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Comparison of Prostate Imaging and Reporting Data System V2.0 and V2.1 for Evaluation of Transition Zone Lesions: A 5-Reader 202-Patient Analysis

Kim, Nancy; Kim, Sooah; Prabhu, Vinay; Shanbhogue, Krishna; Smereka, Paul; Tong, Angela; Anthopolos, Rebecca; Taneja, Samir S; Rosenkrantz, Andrew B
OBJECTIVE:The aim of the study was to compare the distribution of Prostate Imaging and Reporting Data System (PI-RADS) scores, interreader agreement, and diagnostic performance of PI-RADS v2.0 and v2.1 for transition zone (TZ) lesions. METHODS:The study included 202 lesions in 202 patients who underwent 3T prostate magnetic resonance imaging showing a TZ lesion that was later biopsied with magnetic resonance imaging/ultrasound fusion. Five abdominal imaging faculty reviewed T2-weighted imaging and high b value/apparent diffusion coefficient images in 2 sessions. Cases were randomized using a crossover design whereby half in the first session were reviewed using v2.0 and the other half using v2.1, and vice versa for the 2nd session. Readers provided T2-weighted imaging and DWI scores, from which PI-RADS scores were derived. RESULTS:Interreader agreement for all PI-RADS scores had κ of 0.37 (v2.0) and 0.26 (v2.1). For 4 readers, the percentage of lesions retrospectively scored PI-RADS 1 increased greater than 5% and PI-RADS 2 score decreased greater than 5% from v2.0 to v2.1. For 2 readers, the percentage scored PI-RADS 3 decreased greater than 5% and, for 2 readers, increased greater than 5%. The percentage of PI-RADS 4 and 5 lesions changed less than 5% for all readers. For the 4 readers with increased frequency of PI-RADS 1 using v2.1, 4% to 16% were Gleason score ≥3 + 4 tumor. Frequency of Gleason score ≥3 + 4 in PI-RADS 3 lesions increased for 2 readers and decreased for 1 reader. Sensitivity of PI-RADS of 3 or greater for Gleason score ≥3 + 4 ranged 76% to 90% (v2.0) and 69% to 96% (v2.1). Specificity ranged 32% to 64% (v2.0) and 25% to 72% (v2.1). Positive predictive value ranged 43% to 55% (v2.0) and 41% to 58% (v2.1). Negative predictive value ranged 82% to 87% (v2.0) and 81% to 91% (v2.1). CONCLUSIONS:Poor interreader agreement and lack of improvement in diagnostic performance indicate an ongoing need to refine evaluation of TZ lesions.
PMID: 35405714
ISSN: 1532-3145
CID: 5218952

Inter-reader agreement of the Society of Abdominal Radiology-American Gastroenterological Association (SAR-AGA) consensus reporting for key phenotypes at MR enterography in adults with Crohn disease: impact of radiologist experience

Dane, Bari; Qian, Kun; Gauvin, Simon; Ji, Hoon; Karajgikar, Jay; Kim, Nancy; Chang, Shannon; Chandarana, Hersh; Kim, Sooah
PURPOSE/OBJECTIVE:To assess inter-reader agreement of key features from the SAR-AGA recommendations for the interpretation and reporting of MRE in adult patients with CD, focusing on the impact of radiologist experience on inter-reader agreement of CD phenotypes. METHODS:Two experienced and two less-experienced radiologists retrospectively evaluated 99 MRE in CD patients (50 initial MRE, 49 follow-up MRE) performed from 1/1/2019 to 3/20/2020 for the presence of active bowel inflammation (stomach, proximal small bowel, ileum, colon), stricture, probable stricture, penetrating disease, and perianal disease. The MRE protocol did not include dedicated perianal sequences. Inter-rater agreement was determined for each imaging feature using prevalence-adjusted bias-adjusted kappa and compared by experience level. RESULTS:All readers had almost-perfect inter-reader agreement (κ > 0.90) for penetrating disease, abscess, and perianal abscess in all 99 CD patients. All readers had strong inter-reader agreement (κ: 0.80-0.90) in 99 CD patients for active ileum inflammation, proximal small bowel inflammation, and stricture. Less-experienced readers had significantly lower inter-reader agreement for active ileum inflammation on initial than follow-up MRE (κ 0.68 versus 0.96, p = 0.018) and for strictures on follow-up than initial MRE (κ 0.76 versus 1.0, p = 0.027). Experienced readers had significantly lower agreement for perianal fistula on follow-up than initial MRE (κ: 0.55 versus 0.92, p = 0.008). CONCLUSION/CONCLUSIONS:There was strong to almost-perfect inter-reader agreement for key CD phenotypes described in the SAR-AGA consensus recommendations including active ileum and proximal small bowel inflammation, stricture, penetrating disease, abscess, and perianal abscess. Areas of lower inter-reader agreement could be targeted for future education efforts to further standardize CD MRE reporting. Dedicated perianal sequences should be included on follow-up MRE.
PMID: 34324038
ISSN: 2366-0058
CID: 4949952

Pathologic, Molecular, and Prognostic Radiologic Features of Hepatocellular Carcinoma

Fowler, Kathryn J; Burgoyne, Adam; Fraum, Tyler J; Hosseini, Mojgan; Ichikawa, Shintaro; Kim, Sooah; Kitao, Azusa; Lee, Jeong Min; Paradis, Valérie; Taouli, Bachir; Theise, Neil D; Vilgrain, Valérie; Wang, Jin; Sirlin, Claude B; Chernyak, Victoria
Hepatocellular carcinoma (HCC) is a malignancy with variable biologic aggressiveness based on the tumor grade, presence or absence of vascular invasion, and pathologic and molecular classification. Knowledge and understanding of the prognostic implications of different pathologic and molecular phenotypes of HCC are emerging, with therapeutics that promise to provide improved outcomes in what otherwise remains a lethal cancer. Imaging has a central role in diagnosis of HCC. However, to date, the imaging algorithms do not incorporate prognostic features or subclassification of HCC according to its biologic aggressiveness. Emerging data suggest that some imaging features and further radiologic, pathologic, or radiologic-molecular phenotypes may allow prediction of the prognosis of patients with HCC. An invited commentary by Bashir is available online. Online supplemental material is available for this article. ©RSNA, 2021.
PMID: 34597222
ISSN: 1527-1323
CID: 5061692

Cholangiopathy After Severe COVID-19: Clinical Features and Prognostic Implications

Faruqui, Saamia; Okoli, Fidelis C; Olsen, Sonja K; Feldman, David M; Kalia, Harmit S; Park, James S; Stanca, Carmen M; Figueroa Diaz, Viviana; Yuan, Sarah; Dagher, Nabil N; Sarkar, Suparna A; Theise, Neil D; Kim, Sooah; Shanbhogue, Krishna; Jacobson, Ira M
INTRODUCTION/BACKGROUND:Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus, is a predominantly respiratory tract infection with the capacity to affect multiple organ systems. Abnormal liver tests, mainly transaminase elevations, have been reported in hospitalized patients. We describe a syndrome of cholangiopathy in patients recovering from severe COVID-19 characterized by marked elevation in serum alkaline phosphatase (ALP) accompanied by evidence of bile duct injury on imaging. METHODS:We conducted a retrospective study of COVID-19 patients admitted to our institution from March 1, 2020, to August 15, 2020, on whom the hepatology service was consulted for abnormal liver tests. Bile duct injury was identified by abnormal liver tests with serum ALP > 3x upper limit of normal and abnormal findings on magnetic resonance cholangiopacreatography. Clinical, laboratory, radiological, and histological findings were recorded in a Research Electronic Data Capture database. RESULTS:Twelve patients were identified, 11 men and 1 woman, with a mean age of 58 years. Mean time from COVID-19 diagnosis to diagnosis of cholangiopathy was 118 days. Peak median serum alanine aminotransferase was 661 U/L and peak median serum ALP was 1855 U/L. Marked elevations of erythrocyte sedimentation rate, C-reactive protein, and D-dimers were common. Magnetic resonance cholangiopacreatography findings included beading of intrahepatic ducts (11/12, 92%), bile duct wall thickening with enhancement (7/12, 58%), and peribiliary diffusion high signal (10/12, 83%). Liver biopsy in 4 patients showed acute and/or chronic large duct obstruction without clear bile duct loss. Progressive biliary tract damage has been demonstrated radiographically. Five patients were referred for consideration of liver transplantation after experiencing persistent jaundice, hepatic insufficiency, and/or recurrent bacterial cholangitis. One patient underwent successful living donor liver transplantation. DISCUSSION/CONCLUSIONS:Cholangiopathy is a late complication of severe COVID-19 with the potential for progressive biliary injury and liver failure. Further studies are required to understand pathogenesis, natural history, and therapeutic interventions.
PMID: 33993134
ISSN: 1572-0241
CID: 4876442

Frequency and significance of incidental liver lesions on MR enterography in adult patients

Dane, Bari; Bearison, Craig; Kim, Sooah
PURPOSE/OBJECTIVE:To evaluate the frequency and significance of incidental liver lesions identified on MR enterography (MRE) examinations to determine if dedicated sequences for liver evaluation are necessary in the routine MRE protocol. METHODS:A retrospective departmental database search identified 353 adult (212 women and 141 men; mean [±SD] age, 41.4 [17.0] years; range 18.1-91.9 years) MRE examinations performed in 2017. Radiology reports were reviewed for the presence and characterization of liver lesions, follow-up recommendation, and known malignancy. Follow-up cross-sectional imaging reports were reviewed for liver lesion stability. A senior abdominal radiologist with expertise in liver imaging categorized liver lesions as benign, indeterminate, or malignant and re-characterized indeterminate lesions using follow-up imaging as benign or malignant. RESULTS:Seventy-nine MRE (22.4%) described liver lesions and follow-up imaging was recommended in 4/79 (5.1%). Seventy-six liver lesions (96.2%) were characterized as benign (cysts/hemangiomas) on routine interpretation and expert review. One of these was recommended for follow-up imaging on initial report, which was characterized as hemangioma by expert review. The remaining 3 lesions (3.8%) were characterized as indeterminate both by initial report and expert radiologist review but re-characterized as benign after reviewing follow-up examinations. CONCLUSION/CONCLUSIONS:All incidental liver lesions identified on MRE in our cohort were benign. Therefore, additional sequences evaluating the liver are unnecessary for routine MRE.
PMID: 34217035
ISSN: 1873-4499
CID: 4932772

Comparison of Non-Tumoral Portal Vein Thrombosis Management in Cirrhotic Patients: TIPS Versus Anticoagulation Versus No Treatment

Zhan, Chenyang; Prabhu, Vinay; Kang, Stella K; Li, Clayton; Zhu, Yuli; Kim, Sooah; Olsen, Sonja; Jacobson, Ira M; Dagher, Nabil N; Carney, Brendan; Hickey, Ryan M; Taslakian, Bedros
BACKGROUND:There is a lack of consensus in optimal management of portal vein thrombosis (PVT) in patients with cirrhosis. The purpose of this study is to compare the safety and thrombosis burden change for cirrhotic patients with non-tumoral PVT managed by transjugular intrahepatic portosystemic shunt (TIPS) only, anticoagulation only, or no treatment. METHODS:This single-center retrospective study evaluated 52 patients with cirrhosis and non-tumoral PVT managed by TIPS only (14), anticoagulation only (11), or no treatment (27). The demographic, clinical, and imaging data for patients were collected. The portomesenteric thrombosis burden and liver function tests at early follow-up (6-9 months) and late follow-up (9-16 months) were compared to the baseline. Adverse events including bleeding and encephalopathy were recorded. RESULTS:= 0.007). No bleeding complications attributable to anticoagulation were observed. CONCLUSION/CONCLUSIONS:TIPS decreased portomesenteric thrombus burden compared to anticoagulation or no treatment for cirrhotic patients with PVT. Both TIPS and anticoagulation were safe therapies.
PMID: 34073236
ISSN: 2077-0383
CID: 4891422

Tricky Findings in Liver Transplant Imaging: A Review of Pitfalls With Solutions

Sannananja, Bhagya; Seyal, Adeel R; Baheti, Akshay D; Kim, Sooah; Lall, Chandana; Bhargava, Puneet
Orthotopic liver transplantation is the preferred treatment for end-stage liver disease. Imaging plays an important role in the follow-up of transplant recipients by identifying a variety of complications. Posttransplant liver imaging can be challenging with altered vascular and nonvascular postoperative findings closely mimicking pathologies. A thorough knowledge of these common imaging findings in a posttransplant liver is essential for the radiologist to avoid erroneous diagnoses and unnecessary workup. We focus on such imaging findings and provide tips to avoid misinterpretation.
PMID: 28688531
ISSN: 1535-6302
CID: 3013122

Radiologically Undetected Hepatocellular Carcinoma in Patients Undergoing Liver Transplantation: An Immunohistochemical Correlation With LI-RADS Score

Xiong, Wei; Cheeney, Gregory; Kim, Sooah; Kolesnikova, Violetta; Henninger, Brooke; Alexander, Jacob; Swanson, Paul E; Upton, Melissa P; Truong, Camtu D; Yeh, Matthew M
Orthotopic liver transplantation is the best option for patients with carefully selected unresectable disease because of underlying liver dysfunction. The 5-year survival rate after orthotopic liver transplantation for early detected hepatocellular carcinoma (HCC) is high, and a similar or even higher rate is reported in those with radiologically undetected HCC. This study evaluated and compared the histologic features of pretransplant radiologically undetected (14 patients, 25 tumors) versus detected (36 patients, 45 tumors) HCCs. Tumor size, tumor differentiation, number of unpaired arteries, mitotic count per 10 high-power fields, CD34 immunostain to assess microvessel density, and Ki67 immunostain were compared with the Liver Imaging Reporting and Data System score, which was retrospectively assigned to each tumor in both groups. The Liver Imaging Reporting and Data System score was significantly higher in the HCC detected group (P<0.001). The vast majority of the undetected HCCs (88%) was <2 cm in size. Only 12% of the undetected HCCs were ≥2 cm, whereas 51% of the detected HCCs were ≥2 cm in size. Higher rate of moderate to poor tumor differentiation was noted in the detected HCCs compared with the undetected group (89% vs. 60%; P=0.004). No statistically significant difference in the number and distribution of unpaired arteries, or mitotic count was observed in 2 groups (although fewer unpaired arteries were identified in the undetected group). The detected HCCs had a higher rate of 2+ CD34 staining compared with the undetected HCCs (68% vs. 27%; P=0.002), whereas the opposite was observed for 1+ CD34 staining (59% undetected HCCs vs. 17% detected HCCs; P=0.002). Ki67 proliferative index was not statistically different between the 2 groups (120.8/1000 cells detected HCCs vs. 81.8/1000 cells undetected HCCs; P=0.36). The factors associated with failing to detect HCCs pretransplant by radiologic studies include small tumor size (<2 cm), low-grade histologic differentiation, and low microvessel density (low CD34 staining). A significant association between the number and distribution of unpaired arteries and HCC detection has not been established by our study.
PMID: 28914714
ISSN: 1532-0979
CID: 3013132

Metabolite profiles of synovial fluid change with the radiographic severity of knee osteoarthritis

Kim, Sooah; Hwang, Jiwon; Kim, Jungyeon; Ahn, Joong Kyong; Cha, Hoon-Suk; Kim, Kyoung Heon
OBJECTIVES/OBJECTIVE:To investigate potential pathogenic pathways in the synovial fluid of osteoarthritis (OA) patients at different disease stages [early vs. late, determined based on the Kellgren-Lawrence (KL) grading scale], through metabolite profiles that were performed by using gas-chromatography/time-of-flight mass spectrometry (GC/TOF MS). METHODS:Synovial fluid samples were obtained from 15 patients with knee OA, divided into early- (KL grade: 1 and 2) and late-stage OA (KL grade: 3 and 4). Metabolite profiles of OA based on KL grading scale were performed using GC/TOF MS, with multivariate statistical analyses conducted by orthogonal partial least squares discriminant analysis (OPLS-DA) and hierarchical clustering analysis (HCA). RESULTS:A total of 114 metabolites were identified and classified into various classes, such as amino acids, sugars and sugar alcohols, fatty acids, and organic acids. Significant discrimination of metabolite profiles between the early- and late-stage OA groups was shown by OPLS-DA and HCA. Twenty-eight metabolites, including malate, ethanolamine, squalene, glycerol, myristic acid, oleic acid, lanosterol, heptadecanoic acid, and capric acid, were identified as critical metabolites for discriminating between the early- and late-OA groups by using Student's t-test, as they showed significant differences in abundance between the two OA groups. These metabolites were related to fatty acid metabolism, glycerolipid metabolism, and the tricarboxylic acid cycle. CONCLUSIONS:These results revealed that metabolite profiles are robustly altered along the radiographic stage of knee OA. Metabolomic approaches based on GC/TOF MS could provide valuable information on the underlying pathogenic mechanisms of OA progression.
PMID: 27461192
ISSN: 1778-7254
CID: 3013092

3D printing from MRI Data: Harnessing strengths and minimizing weaknesses

Ripley, Beth; Levin, Dmitry; Kelil, Tatiana; Hermsen, Joshua L; Kim, Sooah; Maki, Jeffrey H; Wilson, Gregory J
3D printing facilitates the creation of accurate physical models of patient-specific anatomy from medical imaging datasets. While the majority of models to date are created from computed tomography (CT) data, there is increasing interest in creating models from other datasets, such as ultrasound and magnetic resonance imaging (MRI). MRI, in particular, holds great potential for 3D printing, given its excellent tissue characterization and lack of ionizing radiation. There are, however, challenges to 3D printing from MRI data as well. Here we review the basics of 3D printing, explore the current strengths and weaknesses of printing from MRI data as they pertain to model accuracy, and discuss considerations in the design of MRI sequences for 3D printing. Finally, we explore the future of 3D printing and MRI, including creative applications and new materials.
PMID: 27875009
ISSN: 1522-2586
CID: 3013112