Faculty Bibliography

Patients with renal cell carcinoma may develop metastases after radical nephrectomy, and therefore monitoring with imaging for recurrent or metastatic disease is critical. Imaging varies with specific suspected site of disease. Computed tomography/MRI of the abdomen and pelvis are mainstay modalities. Osseous and central nervous system imaging is reserved for symptomatic patients. Radiologic reporting is evolving to reflect effects of systemic therapy on lesion morphology. Nuclear medicine studies compliment routine imaging as newer agents are evaluated for more accurate tumor staging. Imaging research aims to fill gaps in treatment selection and monitoring of treatment response in metastatic renal cell carcinoma.

Coronavirus disease 2019 (COVID-19) is a serious public health crisis and can have neurologic manifestations. This is a retrospective observational case series performed March 1-31, 2020, at New York University Langone Medical Center campuses. Clinical and imaging data were extracted, reviewed, and analyzed. Two hundred forty-two patients with COVID-19 underwent CT or MRI of the brain within 2 weeks after the positive result of viral testing (mean age, 68.7 ± 16.5 years; 150 men/92 women [62.0%/38.0%]). The 3 most common indications for imaging were altered mental status (42.1%), syncope/fall (32.6%), and focal neurologic deficit (12.4%). The most common imaging findings were nonspecific white matter microangiopathy (134/55.4%), chronic infarct (47/19.4%), acute or subacute ischemic infarct (13/5.4%), and acute hemorrhage (11/4.5%). No patients imaged for altered mental status demonstrated acute ischemic infarct or acute hemorrhage. White matter microangiopathy was associated with higher 2-week mortality (P < .001). Our data suggest that in the absence of a focal neurologic deficit, brain imaging in patients with early COVID-19 with altered mental status may not be revealing.

The cavernous sinus is a complex structure susceptible to a wide variety of vascular, neoplastic and inflammatory pathologies. Vascular pathologies include ICA aneurysms, carotid-cavernous fistulas, cavernous sinus thrombosis, and cavernous hemangioma. Neoplasms that involve the cavernous sinus include pituitary adenoma, meningioma, schwannoma, lymphoma, perineural tumor spread, metastases, and direct tumor invasion. Infectious and inflammatory diseases include Tolosa-Hunt syndrome, sarcoidosis, granulomatosis with polyangiitis, IgG-4 related disease and invasive fungal infections. In this article, we review the clinical and imaging findings of a number of pathologies involving the cavernous sinus, focusing on key features that can narrow the differential diagnosis and, in some cases, support a particular diagnosis.

Coronavirus disease 2019 (COVID-19) has been reported in association with a variety of brain imaging findings such as ischemic infarct, hemorrhage, and acute hemorrhagic necrotizing encephalopathy. Here, we report brain imaging features in 11 critically ill COVID-19 patients with persistently depressed mental status who underwent MRI between April 5-25, 2020 at our institution. These features include, 1) Confluent T2 hyperintensity and mild restricted diffusion in bilateral supratentorial deep and subcortical white matter (in 10 of 11 patients), and 2) multiple punctate microhemorrhages in juxtacortical and callosal white matter (in 7 of 11 patients). We also discuss potential pathogeneses.

BACKGROUND AND PURPOSE/OBJECTIVE:Conventional imaging frequently shows overlapping features between benign and malignant parotid neoplasms. We investigated dynamic contrast-enhanced MR imaging using golden-angle radial sparse parallel imaging in differentiating parotid neoplasms. MATERIALS AND METHODS/METHODS:= 32) combined semiquantitative time-intensity curve metrics with ADC values. RESULTS:< .001). CONCLUSIONS:Golden-angle radial sparse parallel MR imaging allows high spatial and temporal resolution permeability characterization of parotid neoplasms, with a high negative predictive value for malignancy prediction. Combining time-to-maximum and ADC improves pleomorphic adenoma prediction compared with either metric alone.

Purpose: Concurrent chemotherapy with radiotherapy is the standard of care for locally advanced oropharyngeal cancer patients. However, the main drawback of this approach is the high toxicities experienced by the patients. This has motivated new clinical trials that investigate the role of imaging biomarkers in dose de-escalation to mitigate the side effects of treatments.
Method(s): Ten patients from an institutional phase II clinical trial were CE-CT (Contrast-Enhanced-CT) simulated prior to starting radiotherapy treatment and at week-four as part of the protocol. A radiation oncologist manually contoured the GTVn (primary nodal disease) on both scans. Based on GTVn volume variation (>=40%) patients were eligible/ineligible for dose de-escalation. CE-CT scans and contours were transfer to IBEX for texture-feature calculation. The relative net change for 77 texture-features was calculated. The Pearson correlation coefficient (r) was used to correlate the volume change with the feature changes. Texture-features that presented an r >0.5 are possible candidates for treatment assessment. Significance level was evaluated using the t-test (P < 0.05) Results: Eight patients met criteria for mid-treatment nodal response and were de-escalated. For the two patients who proceeded with standard treatment, shape texture-features variation were low, ranging [-6% to 14%] when compared to de-escalated patients range [-0% to 60%]. Across all the patients two shape features (surface area and surface area density) showed high correlation with node-tumor volume changes, with r-values of 0.81 (P < 0.05) and -0.66 (P < 0.05). Histogram-based-likeskewness showed a medium correlation with r-value of 0.52 (P > 0.05), whereas dissimilarity feature from the Gray-Level-Occurrence-Matrix showed correlation of 0.63 (P < 0.05).
Conclusion(s): Features with high Pearson correlation values are potential candidates to be used as additional metrics for treatment assessment. The study includes other imaging modalities (e.g MRI and PET) which will be included as a future work. More analysis will be added to the study as more patients are continually enrolled in the protocol