Faculty Bibliography
Searched for:
in-biosketch:true
person:rosena23
Total Results:
534
Public Interest in Imaging-Based Cancer Screening Examinations in the United States: Analysis Using a Web-Based Search Tool
OBJECTIVE: The objective of this study was to identify geographic and temporal patterns related to the frequencies of online searches within the United States for information on imaging-based cancer screening tests. MATERIALS AND METHODS: Google Trends, a web-based tool for identifying the frequency of online searches, was used to determine, on both a monthly and a geographic basis, the relative frequency of searches for imaging-based cancer screening tests in the United States from 2004 through 2014. Findings were evaluated qualitatively. RESULTS: Searches for "mammography" decreased slightly overall, although they peaked in October (Breast Cancer Awareness Month) in most years and spiked in November 2009 (when the updated U.S. Preventive Services Task Force screening mammography guidelines were released). The frequency of searches for "tomosynthesis" increased rapidly from 2009 through 2014. On the other hand, the frequency of searches for "lung cancer screening" decreased slightly from 2006 through 2010, increased rapidly from 2011 through 2014, and exhibited a spike in November 2010 (when the results of the National Lung Screening Trial were released). Searches for "virtual colonoscopy" decreased substantially from 2004 through 2010, remained stable from 2011 through 2014, and spiked in months coinciding with the publication of the results of large relevant clinical trials and a press release announcing that the president of the United States was undergoing virtual colonoscopy. The frequency of searches for "prostate MRI" was stable from 2006 through 2010 and increased rapidly from 2011 through 2014. Searches for "prostate MRI biopsy" increased rapidly in 2013 and 2014. These searches occurred predominantly in densely populated areas (e.g., searches for "lung cancer screening," "prostate MRI," and "tomosynthesis" were highest in New York City). CONCLUSION: Online search patterns indicate geographic and short- and long-term temporal variation in the interest in cancer screening examinations among the U.S. POPULATION: These trends may indicate pending shifts in the use of these examinations.
PMID: 26700342
ISSN: 1546-3141
CID: 1884282
Hypovascular hepatic nodules at gadoxetic acid-enhanced MRI: whole-lesion hepatobiliary phase histogram metrics for prediction of progression to arterial-enhancing hepatocellular carcinoma
PURPOSE: To explore whole-lesion histogram analysis of the hepatobiliary phase (HBP) defect in indeterminate hypovascular liver lesions for predicting progression to arterial-enhancing hepatocellular carcinoma (HCC). METHODS: Twenty patients undergoing gadoxetic acid-enhanced MRI for HCC screening with 12 degrees and 25 degrees flip angle (FA) HBP acquisitions demonstrating an indeterminate lesion showing HBP hypointensity but no arterial enhancement were included. Volumes-of-interest were placed on HBP defects, from which histogram metrics were obtained. Associations between these metrics and progression to arterial-enhancing HCC on follow-up imaging were investigated. Lesions were also assessed for the presence of a signal abnormality on conventional sequences. RESULTS: 40% of lesions progressed to arterial-enhancing HCC; 60% were stable at >/=6 months follow-up. Neither T2-hyperintensity increased diffusion signal nor portal/equilibrium phase washout was different between progressing and nonprogressing lesions (p = 1.0). Among direct signal intensity-based measures (overall mean; mean of bottom 10th, 10-25th, and 25-50th percentiles), area-under-the-curve (AUC) for prediction of progression to arterial-enhancing HCC was consistently higher at 25 degrees (range 0.619-0.657) than at 12 degrees (range 0.512-0.548). However, at both FAs, the four measures with highest AUC were measures related to lesion texture and heterogeneity [standard deviation (SD), coefficient of variation (CV), skewness, and entropy], having AUC of 0.655-0.750 at 12 degrees and 0.686-0.800 at 25. The metric with highest AUC at 12 degrees was SD (AUC = 0.750) and at 25 degrees was CV (AUC = 0.800). CONCLUSION: Whole-lesion histogram HBP measures of indeterminate hypovascular liver lesions may help predict progression to arterial-enhancing HCC by reflecting greater lesion heterogeneity, particularly at higher FA. Larger studies are therefore warranted.
PMID: 26830613
ISSN: 2366-0058
CID: 1931892
Practical Barriers to Obtaining Pre-Biopsy Prostate MRI: Assessment in Over 1,500 Consecutive Men Undergoing Prostate Biopsy in a Single Urologic Practice
PMID: 27160263
ISSN: 1423-0399
CID: 2107492
MRI-Ultrasound Fusion-Targeted Prostate Biopsy in a Consecutive Cohort of Men with No Previous Biopsy: Reduction of Over-Detection through Improved Risk Stratification
BACKGROUND: MRI-ultrasound fusion-targeted prostate biopsy (MRF-TB) may improve detection of prostate cancer (PCa) in men presenting for prostate biopsy. We report clinical outcomes of 12-core systematic biopsy (SB) and MRF-TB in men presenting for primary biopsy and further describe pathological characteristics of cancers detected by SB and not by MRF-TB. MATERIALS & METHODS: Clinical outcomes of 435 consecutive men who underwent pre-biopsy mpMRI followed by MRF-TB and SB at our institution between June 2012 and March 2015 were captured in an IRB-approved database Clinical characteristics, biopsy results and MRI suspicion scores (mSS) were queried from the database. RESULTS: Among 370 men (mean age 64+/-8.5 years; mean PSA 6.8, SEM 0.3 ng/mL) who met inclusion criteria, PCa was detected in 200 (54.1%) cases. Cancer detection rates for SB and MRF-TB were 47.3% and 43.5%, respectively (p = 0.104). MRF-TB detected more Gleason score >/=7 cancers than SB (114/128 (89.1%) vs 95/128 (74.2%), respectively, p = 0.008). Of 39 cancers detected by SB, but not by MRF-TB, 32/39 (82.1%) demonstrated Gleason 6 disease, and 24/39 (61.5%) and 32/39 (82.1%) were clinically insignificant by Epstein and UCSF CAPRA (score
PMID: 26100327
ISSN: 1527-3792
CID: 1640862
Pre-Biopsy MRI and MRI-Ultrasound Fusion-Targeted Prostate Biopsy in Men with Previous Negative Biopsies: Impact on Repeat Biopsy Strategies
OBJECTIVE: To report outcomes of MRI-ultrasound fusion (MRF-TB) and 12-core systematic biopsy (SB) over a 26-month period in men with prior negative prostate biopsy. METHODS: Between 6/12 and 8/14, 210 men presenting to our institution for prostate biopsy with >/=1 prior negative biopsy underwent multiparametric MRI followed by MRF-TB and SB and were entered into a prospective database. Clinical characteristics, MRI suspicion scores (mSS), and biopsy results were queried from the database and the detection rates of Gleason >/=7 prostate cancer (PCa) and overall PCa were compared between biopsy techniques using McNemar's test. RESULTS: Fifty-three (31%) of 172 men meeting inclusion criteria (mean age 65+/-8 years; mean PSA 8.9+/-8.9) were found to have PCa. MRF-TB and SB had overall cancer detection rates (CDR) of 23.8% and 18.0% (p=0.12), respectively, and CDR for Gleason score (GS)>/=7 disease of 16.3% and 9.3% (p=0.01), respectively. Of 31 men with GS>/=7 disease, MRF-TB detected 28 (90.3%) while SB detected 16 (51.6%) (p<0.001). Using UCSF-CAPRA criteria, only one man was re-stratified from low-risk to higher risk based on SB results compared to MRF-TB alone. Among men with mSS<4, 80% of detected cancers were low-risk by UCSF-CAPRA criteria. CONCLUSIONS: In men with previous negative biopsies and persistent suspicion for PCa, SB contributes little to the detection of GS>/=7 disease by MRF-TB, and avoidance of SB bears consideration. Based on the low likelihood of detecting GS>/=7 cancer and overall low-risk features of PCa in men with mSS<4, limiting biopsy to men with mSS>/=4 warrants further investigation.
PMCID:4726647
PMID: 26335497
ISSN: 1527-9995
CID: 1761932
Prostate Cancer: Utility of Whole-Lesion Apparent Diffusion Coefficient Metrics for Prediction of Biochemical Recurrence After Radical Prostatectomy
OBJECTIVE: The purpose of this study was to investigate the additional value of whole-lesion histogram apparent diffusion coefficient (ADC) metrics, when combined with standard pathologic features, in prediction of biochemical recurrence (BCR) after radical prostatectomy for prostate cancer. MATERIALS AND METHODS: The study included 193 patients (mean age, 61 +/- 7 years) who underwent 3-T MRI with DWI (b values, 50 and 1000 s/mm(2)) before prostatectomy. Histogram metrics were derived from 3D volumes of interest encompassing the entire lesion on ADC maps. Pathologic features from radical prostatectomy and subsequent BCR were recorded for each patient. The Fisher exact test and Mann-Whitney test were used to compare ADC-based metrics and pathologic features between patients with and patients without BCR. Stepwise logistic regression analysis was used to construct multivariable models for prediction of BCR, which were assessed by ROC analysis. RESULTS: BCR occurred in 16.6% (32/193) of patients. Variables significantly associated with BCR included primary Gleason grade, Gleason score, extraprostatic extension, seminal vesicle invasion, positive surgical margin, preoperative prostate-specific antigen level, MRI tumor volume, mean whole-lesion ADC, entropy ADC, and mean ADC of the bottom 10th, 10-25th, and 25-50th percentiles (p
PMCID:4691847
PMID: 26587927
ISSN: 1546-3141
CID: 1848852
Body diffusion kurtosis imaging: Basic principles, applications, and considerations for clinical practice
Technologic advances enable performance of diffusion-weighted imaging (DWI) at ultrahigh b-values, where standard monoexponential model analysis may not apply. Rather, non-Gaussian water diffusion properties emerge, which in cellular tissues are, in part, influenced by the intracellular environment that is not well evaluated by conventional DWI. The novel technique, diffusion kurtosis imaging (DKI), enables characterization of non-Gaussian water diffusion behavior. More advanced mathematical curve fitting of the signal intensity decay curve using the DKI model provides an additional parameter Kapp that presumably reflects heterogeneity and irregularity of cellular microstructure, as well as the amount of interfaces within cellular tissues. Although largely applied for neural applications over the past decade, a small number of studies have recently explored DKI outside the brain. The most investigated organ is the prostate, with preliminary studies suggesting improved tumor detection and grading using DKI. Although still largely in the research phase, DKI is being explored in wider clinical settings. When assessing extracranial applications of DKI, careful attention to details with which body radiologists may currently be unfamiliar is important to ensure reliable results. Accordingly, a robust understanding of DKI is necessary for radiologists to better understand the meaning of DKI-derived metrics in the context of different tumors and how these metrics vary between tumor types and in response to treatment. In this review, we outline DKI principles, propose biostructural basis for observations, provide a comparison with standard monoexponential fitting and the apparent diffusion coefficient, report on extracranial clinical investigations to date, and recommend technical considerations for implementation in body imaging. J. Magn. Reson. Imaging 2015.
PMID: 26119267
ISSN: 1522-2586
CID: 1649762
Journal of the American College of Radiology : JACR. 2015:12(11):1223-5.DOI: 10.1016/j.jacr.2015.03.049
Use of a Referring Physician Survey to Direct and Evaluate Department-Wide Radiology Quality Improvement Efforts
PMID: 26439737
ISSN: 1558-349x
CID: 1794602
Imaging and evaluation of patients with high-risk prostate cancer
Approximately 15% of men with newly diagnosed prostate cancer have high-risk disease. Imaging is critically important for the diagnosis and staging of these patients, and also for the selection of management. While established prostate cancer staging guidelines have increased the appropriate use of imaging, underuse for high-risk prostate cancer remains substantial. Several factors affect the utility of initial diagnostic imaging, including the variable definition of high-risk prostate cancer, variable guideline recommendations, poor accuracy of existing imaging tests, and the difficulty in validating imaging findings. Conventional imaging modalities, including CT and radionuclide bone scan, have been employed for local and metastatic staging, but their performance characteristics have generally been poor. Emerging modalities including multiparametricMRI, positron emission tomography (PET)-CT, and PET-MRI have shown increased diagnostic accuracy and could improve accuracy in staging patients with high-risk prostate cancer.
PMID: 26481576
ISSN: 1759-4820
CID: 1810402
Frequency of recommendations for additional imaging in diagnostic ultrasound examinations: Evaluation of radiologist, technologist, and other examination-related factors
OBJECTIVE: Our aim in this study was to evaluate the effect of the radiologist, technologist, and other examination-related factors on the frequency of recommendations for additional imaging (RAI) during sonographic (US) interpretation. METHODS: We retrospectively reviewed 719 US reports from a single academic medical center for the presence of RAI. All studies had been interpreted by one of three abdominal radiologists. Examinations were performed at an outpatient radiology facility with no onsite radiologist (n = 299) or at an inpatient emergency department or hospital-based outpatient setting that had an onsite radiologist (n = 420). Possible associations between the frequency of RAI and the presence of an onsite radiologist, location of the examination, body part or region imaged, patient age, technologist performing the exam, and radiologist reading the exam were evaluated. RESULTS: There were significant differences between each pair of radiologists in terms of overall frequency of RAI (p < 0.001) (radiologist 1: 12.0% [22/184]; radiologist 2: 21.6% [78/361]; and radiologist 3: 45.5% [79/174]). In addition, there were statistically significant differences in the frequency of RAI among studies scanned by the 10 different US technologists (13.6%-40.0%, p = 0.03). However, other factors such as patient age, patient sex, US unit, patient location, and radiologist location were not associated with the frequency of RAI (p = 0.15-0.93). CONCLUSIONS: The individual radiologist and technologist influenced the frequency of RAI for US examinations, whereas other examination-related factors did not. The observed substantial variability in RAI between radiologists and technologists warrants further study, with consideration of strategies to optimize RAI within US reports. (c) 2015 Wiley Periodicals, Inc. J Clin Ultrasound, 2015.
PMID: 25704133
ISSN: 0091-2751
CID: 1473382
