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Ovarian-Adnexal Reporting and Data Systems MR Imaging: Nuts and Bolts

Melamud, Kira; Hindman, Nicole; Sadowski, Elizabeth
MR imaging plays a key role in the characterization of adnexal lesions of indeterminate malignant potential found at ultrasound. Recently, the Ovarian-Adnexal Reporting and Data Systems (O-RADS) MRI lexicon and scoring system was developed to aid in standardization of reporting and interpretation of adnexal lesions, allowing for risk stratification based on MR imaging findings. This in turn can help improve communication between radiologists and referring providers, and potentially aid the selection of optimal treatment options. This article provides a detailed review of the lexicon and the scoring rubric of the O-RADS MRI risk stratification system.
PMID: 36368864
ISSN: 1557-9786
CID: 5357672

Peripheral vascular lesions in adults referred to MRI/MRA: Multivariable analysis of imaging features to help differentiate benign vascular anomalies from malignancies

Zhao, Ken; Melamud, Kira; Hindman, Nicole
PURPOSE/OBJECTIVE:Symptomatic peripheral vascular lesions in adults are often clinically diagnosed as benign vascular anomalies and may receive MRI/MRA for pre-treatment vascular mapping. Malignant neoplasms are difficult to distinguish from benign vascular anomalies on MRI/MRA. This study was performed to determine if there are imaging signs that can distinguish malignancies from benign vascular anomalies in adults imaged with MRI/MRA. MATERIALS AND METHODS/METHODS:A radiology database was retrospectively searched for ISSVA classification terms in MRI/MRA reports from 1/1/2002-1/1/2019. Adult patients (n = 50, 52 corresponding lesions) with contrast-enhanced MRI/MRA, peripheral soft tissue based lesion (s), and available pathology or long-term (>1 year) imaging follow-up were included. MRI/MRA images were reviewed by 3 readers for the following lesional characteristics: morphology (marginal lobulation, internal septations, distinct soft tissue mass), peri-articular location, T2-weighted characteristics (hyperintensity, heterogeneity, perilesional edema, and adjacent triangular T2-peaks), bulk fat, hemorrhage, enhancement pattern (peripheral, diffuse, or absent), neovascularity, low-flow venous malformation type enhancement, arterial enhancement within 6 s, enhancement curve (progressive, plateau, or washout), measured size, and multifocality. The MRI/MRA features' associated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. To identify factors predictive of malignancy, a two-stage multivariable analysis was performed. RESULTS:23% (12/52) of the lesions, corresponding to 22% (11/50) of the patients, were malignant neoplasms. No single imaging feature reliably predicted malignancy (PPV ≤ 60%). Absence of distinct soft tissue mass excluded malignancy (NPV 100%). Multivariate analysis derived a summary score based on the five strongest predictors of malignancy: adjacent T2 peaks, age ≥ 70 years, distinct soft tissue mass, lesion size ≥ 5 cm, and absence of septations. A score ≥ 3 resulted in sensitivity of 92% and specificity of 85%. CONCLUSION/CONCLUSIONS:Extremity MRI/MRA rarely differentiates malignant from benign soft-tissue vascular tumors in adults. However, MRI/MRA can suggest malignancy when patient age and multiple imaging features are considered. Periodic clinical follow-up after the planned endovascular or operative procedure should be performed to avoid missing a malignancy.
PMID: 35988473
ISSN: 1873-4499
CID: 5312402

Deep Learning Reconstruction Enables Highly Accelerated Biparametric MR Imaging of the Prostate

Johnson, Patricia M; Tong, Angela; Donthireddy, Awani; Melamud, Kira; Petrocelli, Robert; Smereka, Paul; Qian, Kun; Keerthivasan, Mahesh B; Chandarana, Hersh; Knoll, Florian
BACKGROUND:Early diagnosis and treatment of prostate cancer (PCa) can be curative; however, prostate-specific antigen is a suboptimal screening test for clinically significant PCa. While prostate magnetic resonance imaging (MRI) has demonstrated value for the diagnosis of PCa, the acquisition time is too long for a first-line screening modality. PURPOSE/OBJECTIVE:To accelerate prostate MRI exams, utilizing a variational network (VN) for image reconstruction. STUDY TYPE/METHODS:Retrospective. SUBJECTS/METHODS:One hundred and thirteen subjects (train/val/test: 70/13/30) undergoing prostate MRI. FIELD STRENGTH/SEQUENCE/UNASSIGNED:3.0 T; a T2 turbo spin echo (TSE) T2-weighted image (T2WI) sequence in axial and coronal planes, and axial echo-planar diffusion-weighted imaging (DWI). ASSESSMENT/RESULTS:, and apparent diffusion coefficient map-according to the Prostate Imaging Reporting and Data System (PI-RADS v2.1), for both VN and standard reconstructions. Accuracy of PI-RADS ≥3 for clinically significant cancer was computed. Projected scan time of the retrospectively under-sampled biparametric exam was also computed. STATISTICAL TESTS/UNASSIGNED:One-sided Wilcoxon signed-rank test was used for comparison of image quality. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for lesion detection and grading. Generalized estimating equation with cluster effect was used to compare differences between standard and VN bp-MRI. A P-value of <0.05 was considered statistically significant. RESULTS:(Reader 1: 3.20 ± 0.70 (Standard), 3.40 ± 0.75 (VN) P = 0.98; Reader 2: 2.85 ± 0.81 (Standard), 3.00 ± 0.79 (VN) P = 0.93; Reader 3: 4.45 ± 0.72 (Standard), 4.05 ± 0.69 (VN) P = 0.02; Reader 4: 4.50 ± 0.69 (Standard), 4.45 ± 0.76 (VN) P = 0.50). In the lesion evaluation study, there was no significant difference in the number of PI-RADS ≥3 lesions identified on standard vs. VN bp-MRI (P = 0.92, 0.59, 0.87) with similar sensitivity and specificity for clinically significant cancer. The average scan time of the standard clinical biparametric exam was 11.8 minutes, and this was projected to be 3.2 minutes for the accelerated exam. DATA CONCLUSION/UNASSIGNED:Diagnostic accelerated biparametric prostate MRI exams can be performed using deep learning methods in <4 minutes, potentially enabling rapid screening prostate MRI. LEVEL OF EVIDENCE/METHODS:3 TECHNICAL EFFICACY: Stage 5.
PMID: 34877735
ISSN: 1522-2586
CID: 5110242

Retrospective analysis of the effect of limited english proficiency on abdominal MRI image quality

Taffel, Myles T; Huang, Chenchan; Karajgikar, Jay A; Melamud, Kira; Zhang, Hoi Cheung; Rosenkrantz, Andrew B
PURPOSE/OBJECTIVE:To evaluate the effect of English proficiency on abdominal MRI imaging quality. METHODS:Three equal-sized cohorts of patients undergoing 3T abdominal MRI were identified based on English proficiency as documented in the EMR: Primary language of English; English as a second language (ESL)/no translator needed; or ESL, translator needed (42 patients per cohort for total study size of 126 patients). Three radiologists independently used a 1-5 Likert scale to assess respiratory motion and image quality on turbo spin-echo T2WI and post-contrast T1WI. Groups were compared using Kruskal-Wallis tests. RESULTS:For T2WI respiratory motion, all three readers scored the Translator group significantly worse than the English and ESL/no-Translator groups (mean scores across readers of 2.98 vs. 3.58 and 3.51; p values < 0.001-0.008). For T2WI overall image quality, all three readers also scored the Translator group significantly worse than the English and ESL/no-Translator groups (2.77 vs. 3.28 and 3.31; p values 0.002-0.005). For T1WI respiratory motion, mean scores were not significantly different between groups (English: 4.14, ESL/no-Translator: 4.02, Translator: 3.94; p values 0.398-0.597). For T1WI overall image quality, mean scores also were not significantly different (4.09, 3.99, and 3.95, respectively; p values 0.369-0.831). CONCLUSION/CONCLUSIONS:Abdominal MR examinations show significantly worse T2WI respiratory motion and overall image quality when requiring a translator, even compared with non-translator exams in non-English primary language patients. Strategies are warranted to improve coordination among MR technologists, translators, and non-English speaking patients undergoing abdominal MR, to ensure robust image quality in this vulnerable patient population.
PMID: 32047995
ISSN: 2366-0058
CID: 4304382

Imaging manifestations of immune-related adverse effects in checkpoint inhibitor therapies: A primer for the radiologist

Furtado, Vanessa Fiorini; Melamud, Kira; Hassan, Khalid; Rohatgi, Saurabh; Buch, Karen
Immune checkpoint inhibitors are monoclonal antibodies directed against cellular pathways on T-cells to treat different types of malignancies. This new therapy can cause immune-related adverse events that can involve almost any organ system. This article will review clinical presentations, molecular mechanisms and imaging manifestations of adverse events caused by checkpoint inhibitors and also illustrate the pseudoprogression tumor response pattern.
PMID: 32120311
ISSN: 1873-4499
CID: 4339612

Utility of an Automated Radiology-Pathology Feedback Tool

Doshi, Ankur M; Huang, Chenchan; Melamud, Kira; Shanbhogue, Krishna; Slywotsky, Chrystia; Taffel, Myles; Moore, William; Recht, Michael; Kim, Danny
PURPOSE/OBJECTIVE:To determine the utility of an automated radiology-pathology feedback tool. METHODS:We previously developed a tool that automatically provides radiologists with pathology results related to imaging examinations they interpreted. The tool also allows radiologists to mark the results as concordant or discordant. Five abdominal radiologists prospectively scored their own discordant results related to their previously interpreted abdominal ultrasound, CT, and MR interpretations between August 2017 and June 2018. Radiologists recorded whether they would have followed up on the case if there was no automated alert, reason for the discordance, whether the result required further action, prompted imaging rereview, influenced future interpretations, enhanced teaching files, or inspired a research idea. RESULTS:There were 234 total discordances (range 30-66 per radiologist), and 70.5% (165 of 234) of discordances would not have been manually followed up in the absence of the automated tool. Reasons for discordances included missed findings (10.7%; 25 of 234), misinterpreted findings (29.1%; 68 of 234), possible biopsy sampling error (13.3%; 31 of 234), and limitations of imaging techniques (32.1%; 75/234). In addition, 4.7% (11 of 234) required further radiologist action, including report addenda or discussion with referrer or pathologist, and 93.2% (218 of 234) prompted radiologists to rereview the images. Radiologists reported that they learned from 88% (206 of 234) of discordances, 38.6% (90 of 233) of discordances probably or definitely influenced future interpretations, 55.6% (130 of 234) of discordances prompted the radiologist to add the case to his or her teaching files, and 13.7% (32 of 233) inspired a research idea. CONCLUSION/CONCLUSIONS:Automated pathology feedback provides a valuable opportunity for radiologists across experience levels to learn, increase their skill, and improve patient care.
PMID: 31072775
ISSN: 1558-349x
CID: 3919182

Effects of testosterone administration (and its 5-alpha-reduction) on parenchymal organ volumes in healthy young men: findings from a dose-response trial

Gagliano-Juca, T; Tang, E R; Bhasin, S; Pencina, K M; Anderson, S; Jara, H; Li, Z; Melamud, K; Coleman, S L; Aakil, A; Almeida, R R; Huang, G; Travison, T G; Storer, T W; Basaria, S
Animal data shows that testosterone administration increases the volume of some parenchymal organs. However, the effects of exogenous testosterone on solid abdominal organs in humans remain unknown. The present study evaluated the effects of testosterone administration on the volume of liver, spleen and kidneys in a dose-response trial. Young healthy men aged 18-50 years participating in the 5alpha-Reductase (5aR) Trial. All participants received monthly injections of 7.5 mg leuprolide acetate to suppress endogenous testosterone secretion and weekly injections of 50, 125, 300 or 600 mg of testosterone enanthate, and were randomized to receive either 2.5 mg dutasteride (5 alpha-reductase inhibitor) or placebo daily for 20 weeks. Liver, spleen and kidney volumes were measured at baseline and the end of treatment using 1.5-Tesla magnetic resonance imaging. The dose-effect of testosterone on changes in the volume of parenchymal organs was evaluated by linear regression model. The association between changes in total testosterone (TT) levels and changes in organ volumes were assessed. Testosterone administration increased liver volume dose-dependently (17.4 cm3 per 100 mg of weekly testosterone enanthate; p = 0.031); the increase in liver volume was positively associated with changes in TT levels (R2 = 0.08, p = 0.024). A dose-dependent, but non-significant, increase in kidney volumes was also seen. Inclusion of dutasteride use into the models showed an independent association of randomization to dutasteride group with liver volume increase. In conclusion, Testosterone administration increased the liver volume in a dose-dependent manner. The potential changes in parenchymal organs should be considered when interpreting apparent changes in lean mass in response to anabolic interventions.
PMCID:5600666
PMID: 28704587
ISSN: 2047-2927
CID: 2630732

Imaging of Pancreatic and Duodenal Trauma

Melamud, Kira; LeBedis, Christina A; Soto, Jorge A
Pancreatic and duodenal injuries are rare but life-threatening occurrences, often occurring in association with other solid organ injuries. Findings of pancreatic and duodenal trauma on computed tomography and MR imaging are often nonspecific, and high levels of clinical suspicion and understanding of mechanism of injury are imperative. Familiarity with the grading schemes of pancreatic and duodenal injury is important because they help in assessing for key imaging findings that directly influence management. This article presents an overview of imaging of blunt and penetrating pancreatic and duodenal injuries, including pathophysiology, available imaging techniques, and variety of imaging features.
PMID: 26046509
ISSN: 1557-8275
CID: 1985662

Diagnostic imaging of benign and malignant osseous tumors of the fingers

Melamud, Kira; Drape, Jean-Luc; Hayashi, Daichi; Roemer, Frank W; Zentner, Joachim; Guermazi, Ali
Primary lesions of the tubular bones of the digits are not uncommon, and the vast majority of these lesions are benign. Benign intramedullary lesions such as enchondromas are frequently discovered incidentally, unless they are associated with a pathologic fracture. Expansile lesions or lesions that are pedunculated and protrude from the cortex may manifest with pain and functional deficits from local inflammatory reactions. Systemic disorders such as sarcoidosis and local soft-tissue lesions with involvement of adjacent bone may mimic primary phalangeal bone tumors. Primary or secondary malignant lesions of the phalanges, most commonly chondrosarcomas, are extremely rare, and their characterization may require the use of multiple modalities, including radiography, computed tomography, and magnetic resonance imaging. Although ultrasonography is extremely useful in the evaluation of soft-tissue lesions of the hand, its role in the evaluation of osseous lesions is limited. The authors describe the imaging features of the most common benign osseous and chondral lesions of the fingers, including enchondromas, cystic lesions, and osteochondromas. In addition, they discuss malignant entities that may occur in the fingers (eg, chondrosarcomas and metastatic lesions) and commonly encountered mimics of primary osseous lesions (eg, glomus tumors, intraosseous epidermal inclusion cysts, infectious entities, and manifestations of systemic diseases). They also discuss the advantages and disadvantages of the most commonly used imaging modalities in differentiating benign from malignant lesions.
PMID: 25384295
ISSN: 1527-1323
CID: 1985672

Biliary imaging: multimodality approach to imaging of biliary injuries and their complications

Melamud, Kira; LeBedis, Christina A; Anderson, Stephan W; Soto, Jorge A
Although traumatic and iatrogenic bile leaks are rare, they have become more prevalent in recent years due to an increased propensity toward nonsurgical management of patients with liver trauma and an overall increase in the number of hepatobiliary surgeries being performed. Because clinical signs and symptoms of bile leaks are nonspecific and delay in the recognition of bile leaks is associated with high morbidity and mortality rates, imaging is crucial for establishing an early diagnosis and guiding the treatment algorithm. At computed tomography or ultrasonography, free or contained peri- or intrahepatic low-attenuation (low-density) fluid in the setting of recent trauma or hepatobiliary surgery should raise suspicion for a bile leak. Hepatobiliary scintigraphy and magnetic resonance (MR) cholangiopancreatography with hepatobiliary contrast agents can help detect active or contained bile leaks. MR cholangiopancreatography with hepatobiliary contrast agents has the added advantage of being able to help localize the bile leak, which in turn can help determine if endoscopic management is sufficient or if surgical management is warranted. Endoscopic retrograde cholangiopancreatography may provide diagnostic confirmation and concurrent therapy when nonsurgical management is pursued. A multimodality imaging approach is helpful in diagnosing traumatic or iatrogenic biliary injuries, accurately localizing a bile leak, and determining appropriate treatment.
PMID: 24819784
ISSN: 1527-1323
CID: 1985682