Faculty Bibliography
Searched for:
person:rosena23
Total Results:
547
OUTCOMES OF MRI-US FUSION TARGETED PROSTATE BIOPSY IN MEN WITHOUT HISTORY OF PREVIOUS BIOPSY: REDUCTION OF OVER-DETECTION AND IMPROVED RISK STRATIFICATION. [Meeting Abstract]
ISI:000362826600373
ISSN: 1527-3792
CID: 1871642
OUTCOMES OF MRI-US FUSION TARGETED PROSTATE BIOPSY IN MEN WITH HISTORY OF PROSTATIC INTRAEPITHELIAL NEOPLASIA AND/OR ATYPICAL SMALL ACINAR PROLIFERATION: EVIDENCE FOR AN ALTERATION OF CURRENT PRACTICE. [Meeting Abstract]
ISI:000362826600377
ISSN: 1527-3792
CID: 1871652
PREDICTION OF OVERALL AND CLINICALLY SIGNIFICANT CANCER RISK ON MRI-TARGETED AND SYSTEMATIC PROSTATE BIOPSY USING PREBIOPSY NOMOGRAMS [Meeting Abstract]
ISI:000362826600554
ISSN: 1527-3792
CID: 1871662
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
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
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
State Variation in Medical Imaging: Despite Great Variation, the Medicare Spending Decline Continues
OBJECTIVE: The purpose of this study was to assess state-level trends in per beneficiary Medicare spending on medical imaging. MATERIALS AND METHODS: Medicare part B 5% research identifiable files from 2004 through 2012 were used to compute national and state-by-state annual average per beneficiary spending on imaging. State-to-state geographic variation and temporal trends were analyzed. RESULTS: National average per beneficiary Medicare part B spending on imaging increased 7.8% annually between 2004 ($350.54) and its peak in 2006 ($405.41) then decreased 4.4% annually between 2006 and 2012 ($298.63). In 2012, annual per beneficiary spending was highest in Florida ($367.25) and New York ($355.67) and lowest in Ohio ($67.08) and Vermont ($72.78). Maximum state-to-state geographic variation increased over time, with the ratio of highest-spending state to lowest-spending state increasing from 4.0 in 2004 to 5.5 in 2012. Spending in nearly all states decreased since peaks in 2005 (six states) or 2006 (43 states). The average annual decrease among states was 5.1% +/- 1.8% (range, 1.2-12.2%) The largest decrease was in Ohio. In only two states did per beneficiary spending increase (Maryland, 12.5% average annual increase since 2005; Oregon, 4.8% average annual increase since 2008). CONCLUSION: Medicare part B average per beneficiary spending on medical imaging declined in nearly every state since 2005 and 2006 peaks, abruptly reversing previously reported trends. Spending continued to increase, however, in Maryland and Oregon. Identification of state-level variation may facilitate future investigation of the potential effect of specific and regional changes in spending on patient access and outcomes.
PMID: 26397330
ISSN: 1546-3141
CID: 1786522
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
Differentiation of deep venous thrombosis from femoral vein mixing artifact on routine abdominopelvic CT
PURPOSE: The objective of this study is to assess the performance of qualitative and quantitative imaging features for the differentiation of deep venous thrombosis (DVT) from mixing artifact on routine portal venous phase abdominopelvic CT. METHODS: This retrospective study included 40 adult patients with a femoral vein filling defect on portal venous phase CT and a Duplex ultrasound (n = 36) or catheter venogram (n = 4) to confirm presence or absence of DVT. Two radiologists (R1, R2) assessed the femoral veins for various qualitative and quantitative features. RESULTS: 60% of patients were confirmed to have DVT and 40% had mixing artifact. Features with significantly greater frequency in DVT than mixing artifact (all p
PMID: 26296540
ISSN: 1432-0509
CID: 1741932
Acute Appendicitis: Use of Clinical and CT Findings for Modeling Hospital Resource Utilization
OBJECTIVE: The purpose of this study was to retrospectively investigate associations between baseline CT findings in suspected acute appendicitis and subsequent hospital resource utilization. MATERIALS AND METHODS: One hundred thirty-eight patients (76 male and 62 female patients; mean [+/- SD] age, 40 +/- 21 years) who were admitted for suspected acute appendicitis and underwent baseline CT were included. A single radiologist reviewed CT examinations for appendiceal-related findings. Linear and logistic regressions were performed to identify independent predictors of payer and hospital resource utilization. Combined performance of identified independent factors for predicting outcomes was determined. RESULTS: Greater age, lower Charlson comorbidity index (CCI), lesser appendiceal wall thickness, absence of loculated fluid collection, and absence of periappendiceal fluid were significant independent predictors of inpatient surgery (joint sensitivity, 92.7%; specificity, 65.8%). Smaller appendiceal diameter, absence of periappendiceal fluid, and laparoscopic surgery were significant independent predictors of same-day discharge (joint sensitivity, 79.1%; specificity, 64.2%). Greater CCI, greater wall thickness, and presence of periappendiceal fluid were significant independent predictors of repeat abdominopelvic CT (joint sensitivity, 82.5%; specificity, 68.1%). Presence of an appendicolith was the only significant predictor of repeat emergency department visit within 30 days (sensitivity, 61.2%; specificity, 68.8%) and the only significant predictor of repeat inpatient admission within 30 days (sensitivity, 63.6%; specificity, 68.5%). Greater appendiceal diameter and presence of free air were significant predictors of inpatient costs, and predicted costs were as follows: $8047 + ($745 x appendiceal diameter) if free air was absent; and $-39,261 + ($4426 x appendiceal diameter) if free air was present. However, costs were poorly predicted when greater than $45,000. Sex, WBC count, and payer category were not independent predictors, relative to CT findings, of any outcome. CONCLUSION: Admission CT findings serve as independent predictors of hospital resource utilization in suspected acute appendicitis.
PMID: 26295663
ISSN: 1546-3141
CID: 1732542
