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Early-onset osteoradionecrosis following adjuvant volumetric-modulated arc therapy to an osteocutaneous free fibula flap with customized titanium plate [Case Report]

Daar, David A; Byun, David J; Spuhler, Karl; Anzai, Lavinia; Witek, Lukasz; Barbee, David; Hu, Kenneth S; Levine, Jamie P; Jacobson, Adam S
BACKGROUND:Computerized surgical planning (CSP) in osseous reconstruction of head and neck cancer defects has become a mainstay of treatment. However, the consequences of CSP-designed titanium plating systems on planning adjuvant radiation remains unclear. METHODS:Two patients underwent head and neck cancer resection and maxillomandibular free fibula flap reconstruction with CSP-designed plates and immediate placement of osseointegrated dental implants. Surgical treatment was followed by adjuvant intensity modulated radiation therapy (IMRT). RESULTS:Both patients developed osteoradionecrosis (ORN), and one patient had local recurrence. The locations of disease occurred at the areas of highest titanium plate burden, possibly attributed to IMRT dosing inaccuracy caused by the CSP-designed plating system. CONCLUSION/CONCLUSIONS:Despite proven benefits of CSP-designed plates in osseous free flap reconstruction, there may be an underreported risk to adjuvant IMRT treatment planning leading to ORN and/or local recurrence. Future study should investigate alternative plating methods and materials to mitigate this debilitating outcome.
PMID: 34906727
ISSN: 2468-7855
CID: 5109702

Osteoradionecrosis following radiation to reconstructed mandible with titanium plate and osseointegrated dental implants

Byun, David J; Daar, David A; Spuhler, Karl; Anzai, Lavinia; Witek, Lukasz; Barbee, David; Jacobson, Adam S; Levine, Jamie P; Hu, Kenneth S
PMID: 34706296
ISSN: 1879-8519
CID: 5042562

Multitask Learning Based Three-Dimensional Striatal Segmentation of MRI: fMRI and PET Objective Assessments

Serrano-Sosa, Mario; Van Snellenberg, Jared X; Meng, Jiayan; Luceno, Jacob R; Spuhler, Karl; Weinstein, Jodi J; Abi-Dargham, Anissa; Slifstein, Mark; Huang, Chuan
BACKGROUND:Recent studies have established a clear topographical and functional organization of projections to and from complex subdivisions of the striatum. Manual segmentation of these functional subdivisions is labor-intensive and time-consuming, and automated methods are not as reliable as manual segmentation. PURPOSE:To utilize multitask learning (MTL) as a method to segment subregions of the striatum consisting of pre-commissural putamen (prePU), pre-commissural caudate (preCA), post-commissural putamen (postPU), post-commissural caudate (postCA), and ventral striatum (VST). STUDY TYPE:Retrospective. POPULATION:Eighty-seven total data sets from patients with schizophrenia and matched controls. FIELD STRENGTH/SEQUENCE:-weighted (SPGR SENSE, 3D BRAVO). ASSESSMENT:, and region of interest (ROI) time series and whole-brain connectivity using functional magnetic resonance imaging (fMRI) images were compared between manual and both automated segmentations. STATISTICAL TESTS:Pearson correlation and paired t-test. RESULTS: = 0.69 in VST. Mean Pearson correlation coefficients of the fMRI data between MTL-generated and manual segmentations were also high in time series (≥0.86) and whole-brain connectivity (≥0.89) across all subregions. DATA CONCLUSION:Across both PET and fMRI task-based assessments, results from MTL-generated segmentations more closely corresponded to results from manually drawn ROIs than CIC-generated segmentations did. Therefore, the proposed MTL approach is a fast and reliable method for three-dimensional striatal subregion segmentation with results comparable to manually segmented ROIs. LEVEL OF EVIDENCE:2 TECHNICAL EFFICACY STAGE: 1.
PMID: 33970510
ISSN: 1522-2586
CID: 5320762

Assessing the reproducibility of CBCT-derived radiomics features using a novel three-dimensional printed phantom

Spuhler, Karl D; Teruel, Jose R; Galavis, Paulina E
PURPOSE/OBJECTIVE:Radiomics modeling is an exciting avenue for enhancing clinical decision making and personalized treatment. Radiation oncology patients often undergo routine imaging for position verification, particularly using LINAC-mounted cone beam computed tomography (CBCT). The wealth of imaging data collected in modern radiation therapy presents an ideal use case for radiomics modeling. Despite this, texture feature (TF) calculation can be limited by concerns over feature stability and reproducibility; in theory, this issue is compounded by the relatively poor image quality of CBCT, as well as variation of acquisition and reconstruction parameters. METHODS:In this study, we developed and validated a novel three-dimensional (3D) printed phantom for evaluating CBCT-based TF reliability. The phantom has a cylindrical shape (22 cm diameter and 25.5 cm height) with five inner inserts designed to hold custom-printed rods (1 cm diameter and 10-20 cm height) of various materials, infill shapes, and densities. TF reproducibility was evaluated across and within three LINACs from a single vendor using sets of three consecutive CBCT taken with the head, thorax, and pelvis clinical imaging protocols. PyRadiomics was used to extract a standard set of TFs from regions of interest centered on each rod. Two-way mixed effects absolute agreement intra-class correlation coefficient (ICC) was used to evaluate TF reproducibility, with features showing ICC values above 0.9 considered robust if their Bonferroni-corrected p-value was below 0.05. RESULTS:A total of 63, 87, and 83 features exhibited test-retest reliability for the head, thorax, and pelvis imaging protocols respectively. When assessing stability between discreet imaging sessions on the same LINAC, these numbers were reduced to 5, 63, and 70 features, respectively. The thorax and pelvis protocols maintained a rich candidate feature space in inter-LINAC analysis with 61 and 65 features, respectively, exceeding the ICC criteria. Crucially, no features were deemed reproducible when compared between protocols. CONCLUSIONS:We have developed a 3D phantom for consistent evaluation of TF stability and reproducibility. For LINACs from a single vendor, our study found a substantial number of features available for robust radiomics modeling from CBCT imaging. However, some features showed variations across LINACs. Studies involving CBCT-based radiomics must preselect features prior to their use in clinical-based models.
PMID: 34120354
ISSN: 2473-4209
CID: 4964812

Dose Perturbation From Titanium Plates in Post-Operative Oral Cavity Volumetric Modulated Arc Therapy: The Utility of Model-Based Algorithm [Meeting Abstract]

Byun, D. J.; Spuhler, K.; Daar, D.; Anzai, L.; Witek, L.; Levine, J.; Jacobson, A.; Barbee, D.; Hu, K. S.
ISSN: 0360-3016
CID: 5071862

PET and fMRI Assessment of 3-D Striatal Segmentation using Multi-Task Learning [Meeting Abstract]

Serrano-Sosa, Mario; Van Snellenberg, Jared; Meng, Jiayan; Spuhler, Karl; Luceno, Jacob; Weinstein, Jodi; Abi-Dargham, Anissa; Slifstein, Mark; Huang, Chuan
ISSN: 0161-5505
CID: 5320892

Data-Driven Generation of CBCT-To-CT HU Mapping for Adaptive Radiotherapy in H&N Cancer [Meeting Abstract]

Wang, H.; Rea, A.; Xue, J.; Spuhler, K.; Qu, T.; Chen, T.; Barbee, D.; Hu, K.
ISSN: 0094-2405
CID: 5320842

The importance of identifying functional Val158Met polymorphism in catechol-O- Methyltransferase when assessing MRI-based volumetric measurements in major depressive disorder

Serrano-Sosa, Mario; Sampathgiri, Kruthika; Spuhler, Karl Douglas; DeLorenzo, Christine; Parsey, Ramin; Huang, Chuan
Many studies have shown volumetric differences in the hippocampus between COMT gene polymorphisms and other studies have shown differences between depressed patients and controls; yet, few studies have been completed to identify the volumetric differences when taking both factors into consideration. Using voxel-based morphology (VBM) we investigated, in major depressive disorder (MDD) patients and healthy controls, the relationship between COMT gene polymorphism and volumetric abnormalities. Data from 60 MDD patients and 25 healthy controls were included in this study. Volumetric measurements and genotyping of COMTval158met polymorphism were conducted to determine its impact on gray matter volume (GMV) in the hippocampus and amygdala using a Met dominant model (Val/Val vs Met/Val & Met/Met). In the analysis, a significant difference in the right hippocampus (p = 0.015), right amygdala (p = 0.003) and entire amygdala (p = 0.019) was found between the interaction of diagnosis and genotype after MRI scanner, age and sex correction. Healthy controls (HC) with the Met dominant genotype exhibited a larger right hippocampal, right amygdalar and entire amydgalar volume than MDD patients with the Met dominant genotype. Conversely, HC with the Val/Val genotype displayed a lower right hippocampal, right amygdalar and entire amygdalar volume than their MDD counterparts. This study shows that COMT polymorphism and depression may have a confounding effect on neuroimaging studies.
PMID: 31898087
ISSN: 1931-7565
CID: 5320742

Full-count PET recovery from low-count image using a dilated convolutional neural network

Spuhler, Karl; Serrano-Sosa, Mario; Cattell, Renee; DeLorenzo, Christine; Huang, Chuan
PURPOSE/OBJECTIVE:Positron emission tomography (PET) is an essential technique in many clinical applications that allows for quantitative imaging at the molecular level. This study aims to develop a denoising method using a novel dilated convolutional neural network (CNN) to recover full-count images from low-count images. METHODS:F-Fluorodeoxyglucose (FDG) study. Low-count PET data (10% count) were generated by randomly selecting one-tenth of all events in the associated listmode file. Analysis was done on the static image from the last 10 minutes of emission data. Both low-count PET and full-count PET were reconstructed using ordered subset expectation maximization (OSEM). Objective image quality metrics, including mean absolute percent error (MAPE), peak signal-to-noise ratio (PSNR), and structural similarity index metric (SSIM), were used to analyze the deep learning methods. Both deep learning methods were further compared to a traditional Gaussian filtering method. Further, region of interest (ROI) quantitative analysis was also used to compare U-Net and dNet architectures. RESULTS:Both the U-Net and our proposed network were successfully trained to synthesize full-count PET images from the generated low-count PET images. Compared to low-count PET and Gaussian filtering, both deep learning methods improved MAPE, PSNR, and SSIM. Our dNet also systematically outperformed U-Net on all three metrics (MAPE: 4.99 ± 0.68 vs 5.31 ± 0.76, P < 0.01; PSNR: 31.55 ± 1.31 dB vs 31.05 ± 1.39, P < 0.01; SSIM: 0.9513 ± 0.0154 vs 0.9447 ± 0.0178, P < 0.01). ROI quantification showed greater quantitative improvements using dNet over U-Net. CONCLUSION/CONCLUSIONS:This study proposed a novel approach of using dilated convolutions for recovering full-count PET images from low-count PET images.
PMID: 32687608
ISSN: 2473-4209
CID: 5320752

Assessment of Texture Feature Robustness Using a Novel 3D-Printed Phantom [Meeting Abstract]

Spuhler, K.; Teruel, J.; Galavis, P.
ISSN: 0094-2405
CID: 5320862