathered from two thoracic radiologists. Noise reduction performances of FNC were demonstrated, with the level depending on specific FNC parameters, dose levels, ROI placement, and phantom sizes. Higher frequency textural patterns were revealed through the NPS analysis, which varied based on FNC parameters, dose levels, and phantom sizes. Overall, the vendor default parameter FGA0.5 yielded the highest noise reduction and textural artifacts. Radiologist feedback showed consistent preference of no FNC due to the presence of textural artifacts in the FNC-processed images. An algorithm improvement to avoid introducing artifacts would be desired.
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Affiliation(s)
| | - Liqiang Ren
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
| | | | | | | | | | - Zaiyang Long
- Department of RadiologyMayo ClinicRochesterMinnesotaUSA
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11
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Li Y, Zheng X, Xie F, Ye L, Bignami E, Tandon YK, Rodríguez M, Gu Y, Sun J. Development and validation of the artificial intelligence (AI)-based diagnostic model for bronchial lumen identification. Transl Lung Cancer Res 2022; 11:2261-2274. [PMID: 36519015 PMCID: PMC9742630 DOI: 10.21037/tlcr-22-761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 08/16/2022] [Accepted: 11/08/2022] [Indexed: 08/29/2023]
Abstract
BACKGROUND Bronchoscopy is a key step in the diagnosis and treatment of respiratory diseases. However, the level of expertise varies among different bronchoscopists. Artificial intelligence (AI) may help them identify bronchial lumens. Thus, a bronchoscopy quality-control system based on AI was built to improve the performance of bronchoscopists. METHODS This single-center observational study consecutively collected bronchoscopy videos from Shanghai Chest Hospital and segmented each video into 31 different anatomical locations to develop an AI-assisted system based on a convolutional neural network (CNN) model. We then designed a single-center trial to compare the accuracy of lumen recognition by bronchoscopists with and without the assistance of the AI system. RESULTS A total of 28,441 qualified images of bronchial lumen were used to train the CNNs. In the cross-validation set, the optimal accuracy of the six models was between 91.83% and 96.62%. In the test set, the visual geometry group 16 (VGG-16) achieved optimal performance with an accuracy of 91.88%, and an area under the curve of 0.995. In the clinical evaluation, the accuracy rate of the AI system alone was 54.30% (202/372). For the identification of bronchi except for segmental bronchi, the accuracy was 82.69% (129/156). In group 1, the recognition accuracy rates of doctors A, B, a and b alone were 42.47%, 34.68%, 28.76%, and 29.57%, respectively, but increased to 57.53%, 54.57%, 54.57%, and 46.24% respectively when combined with the AI system. Similarly, in group 2, the recognition accuracy rates of doctors C, D, c, and d were 37.90%, 41.40%, 30.91%, and 33.60% respectively, but increased to 51.61%, 47.85%, 53.49%, and 54.30% respectively, when combined with the AI system. Except for doctor D, the accuracy of doctors in recognizing lumen was significantly higher with AI assistance than without AI assistance, regardless of their experience (P<0.001). CONCLUSIONS Our AI system could better recognize bronchial lumen and reduce differences in the operation levels of different bronchoscopists. It could be used to improve the quality of everyday bronchoscopies.
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Affiliation(s)
- Ying Li
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Xiaoxuan Zheng
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Fangfang Xie
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Lin Ye
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
| | - Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - María Rodríguez
- Department of Thoracic Surgery, Clínica Universidad de Navarra, Madrid, Spain
| | - Yun Gu
- Institute of Medical Robotics, Shanghai Jiao Tong University, Shanghai, China
- Institute of Image Processing and Pattern Recognition, Shanghai Jiao Tong University, Shanghai, China
| | - Jiayuan Sun
- Department of Respiratory Endoscopy, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Department of Respiratory and Critical Care Medicine, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Engineering Research Center of Respiratory Endoscopy, Shanghai, China
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12
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Tandon YK, Walkoff L. Imaging Patterns in Occupational Lung Disease—When Should I Consider? Radiol Clin North Am 2022; 60:979-992. [DOI: 10.1016/j.rcl.2022.06.011] [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: 11/26/2022]
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13
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Qin W, Ge J, Gong Z, Zhang Y, DiBardino DM, Imperatori A, Tandon YK, Yanagiya M, Yao F, Qiu Y. The incidence and risk factors of acute pain after preoperative needle localization of pulmonary nodules: a cross-sectional study. Transl Lung Cancer Res 2022; 11:1667-1677. [PMID: 36090632 PMCID: PMC9459605 DOI: 10.21037/tlcr-22-557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/11/2022] [Indexed: 11/23/2022]
Abstract
Background The incidence, severity and associated risk factors of acute pain after preoperative needle localization of pulmonary nodules are poorly characterized. We therefore conducted a cross-sectional study to quantify the acute pain induced by preoperative needle localization of small pulmonary nodules before video-assisted thoracoscopic surgery (VATS). Methods We conducted this study at Shanghai Chest Hospital from September 2021 through December 2021. Eligible patients were between 18 and 75 years old and had small pulmonary nodules requiring preoperative CT-guided needle localization. The intensity of acute pain was assessed using the visual analogue scale (VAS) after preoperative needle localization. A VAS score ≥4 cm indicated moderate to severe pain. Patient demographics and CT-guided localization factors were collected to identify significant predictors associated with moderate to severe pain. Results A total of 300 patients were included in the final analysis, with a mean (SD) age of 51 (SD =12) years old; 63% were female. Moderate to severe pain occurred in 50.8% of patients during deep breathing and 45.7% of patients during movement. Multivariate logistic regression analysis showed that multiple localization needles [multiple needle localizations vs. single needle localization, odds ratio (OR): 2.363, 95% confidence interval (CI): 1.157–4.825, P=0.018] and the specific location of needle puncture on the chest wall were significant predictors of moderate to severe pain after CT-guided needle localization (lateral chest wall vs. anterior chest wall OR: 2.235, 95% CI: 1.106–4.518, P=0.025; posterior chest wall vs. anterior chest wall OR: 1.198, 95% CI: 0.611–2.349, P=0.599). Conclusions In adult patients receiving hookwire CT-guided localization, moderate to severe pain was common. Avoiding the localization route through lateral chest wall may be helpful and pharmacological medications or regional blockade is necessitated in high-risk population.
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Affiliation(s)
- Wen Qin
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Ge
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Zhihao Gong
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yunyun Zhang
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - David M. DiBardino
- Section of Interventional Pulmonology, Division of Pulmonary, Allergy and Critical Care Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Masahiro Yanagiya
- Department of Thoracic Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Feng Yao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yuwei Qiu
- Department of Anesthesiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
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14
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Baqir M, Peikert T, Johnson TF, Tandon YK, Yi ES, Schroeder DR, Ryu JH. Idiopathic Chronic Eosinophilic Pneumonia Evolving to Pulmonary Fibrosis: A Retrospective Analysis. Sarcoidosis Vasc Diffuse Lung Dis 2022; 39:e2022020. [PMID: 36118537 PMCID: PMC9437755 DOI: 10.36141/svdld.v39i2.12656] [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] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Patients with idiopathic chronic eosinophilic pneumonia (ICEP) may have pulmonary fibrosis. OBJECTIVES To investigate the predictors of pulmonary fibrosis in ICEP, to describe the timeline of pulmonary fibrosis after ICEP diagnosis, and to detail the radiologic pattern of fibrosis. METHODS A retrospective computer-assisted search was performed to identify patients with ICEP seen at Mayo Clinic in Rochester, Minnesota, from January 1, 1997, through September 1, 2019. Patients with follow-up chest computed tomography (CT) beyond 12 months after the ICEP diagnosis were included in the study. Demographic, clinical, radiologic, and histopathologic characteristics were analyzed. Proportional hazards regression was used to assess the predictors of pulmonary fibrosis. RESULTS We identified 62 patients (mean [SD] age at ICEP diagnosis, 60 [13] years; female sex, 37 [60%]). Cough (87%) and shortness of breath (85%) were the most common presenting symptoms. Of patients, 27 (44%) had a history of smoking and 27 (44%) had a history of asthma. During follow-up, 23 patients (37%) had CT evidence of pulmonary fibrosis, of whom 16 patients (70%) had a CT pattern inconsistent with usual interstitial pneumonia. In 29% of the patients, the CT evidence of pulmonary fibrosis developed within 2 years after ICEP. Age and male sex were predictors of pulmonary fibrosis. Of note, a history of asthma decreased the likelihood of pulmonary fibrosis. CONCLUSIONS Development of pulmonary fibro-sis is not uncommon in patients with ICEP, especially older men, and is associated with increased risk of death.
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Affiliation(s)
- Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, USA
| | - Tobias Peikert
- Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, USA
| | | | | | - Eunhee S. Yi
- Division of Anatomic Pathology, Rochester, Minnesota, USA
| | - Darrell R. Schroeder
- Division of Clinical Trial and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Rochester, Minnesota, USA
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Malyuk DF, François CJ, Tandon YK. Pulmonary Artery Dissection: A Fatal Complication of Pulmonary Artery Aneurysm. Radiol Cardiothorac Imaging 2022; 4:e210144. [PMID: 35833163 PMCID: PMC9274309 DOI: 10.1148/ryct.210144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 05/12/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
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Deng J, Zhao M, Li Q, Zhang Y, Ma M, Li C, Wang J, She Y, Jiang Y, Zhang Y, Wang T, Wu C, Hou L, Zhong S, Jin S, Qian D, Xie D, Zhu Y, Tandon YK, Snoeckx A, Jin F, Yu B, Zhao G, Chen C. Implementation of artificial intelligence in the histological assessment of pulmonary subsolid nodules. Transl Lung Cancer Res 2021; 10:4574-4586. [PMID: 35070762 PMCID: PMC8743520 DOI: 10.21037/tlcr-21-971] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022]
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Jiajun Deng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Mengmeng Zhao
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yikai Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Minjie Ma
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Chuanyi Li
- Department of Thoracic Surgery, Nantong No. 6 People’s Hospital, Nantong, China
| | - Jun Wang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yunlang She
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yan Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunzeng Zhang
- Department of Thoracic Surgery, Shandong Public Health Clinical Center, Jinan, China
| | - Tingting Wang
- Department of Radiology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chunyan Wu
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Likun Hou
- Department of Pathology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | | | | | - Dahong Qian
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Dong Xie
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuming Zhu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | | | - Annemiek Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Feng Jin
- Provincial Key Laboratory for Respiratory Infectious Diseases in Shandong, Shandong Provincial Chest Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Bentong Yu
- Department of Thoracic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Guofang Zhao
- Department of Cardiothoracic Surgery, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China
- Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
- Department of Thoracic Surgery, The First Hospital of Lanzhou University, Lanzhou, China
- The International Science and Technology Cooperation Base for Development and Application of Key Technologies in Thoracic Surgery, Lanzhou, China
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Yang M, Yang Y, Chen J, Stella GM, Um SW, Tandon YK, Liu H. A case report of primary signet ring cell carcinoma of the lung: imaging study and literature review. Transl Lung Cancer Res 2021; 10:3840-3849. [PMID: 34733632 PMCID: PMC8512459 DOI: 10.21037/tlcr-21-654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 09/15/2021] [Indexed: 12/18/2022]
Abstract
Signet ring cell carcinoma (SRCC) is a subtype of adenocarcinoma with characteristics of strong invasion and a poor prognosis. While it can occur in various organs, including the stomach, colon, esophagus, bladder, prostate, pancreas, and breast, primary lung SRCC is rare, and most SRCC found there are from gastrointestinal metastasis. Reports on primary lung SRCC are few and the aim of this study is to describe the imaging, histopathological, and immunohistochemical characteristics of a case of primary lung SRCC in our hospital. A 68-year-old female with no smoking history was admitted with recurrent cough, chest pain, and dyspnea of 2 months duration. Computed tomographic (CT) chest showed multiple solids nodules of different sizes and mass in the left upper lobe, lower lobe, and subpleural region. Multiple enlarged lymph nodes were seen in the mediastinum and left hilum. The aim of this paper is to improve the understanding of this tumor. A literature review identified 15 cases of primary lung SRCC with available CT imaging. Except for two patients with multiple ground glass nodules and multiple small nodules, the rest were solid, and ranged in size from 1.0 to 8 cm. Only one patient had a cavity in the solid lesion. Immunohistochemical stains for thyroid transcription factor-1 (TTF-1) (13/13) and CK7 (12/12) showed positive reaction in all cases evaluated, and napsin A (3/4) were also positive, while all cases including CK20 (12/12) and CDX2 (6/6) were negative.
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Affiliation(s)
- Mingguang Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China.,Medical Imaging Department, Chongqing University Central Hospital, Chongqing, China
| | - Yanli Yang
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jing Chen
- Department of Pathology, Chongqing University Central Hospital, Chongqing, China
| | - Giulia M Stella
- Department of Medical Sciences and Infective Diseases, Unit of Respiratory Diseases, IRCCS Policlinico San Matteo Foundation and University of Pavia Medical School, Pavia, Italy
| | - Sang-Won Um
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Heng Liu
- Department of Radiology, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Bratt A, Blezek DJ, Ryan WJ, Philbrick KA, Rajiah P, Tandon YK, Walkoff LA, Cai JC, Sheedy EN, Korfiatis P, Williamson EE, Erickson BJ, Collins JD. Deep Learning Improves the Temporal Reproducibility of Aortic Measurement. J Digit Imaging 2021; 34:1183-1189. [PMID: 34047906 DOI: 10.1007/s10278-021-00465-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 04/23/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022] Open
Abstract
Imaging-based measurements form the basis of surgical decision making in patients with aortic aneurysm. Unfortunately, manual measurement suffer from suboptimal temporal reproducibility, which can lead to delayed or unnecessary intervention. We tested the hypothesis that deep learning could improve upon the temporal reproducibility of CT angiography-derived thoracic aortic measurements in the setting of imperfect ground-truth training data. To this end, we trained a standard deep learning segmentation model from which measurements of aortic volume and diameter could be extracted. First, three blinded cardiothoracic radiologists visually confirmed non-inferiority of deep learning segmentation maps with respect to manual segmentation on a 50-patient hold-out test cohort, demonstrating a slight preference for the deep learning method (p < 1e-5). Next, reproducibility was assessed by evaluating measured change (coefficient of reproducibility and standard deviation) in volume and diameter values extracted from segmentation maps in patients for whom multiple scans were available and whose aortas had been deemed stable over time by visual assessment (n = 57 patients, 206 scans). Deep learning temporal reproducibility was superior for measures of both volume (p < 0.008) and diameter (p < 1e-5) and reproducibility metrics compared favorably with previously reported values of manual inter-rater variability. Our work motivates future efforts to apply deep learning to aortic evaluation.
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Affiliation(s)
- Alex Bratt
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA.
| | - Daniel J Blezek
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - William J Ryan
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - Kenneth A Philbrick
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - Prabhakar Rajiah
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - Yasmeen K Tandon
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - Lara A Walkoff
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - Jason C Cai
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - Emily N Sheedy
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | | | - Eric E Williamson
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - Bradley J Erickson
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
| | - Jeremy D Collins
- Department of Radiology, Mayo Clinic, 200 1stSt SW, Rochester, MN, 55902, USA
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Kanwar SS, Downey SA, Tandon YK. An Unusual Case of Lung Consolidation: Thinking Beyond Pneumonia. Am J Med 2021; 134:477-481. [PMID: 32997979 DOI: 10.1016/j.amjmed.2020.08.029] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 11/19/2022]
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Abstract
Lung cancer remains the leading cause of cancer related death world-wide despite advances in treatment. This largely relates to the fact that many of these patients already have advanced diseases at the time of initial diagnosis. As most lung cancers present as nodules initially, an accurate classification of pulmonary nodules as early lung cancers is critical to reducing lung cancer morbidity and mortality. There have been significant recent advances in artificial intelligence (AI) for lung nodule evaluation. Deep learning (DL) and convolutional neural networks (CNNs) have shown promising results in pulmonary nodule detection and have also excelled in segmentation and classification of pulmonary nodules. This review aims to provide an overview of progress that has been made in AI recently for pulmonary nodule detection and characterization with the ultimate goal of lung cancer prediction and classification while outlining some of the pitfalls and challenges that remain to bring such advancements to routine clinical use.
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Affiliation(s)
| | | | - Chi Wan Koo
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
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21
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Abstract
Splenosis is a benign condition that can occur after splenic trauma or after surgery involving the spleen. These splenic implants are most often seen within the abdominal and pelvic cavities. On imaging, splenosis can be confused with multiple additional entities including metastatic disease, peritoneal carcinomatosis, peritoneal mesothelioma, abdominal lymphoma, renal cancer, hepatic adenomas, or endometriosis depending on its distribution. In all patients with history of splenic surgery or trauma, splenosis should be on the differential diagnosis of soft tissue nodules in the abdomen and pelvis, especially in the absence of systemic symptoms, to avoid unnecessary biopsy, chemotherapy, or surgery.
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Affiliation(s)
- Yasmeen K Tandon
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA.
| | - Christopher P Coppa
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA
| | - Andrei S Purysko
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH, 44195, USA
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22
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Tandon YK, Sengodan P, Alappan N, Heresi GA, Tong MZY, Renapurkar RD. Caught in the Act: Thrombus Wedged in a Patent Foramen Ovale. Am J Med 2018; 131:927-930. [PMID: 29630861 DOI: 10.1016/j.amjmed.2018.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 03/15/2018] [Accepted: 03/15/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Yasmeen K Tandon
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio.
| | | | | | - Gustavo A Heresi
- Section of Pulmonary and Critical Care Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Michael Zhen-Yu Tong
- Section of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Rahul D Renapurkar
- Section of Thoracic Imaging, Imaging Institute, Cleveland Clinic, Cleveland, Ohio
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23
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Bhatt KM, Tandon YK, Graham R, Lau CT, Lempel JK, Azok JT, Mazzone PJ, Schneider E, Obuchowski NA, Bolen MA. Electromagnetic Navigational Bronchoscopy versus CT-guided Percutaneous Sampling of Peripheral Indeterminate Pulmonary Nodules: A Cohort Study. Radiology 2017; 286:1052-1061. [PMID: 29156147 DOI: 10.1148/radiol.2017170893] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose To compare the diagnostic yield and complication rates of electromagnetic navigational bronchoscopic (ENB)-guided and computed tomography (CT)-guided percutaneous tissue sampling of lung nodules. Materials and Methods Retrospectively identified were 149 patients sampled percutaneously with CT guidance and 146 patients who underwent ENB with transbronchial biopsy of a lung lesion between 2013 and 2015. Clinical data, incidence of complications, and nodule pathologic analyses were assessed through electronic medical record review. Lung nodule characteristics were reviewed through direct image analysis. Molecular marker studies and pathologic analyses from surgical excision were reviewed when available. Multiple-variable logistic regression models were built to compare the diagnostic yield and complication rates for each method and for different patient and disease characteristics. Results CT-guided sampling was more likely to be diagnostic than ENB-guided biopsy (86.0% [129 of 150] vs 66.0% [99 of 150], respectively), and this difference remained significant even after adjustments were made for patient and nodule characteristics (P < .001). Age, American Society of Anesthesiologists class, emphysema grade, nodule size, and distance from pleura were not significant predictors of increased diagnostic yield. Intraprocedural time for physicians was significantly lower with CT-guided sampling (P < .001). Similar yield for molecular analyses was noted with the two approaches (ENB-guided sampling, 88.9% [32 of 36]; CT-guided sampling, 82.0% [41 of 50]). The two groups had similar rates of major complications (symptomatic hemorrhage, P > .999; pneumothorax requiring chest tube and/or admission, P = .417). Conclusion CT-guided transthoracic biopsy provided higher diagnostic yield in the assessment of peripheral pulmonary nodules than navigational bronchoscopy with a similar rate of clinically relevant complications. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Kavita M Bhatt
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Yasmeen K Tandon
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Ruffin Graham
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Charles T Lau
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Jason K Lempel
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Joseph T Azok
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Peter J Mazzone
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Erika Schneider
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Nancy A Obuchowski
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
| | - Michael A Bolen
- From the Departments of Radiology (K.M.B., Y.K.T., R.G., C.T.L., J.K.L., J.T.A., E.S., M.A.B.), Pulmonology (P.J.M.), and Quantitative Health Sciences (N.A.O.), Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195
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Naffaa LN, Tandon YK, Irani N. Transcranial Doppler screening in sickle cell disease: The implications of using peak systolic criteria. World J Radiol 2015; 7:52-56. [PMID: 25729487 PMCID: PMC4326734 DOI: 10.4329/wjr.v7.i2.52] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 12/25/2014] [Accepted: 01/20/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare time average maximum mean velocity (TAMV) and peak systolic velocity (PSV) criteria of Trans Cranial Doppler (TCD) in their ability to predict abnormalities on magnetic resonance imaging (MRI)/magnetic resonance angiogram (MRA) in patients with sickle cell disease.
METHODS: A retrospective evaluation was performed of the outcomes in all patients with a Transcranial Doppler examination at our institution since the implementation of the hospital picture archiving and communication system (PACS) system in January 2003 through December 2012. All ultrasound imaging exams were performed by the same technologist with a 3 MHz transducer. Inclusion criteria was based upon the Transcranial Doppler procedure code in our PACS which had an indication of sickle cell disease in the history. The patient’s age and gender along with the vessel with the highest time averaged mean velocity as well as the highest peak systolic velocity was recorded for analysis. A subset of the study cohort also had subsequent MR imaging and Angiograms performed within 6 mo of the TCD examination. MRI results were categorized as having a disease related abnormality (vessel narrowing, collateral formation/moya-moya, or abnormal fluid attenuation inversion recovery signal in parenchyma indicative of prior stroke) or normal. The MRI results formed the comparison standards for TCD exams in evaluating intracranial injury. Sensitivity and specificity for the two TCD criteria (TAMV and PSV) were calculated to determine which could be a better predictor for intracranial vasculopathy /clinically occult strokes.
RESULTS: The study cohort for our institution was 110 patients with a total of 291 TCD examinations. These patients had a mean age of 7.6 years with a range from 2-18 years of age. Sixty-two of the 110 patients (56%) had two or more TCD exams. Thirty-seven patients (34%) had at least one MRI following a TCD examination. Of the 291 TCD examinations, 46 (16%) were conditional or abnormal by TAMV criteria. One hundred and sixteen (40%) were conditional or abnormal by PSV criteria. All studies that were abnormal by TAMV were also abnormal by PSV criteria. Seventy of the 116 (60%) studies which were conditional or abnormal by peak systolic criteria would not have been identified by time averaged mean maximum velocity criteria. The most frequent location of highest velocity measurement was noted to be in the middle cerebral artery regardless of whether it was measured by PSV or TAMV. From the 37 patients having one or more MRIs, 43 MRI exams were performed within 6 mo of a TCD examination. Twenty two (51%) MRIs had a disease related abnormality reported. When evaluating conditional or abnormal exams by PSV criteria against follow-up MRI/MRA, the sensitivity was 73% [16/(16 + 6)] and specificity was 81% [17/(4 + 17)]. When evaluating conditional or abnormal exams by TAMV criteria by follow-up MRI/MRA as the gold standard, the sensitivity was 41% [9/(9 + 13)] and the specificity was 100% [21/(21 + 0)]. In using conditional or abnormal criteria from PSV and TAMV to predict abnormalities on follow-up MRI/MR Angiogram, PSV was more sensitive (73% vs 41%) while TAMV was more specific (100% vs 81%).
CONCLUSION: Based on the data obtained at our institution and using the assumption that the best screening test is the one with the highest sensitivity, the peak systolic velocity could be the measurement of choice for TCD screening.
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Tandon YK, Rubin M, Kahlifa M, Doumit G, Naffaa L. Bilateral squamosal suture synostosis: A rare form of isolated craniosynostosis in Crouzon syndrome. World J Radiol 2014; 6:507-510. [PMID: 25071892 PMCID: PMC4109103 DOI: 10.4329/wjr.v6.i7.507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 06/01/2014] [Accepted: 06/16/2014] [Indexed: 02/06/2023] Open
Abstract
Craniosynostosis is a pathologic condition which is characterized by the premature fusion of cranial sutures. It may occur alone or in association with other anomalies making up various syndromes. Crouzon syndrome is the most common craniosynostosis syndrome. Bicoronal sutures fusion is most commonly involved in Crouzon syndrome. There have only been a handful of cases of squamosal suture synostosis described in the surgery literature with the few ones described in Crouzon syndrome associated with other types of craniosynostosis. To the best of our knowledge, we are presenting the first case of isolated bilateral squamosal suture synostosis in a patient with Crouzon syndrome in a radiology journal with emphasis on its radiological appearance.
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Naffaa LN, Tandon YK, Rubin M. Myotendinous rupture of temporalis muscle: A rare injury following seizure. World J Radiol 2014; 6:388-391. [PMID: 24976940 PMCID: PMC4072824 DOI: 10.4329/wjr.v6.i6.388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 04/14/2014] [Accepted: 05/08/2014] [Indexed: 02/06/2023] Open
Abstract
Seizures are one of the most common pediatric neurologic disorders. Many complications secondary to seizures have been described in the literature including head trauma, fractures, drowning and burns. However, to the best of our knowledge, rupture of the myotendinous insertion of the temporalis muscle on the mandible secondary to a seizure has never been described in the literature. We report the case of a unilateral temporalis muscle rupture in a 16-year-old boy who developed unilateral facial swelling following new onset tonic-clonic seizures. We emphasize on the computed tomography and magnetic resonance imaging findings in this case report. Two mechanisms have been proposed to explain such an injury. The favored mechanism in our patient is a pull on the temporalis myotendinous insertion on the mandible following vigorous and brisk deviation of the head and neck during seizure. Radiologists should be familiar with this type of injury following seizures in order to prevent misdiagnosis and subsequently mistreatment.
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Tandon YK, Yang MF, Baron ED. Role of photodynamic therapy in psoriasis: a brief review. Photodermatology, Photoimmunology & Photomedicine 2008; 24:222-30. [DOI: 10.1111/j.1600-0781.2008.00376.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Tandon YK, Somani N, Cevasco NC, Bergfeld WF. A histologic review of 27 patients with lichen planopilaris. J Am Acad Dermatol 2008; 59:91-8. [DOI: 10.1016/j.jaad.2008.03.007] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 02/29/2008] [Accepted: 03/09/2008] [Indexed: 11/15/2022]
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