Publications by authors named "Houman Sotoudeh"

37 Publications

Skull base osteomyelitis imaging.

Curr Opin Otolaryngol Head Neck Surg 2021 Oct;29(5):333-341

Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.

Purpose Of Review: Skull base osteomyelitis (SBO) is a challenging entity to diagnose and treat. The goal of this review is to summarize the imaging findings of SBO and present these in the context of recent studies on imaging of SBO.

Recent Findings: This review discusses the clinical presentation, pathophysiology and imaging appearances of SBO. The review further emphasizes the results of latest studies on imaging of SBO, and the role of different modalities in diagnosis and evaluation of disease course and treatment response. Brief discussion on differential diagnoses from an imaging standpoint is also included.

Summary: Various imaging modalities play different and complimentary roles in diagnosis and management of SBO, which are discussed in this review.
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http://dx.doi.org/10.1097/MOO.0000000000000747DOI Listing
October 2021

Leveraging artificial intelligence in ischemic stroke imaging.

J Neuroradiol 2021 May 11. Epub 2021 May 11.

Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35294, USA. Electronic address:

Artificial intelligence (AI) is having a disruptive and transformative effect on clinical medicine. Prompt clinical diagnosis and imaging are critical for minimizing the morbidity and mortality associated with ischemic strokes. Clinicians must understand the current strengths and limitations of AI to provide optimal patient care. Ischemic stroke is one of the medical fields that have been extensively evaluated by artificial intelligence. Presented herein is a review of artificial intelligence applied to clinical management of stroke, geared toward clinicians. In this review, we explain the basic concept of AI and machine learning. This review is without coding and mathematical details and targets the clinicians involved in stroke management without any computer or mathematics' background. Here the AI application in ischemic stroke is summarized and classified into stroke imaging (automated diagnosis of brain infarction, automated ASPECT score calculation, infarction segmentation), prognosis prediction, and patients' selection for treatment.
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http://dx.doi.org/10.1016/j.neurad.2021.05.001DOI Listing
May 2021

The Role of Medical Imaging in COVID-19.

Adv Exp Med Biol 2021 ;1318:413-434

Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran.

The coronavirus disease 2019 (COVID-19) pandemic launched in the third decade of the twenty-first century and continued to present time to cause the worst challenges the modern medicine has ever encountered. Medical imaging is an essential part of the universal fight against this pandemic. In the absence of documented treatment and vaccination, early accurate diagnosis of infected patients is the backbone of this pandemic management. This chapter reviews different aspects of medical imaging in the context of COVID-19.
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http://dx.doi.org/10.1007/978-3-030-63761-3_24DOI Listing
May 2021

Current Status and Quality of Machine Learning-Based Radiomics Studies for Glioma Grading: A Systematic Review.

Oncology 2021 13;99(7):433-443. Epub 2021 Apr 13.

Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, Alabama, USA.

Introduction: Radiomics now has significant momentum in the era of precision medicine. Glioma is one of the pathologies that has been extensively evaluated by radiomics. However, this technique has not been incorporated into clinical practice. In this systematic review, we selected and reviewed the published studies about glioma grading by radiomics to evaluate this technique's feasibility and its challenges.

Material And Methods: Using seven different search strings, we considered all published English manuscripts from 2015 to September 2020 in PubMed, Embase, and Scopus databases. After implementing the exclusion and inclusion criteria, the final papers were selected for the methodological quality assessment based on our in-house Modified Radiomics Standard Scoring (RQS) containing 43 items (minimum score of 0, maximum score of 44). Finally, we offered our opinion about the challenges and weaknesses of the selected papers.

Results: By our search, 1,177 manuscripts were found (485 in PubMed, 343 in Embase, and 349 in Scopus). After the implementation of inclusion and exclusion criteria, 18 papers remained for the final analysis by RQS. The total RQS score ranged from 26 (59% of maximum possible score) to 43 (97% of maximum possible score) with a mean of 33.5 (76% of maximum possible score).

Conclusion: The current studies are promising but very heterogeneous in design with high variation in the radiomics software, the number of extracted features, the number of selected features, and machine learning models. All of the studies were retrospective in design; many are based on small datasets and/or suffer from class imbalance and lack of external validation data-sets.
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http://dx.doi.org/10.1159/000515597DOI Listing
July 2021

Susceptibility-Weighted Imaging in Neurodegenerative Disorders: A Review.

J Neuroimaging 2021 05 23;31(3):459-470. Epub 2021 Feb 23.

Department of Radiology, University of Alabama at Birmingham (UAB), Birmingham, AL.

As human life expectancy increases, there is an increased prevalence of neurodegenerative disorders and dementia. There are many ongoing research trials for early diagnosis and management of dementia, and neuroimaging is a critical part of such studies. However, conventional neuroimaging often fails to provide enough diagnostic findings in patients with neurodegenerative disorders. In this context, different MRI sequences are currently under investigation to facilitate the accurate diagnosis of such disorders. Susceptibility-weighted imaging (SWI) is an innovative MRI technique that utilizes "magnitude" and "phase" images to produce an image contrast that is sensitive for the detection of susceptibility differences of the tissues. As many neurodegenerative disorders are associated with accelerated iron deposition and/or microhemorrhages in different parts of the brain, SWI can be applied to detect these diagnostic clues. For instance, in cerebral amyloid angiopathy, SWI can demonstrate cortical microhemorrhages, which are predominantly in the frontal and parietal regions. Or in Parkinson disease, abnormal swallow-tail sign on high-resolution SWI is highly diagnostic. Also, SWI is a useful sequence to detect the low signal intensity of precentral cortices in patients with amyotrophic lateral sclerosis. Being familiar with SWI findings in neurodegenerative disorders is critical for an accurate diagnosis. In this paper, the authors review the technical parameters of SWI, physiologic, and pathologic iron deposition in the brain, and the role of SWI in the evaluation of neurodegenerative disorders in daily practice.
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http://dx.doi.org/10.1111/jon.12841DOI Listing
May 2021

Optic Nerve Infarction in a Patient With Coronavirus Disease 2019.

J Neuroophthalmol 2021 Mar 23. Epub 2021 Mar 23.

Departments of Ophthalmology and Visual Sciences (MT, MSV, LBK) and Neuroradiology (HS, AR, ZS), University of Alabama at Birmingham School of Medicine, Birmingham, Alabama.

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http://dx.doi.org/10.1097/WNO.0000000000001232DOI Listing
March 2021

Artificial Intelligence Empowers Radiologists to Differentiate Pneumonia Induced by COVID-19 versus Influenza Viruses.

Acta Inform Med 2020 Sep;28(3):190-195

Internal Medicine Department, Amir Al Momenin Hospital, Arak, Iran.

Background: Given the current pandemic, differentiation between pneumonia induced by COVID-19 or influenza viruses is of utmost clinical significance in the patients' management. For this purpose, this study was conducted to develop sensitive artificial intelligence (AI) models to assist radiologists to decisively differentiate pneumonia due to COVID-19 versus influenza viruses.

Methods: Cross sectional chest CT images (N=12744) from well-evaluated cases of pneumonias induced by COVID-19 or H1N1 Influenza viruses, and normal individuals were collected. We examined the computer tomographic (CT) chest images from 137 individuals. Various pre-trained convolutional neural network models, such as ResNet-50, InceptionV3, Wide ResNet, SqueezNet, VGG 16 and VGG 19 were fine-tuned on our datasets. The datasets were used for training (60%), validation (20%), and testing (20%) of the final models. Also, the predictive power and means of precision and recall were determined for each model.

Results: Fine-tuned model differentiated the pneumonia due to COVID-19 or H1N1 influenza virus with accuracies of 96.7% and 92%, respectively This model outperformed all others, i.e., InceptionV3, Wide ResNet, SqueezNet, VGG 16 and VGG 19.

Conclusion: Fine-tuned and pre-trained image classifying models of AI enable radiologists to reliably differentiate the pneumonia induced by COVID-19 versus H1N1 influenza virus. For this purpose, followed by models proved more promising than other AI models. Also in the supplements, we share the source codes and our fine-tuned models for use by researchers and clinicians globally toward the critical task of image differentiation of patients infected with COVID-19 versus H1N1 Influenza viruses.
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http://dx.doi.org/10.5455/aim.2020.28.190-195DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7780838PMC
September 2020

Brainstem Encephalitis. The Role of Imaging in Diagnosis.

Curr Probl Diagn Radiol 2020 Sep 24. Epub 2020 Sep 24.

University of Alabama at Birmingham (UAB), Birmingham, AL.

Encephalitis is a relatively challenging rare condition caused by a diverse group of etiologies. Brainstem encephalitis/Rhombencephalitis (BE), which affects the cerebellum, pons, and medulla, is even less common and more challenging for diagnosis and treatment. At this time, there is scattered data about BE in the literature, mainly in the form of case reports and case series. In this manuscript, the imaging presentation of BE is reviewed with the help of case examples. Many imaging presentations are not pathognomonic for BE; however, in many cases, clinical presentation, the spatial distribution of lesions, and other associated radiological lesions can provide the radiologists and clinician the clues to an accurate diagnosis.
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http://dx.doi.org/10.1067/j.cpradiol.2020.09.004DOI Listing
September 2020

Heavily calcified parapharyngeal space mesenchymal chondrosarcoma: Imaging and pathological findings and a review of the literature.

Neuroradiol J 2021 Feb 30;34(1):45-48. Epub 2020 Sep 30.

Division of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, USA.

Parapharyngeal space (PPS) masses are relatively rare lesions of the head and neck, and account for 0.5-1.5% of head and neck lesions. The most common lesion to occur in the PPS is a benign salivary neoplasm, typically pleomorphic adenoma either from the deep parotid or from ectopic parotid tissue rests within the PPS. A calcified or ossified mass in this location is exceedingly rare, but a calcified variant of pleomorphic adenoma has been reported. In this study, we present a patient with a heavily calcified PPS mesenchymal chondrosarcoma with an unusual presentation. We discuss the imaging and pathologic findings followed by a review of the current literature.
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http://dx.doi.org/10.1177/1971400920962821DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868586PMC
February 2021

Intraventricular metastatic melanoma: A case report and review of the literature.

Clin Case Rep 2020 Sep 3;8(9):1757-1764. Epub 2020 Jul 3.

Department of Neurosurgery The University of Alabama at Birmingham Birmingham AL USA.

Intraventricular melanoma is a very rare and highly malignant disease. Safe resection is the mainstay of treatment, but no standard guidelines exist for adjuvant therapy. Early histologic and molecular diagnosis is key for improved survival.
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http://dx.doi.org/10.1002/ccr3.2983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495808PMC
September 2020

Noncirrhotic Hyperammonemic Encephalopathy Causing Bilateral Cortical Diffusion Restrictions.

Neurohospitalist 2020 Oct 21;10(4):331-332. Epub 2020 May 21.

Division of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, AL, USA.

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http://dx.doi.org/10.1177/1941874420926072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495696PMC
October 2020

NKX3.1 Identifies Prostatic Origin of Dural Metastasis in the Setting of Negative Prostate-Specific Antigen Stain.

Neurohospitalist 2020 Oct 5;10(4):314-317. Epub 2020 Jun 5.

Department of Neurology, University of Alabama at Birmingham, AL, USA.

No clear guidelines exist for the appropriate diagnostic workup of an intracranial mass suspected to be a metastasis from unknown primary origin. Dural metastasis from prostatic origin is very rare. Patients with a known history of metastatic prostate cancer who present with a newly discovered lesion on brain imaging require neurosurgical biopsy to confirm diagnosis prior to initiating treatment. Intracranial metastasis from prostate cancer is rare, and dural metastasis is rarer than intraparenchymal metastasis. Current consensus guidelines support immunohistochemical staining with classic markers such as prostate-specific antigen (PSA) to identify prostatic origin. However, PSA detection of prostate metastases declines with higher Gleason scores and in patients undergoing androgen deprivation therapy. NKX3.1 is another stain that is highly sensitive and specific for prostate. Our patient was a 54-year-old man with a history of metastatic prostate cancer who presented with new-onset seizures. Brain imaging revealed a dural-based lesion with surrounding vasogenic edema and midline shift. The patient underwent resection of the lesion, which was stained with multiple cancer markers. Prostate-specific antigen was negative, but NKX3.1 was positive indicating a prostatic origin for the mass. He underwent a craniectomy to remove the lesion and was given steroids. However, he succumbed to his illness several months later. Here, we document the first report to our knowledge of a patient with prostate metastasis to the dura that is PSA negative, but NKX3.1 positive.
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http://dx.doi.org/10.1177/1941874420931232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495695PMC
October 2020

Critical illness-associated cerebral microbleed in a patient with sickle cell disease: A case report and review of the literature.

Clin Imaging 2020 Dec 25;68:184-187. Epub 2020 Jul 25.

Division of Neuroradiology, Department of Radiology, University of Alabama at Birmingham, 619 19th St S, Birmingham, AL 35294, USA. Electronic address:

Critical illness-associated cerebral microbleed (CICM) is a relatively rare and newly described condition. It can occur in critically ill ICU patients and can be secondary to many underlying etiologies. CICM is associated with high mortality and permanent neurologic deficits in surviving patients. Distribution of cerebral microhemorrhages in neuroimaging findings is critical for accurate diagnosis of this condition. Here, we present an ICU admitted patient with sickle cell disease crisis and CICM and will discuss their clinically and radiologically distinct phenomenon followed by a review of current literature.
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http://dx.doi.org/10.1016/j.clinimag.2020.07.014DOI Listing
December 2020

A hypothesis about the role of fetal hemoglobin in COVID-19.

Med Hypotheses 2020 Nov 12;144:109994. Epub 2020 Jun 12.

Department of Radiology and Neurology, University of Alabama at Birmingham (UAB), 619 19th St S, Birmingham, AL 35294, United States. Electronic address:

COVID-19 infection is less common in children (with higher fetal hemoglobin levels). In our preliminary study, we also observed a low prevalence and fatality of COVID-19 in countries with high rate of hemoglobinopathy carries. Given these two facts, the hemoglobin structure can play a role in the physiopathology of COVID-19 disease. Several drugs are known to increase fetal hemoglobin in adults. Adding these drugs to COVID-19 clinical trials may improve the patients' outcomes.
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http://dx.doi.org/10.1016/j.mehy.2020.109994DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834262PMC
November 2020

18F-FDG Uptake in a T2 Hypointense Paraspinal Mass.

Clin Nucl Med 2020 May;45(5):385-386

From the Section of Neuroradiology, Department of Radiology.

We present a paraspinal amyloidoma found incidentally in a 77-year-old man during lymphoma workup by F-FDG PET/CT. A solitary FDG-avid paraspinal lesion was seen at T11-T12. MRI showed T2 hypointensity and enhancement. Lymphoma was considered the primary differential due to FDG uptake, but biopsy revealed nodules of extracellular acellular homogeneous material with apple-green birefringence on Congo red stain consistent with amyloidoma. Spinal amyloidoma is rare with few cases reported so far in literature.
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http://dx.doi.org/10.1097/RLU.0000000000002976DOI Listing
May 2020

Cauda equina syndrome in an ovarian malignant-mixed müllerian tumor with leptomeningeal spread.

Clin Case Rep 2019 Dec 22;7(12):2341-2345. Epub 2019 Oct 22.

Department of Neurology University of Alabama at Birmingham Birmingham AL USA.

Leptomeningeal metastasis is extremely rare in patients with ovarian cancer, but should be considered in patients presenting with neurologic deficits such as cauda equine syndrome. Given its poor prognosis and lack of data currently on management, additional studies are needed to optimize treatment regimens and improve outcomes.
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http://dx.doi.org/10.1002/ccr3.2472DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6935635PMC
December 2019

F-Sodium Fluoride PET: History, Technical Feasibility, Mechanism of Action, Normal Biodistribution, and Diagnostic Performance in Bone Metastasis Detection Compared with Other Imaging Modalities.

J Nucl Med Technol 2020 Mar 6;48(1):9-16. Epub 2019 Dec 6.

Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama

The skeleton is the third most common site for metastasis overall, after the lungs and liver. Accurate diagnosis of osseous metastasis is critical for initial staging, treatment planning, restaging, treatment monitoring, and survival prediction. Currently, Tc-methylene diphosphonate whole-body scanning is the cornerstone of imaging to detect osseous metastasis. Although F-sodium fluoride (F-NaF) was one of the oldest medical tracers for this purpose, it was replaced by other tracers because of their better physical properties, until recently. Continued development of PET scanners has opened a new era for F-NaF, and given its higher sensitivity, there have been increasing applications in imaging. In this review, we will discuss the history, technical aspects, radiobiology, and biodistribution of this tracer. Finally, we compare the accuracy of F-NaF PET with other conventional imaging methods for detection of osseous metastasis.
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http://dx.doi.org/10.2967/jnmt.119.234336DOI Listing
March 2020

Superior ophthalmic vein thrombosis: What radiologist and clinician must know?

Eur J Radiol Open 2019 11;6:258-264. Epub 2019 Jul 11.

Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Hale Building, 60 Fenwood Road, Boston, MA 02115, USA.

Purpose: Superior ophthalmic vein thrombosis (SOVT) is an extremely rare condition. Few studies have been published about clinical aspects of this condition. In this study, we have studied the symptoms, underlying etiologies, treatment, pathogenesis and complication of the SOVT and we tried to classify it based on the etiology, treatment, and prognosis.

Methods: We reviewed the patients' data from a tertiary academic referral center. Each patient with SOVT was then reviewed for symptoms associated with SOVT, underlying etiology, treatment protocol, treatment response, complications, possible pathogens, and final outcome.

Results: Twenty-four cases of SOVT were included in this study. Overall, 13 cases were diagnosed as right-sided SOVT, out of which, eight had simultaneous right-sided cavernous sinus thrombosis (CST). Eighteen cases were diagnosed to have left-sided SOVT, out of which, 11 had simultaneous left-sided CST.

Conclusions: The SOVT can be secondary to different mechanisms. The SOVT secondary to trauma, recent surgery and coagulopathy are mostly non-aggressive, and can be managed by conservative therapy and anticoagulation. The SOVT in patients with orbital cellulitis, history of active sinusitis or paranasal sinus surgery are aggressive presenting with acute orbital swelling, abscess and visual loss. This type of SOVT can be complicated by extension to the cavernous sinus and intracranial structures. These patients require urgent antibiotics therapy and sinus surgery. The most severe type of SOVT is caused by mucormycosis which may also extend intracranially resulting in stroke and is often life-threatening.
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http://dx.doi.org/10.1016/j.ejro.2019.07.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6796573PMC
July 2019

Pseudohypoxic Brain Swelling: Report of 2 Cases and Introduction of the Lentiform Rim Sign as Potential MRI Marker.

World Neurosurg 2020 Jan 10;133:221-226. Epub 2019 Oct 10.

Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: A rare but important complication related to otherwise uneventful brain and spine surgery is becoming more recognized and more frequently reported in the medical literature. This has been variably labeled as pseudohypoxic brain swelling or postoperative hypotension-associated venous congestion. This poorly understood condition occurs in the setting of surgical intervention and is thought to be related to cerebrospinal fluid leak or evacuation, decreased intracranial pressure, and subsequent development of deep venous congestion affecting the basal ganglia, thalami, and cerebellum. Clinically, patients may have global neurologic deficit and outcomes range from full recovery to vegetative state or death. The imaging correlate includes atypical edema, infarction, or hemorrhage and can overlap the appearance of diffuse hypoxic injury, for which this condition can be mistaken both clinically and radiologically. Although this deep brain tissue edema can be associated with other signs of cerebrospinal fluid hypotension such as dural thickening, brain sagging, and cerebellar herniation, it can be isolated, making the diagnosis challenging.

Case Description: We present 2 cases of unexpected clinical deterioration occurring in patients with otherwise uncomplicated neurosurgery, 1 with craniotomy and the other with lumbar spine intervention. Both patients exhibit similar appearing edema in the deep gray structures on postoperative magnetic resonance imaging scans. In addition to reviewing the prior literature and imaging findings, we evaluate the imaging findings to determine if there are unique features or signatures that might allow differentiation of PHBS from hypoxic-ischemic encephalopathy.

Conclusions: The lentiform rim sign can be helpful for differentiation of pseudohypoxic brain swelling versus hypoxic-ischemic encephalopathy.
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http://dx.doi.org/10.1016/j.wneu.2019.10.018DOI Listing
January 2020

Artificial Intelligence in the Management of Glioma: Era of Personalized Medicine.

Front Oncol 2019 14;9:768. Epub 2019 Aug 14.

Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Alabama, Birmingham, AL, United States.

Artificial intelligence (AI) has accelerated novel discoveries across multiple disciplines including medicine. Clinical medicine suffers from a lack of AI-based applications, potentially due to lack of awareness of AI methodology. Future collaboration between computer scientists and clinicians is critical to maximize the benefits of transformative technology in this field for patients. To illustrate, we describe AI-based advances in the diagnosis and management of gliomas, the most common primary central nervous system (CNS) malignancy. Presented is a succinct description of foundational concepts of AI approaches and their relevance to clinical medicine, geared toward clinicians without computer science backgrounds. We also review novel AI approaches in the diagnosis and management of glioma. Novel AI approaches in gliomas have been developed to predict the grading and genomics from imaging, automate the diagnosis from histopathology, and provide insight into prognosis. Novel AI approaches offer acceptable performance in gliomas. Further investigation is necessary to improve the methodology and determine the full clinical utility of these novel approaches.
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http://dx.doi.org/10.3389/fonc.2019.00768DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6702305PMC
August 2019

Misleading CT perfusion in subacute ischemic stroke.

Emerg Radiol 2019 Oct 20;26(5):581-586. Epub 2019 Aug 20.

Department of Surgery, Iranian Hospital in Dubai, P.O. Box 2330, Al-Wasl Road, Dubai, 2330, United Arab Emirates.

The RAPID© software is the most commonly used computed tomography perfusion (CTP) software in stroke centers. It is estimated that about 1300 hospitals in the world are using this software for decision-making in ischemic stroke. The software provides the estimated volume of infarction and ischemic penumbra, so it is the backbone of treatment planning in these patients. In this manuscript, we present two cases of subacute infarction with misleading CTP using RAPID© software. We believe that given the popularity of this software and increasing application of CTP in subacute infarction, this pitfall is likely underdiagnosed in many patients. In a subacute phase of infarction, we recommend diffusion-weighted imaging magnetic resonance imaging (DWI-MRI) for estimation of infarction to avoid this pitfall and possible mismanagement.
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http://dx.doi.org/10.1007/s10140-019-01719-7DOI Listing
October 2019

Angiosarcoma of the Temporal Bone: Case Report and Review of the Literature.

World Neurosurg 2019 Oct 19;130:351-357. Epub 2019 Jul 19.

Department of Neuroradiology, University of Alabama at Birmingham, Birmingham, Alabama, USA. Electronic address:

Background: Angiosarcomas are rare malignant tumors of endothelial origin. Nearly one half of all angiosarcomas occur in the head and neck. Temporal bone angiosarcomas are extremely uncommon. We present a case of temporal bone angiosarcoma and a review of the relevant data.

Case Description: We present the case of a 20-year-old man with a painful right postauricular mass after a closed head injury. Radiologic studies demonstrated a large right osteolytic and heterogeneously enhancing mass. The patient underwent right transpetrosal craniectomy for resection. Histologic studies confirmed high-grade sarcoma. Immunohistochemical staining demonstrated a uniformly positive ERG endothelial marker, CD31 staining with cytoplasmic and membranous patterns of immunopositivity, positive nuclear staining for FLI-1, positive cytoplasmic and membranous staining for CD99 and STAT6, and negative smooth muscle actin stains in the neoplastic cells. Ki-67 staining showed ∼94% positivity in the neoplastic cell nuclei. Postoperative follow-up imaging studies demonstrated evidence of metastatic right cervical lymphadenopathy.

Conclusions: Angiosarcoma of the temporal bone is extremely uncommon. In the present case report, we explored a relationship between trauma and angiosarcoma of the temporal bone. We reviewed the reported data regarding the pathogenesis, diagnosis, treatment, radiologic findings, and histologic characteristics of angiosarcoma of the temporal bone.
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http://dx.doi.org/10.1016/j.wneu.2019.07.107DOI Listing
October 2019

Fungal Peritonitis with Fungus Balls, a Complication of Trichobezoars and Rapunzel Syndrome.

Am J Case Rep 2019 May 13;20:685-688. Epub 2019 May 13.

Department of Radiology and Neurology, University of Alabama at Birmingham, Birmingham, AL, USA.

BACKGROUND Rapunzel syndrome is a rare condition involving the extension of bezoars from the stomach to the distal gastrointestinal tract. Laparotomy remains the gold standard treatment for this condition because of the size of the bezoars. Although bacterial peritonitis is a known complication of laparotomy in Rapunzel syndrome, very few cases of post-surgical fungal peritonitis have been reported in these patients. CASE REPORT In this case report we present Rapunzel syndrome complicated by post-surgical fungal peritonitis and formation of fungus balls. To our knowledge, fungal peritonitis with fungus balls has never been reported as a Rapunzel syndrome complication.  CONCLUSIONS It is important to cover Candida and other fungi with an antifungal regimen in pediatric patients with Rapunzel syndrome pre- and post-surgery. In addition, prolonged fever and septic symptoms post-surgery warrant a search for peritoneal fungus balls that are not simply responsive to anti-fungal therapy and may necessitate repeat laparotomy.
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http://dx.doi.org/10.12659/AJCR.915517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530519PMC
May 2019

SUMOylation in Glioblastoma: A Novel Therapeutic Target.

Int J Mol Sci 2019 Apr 15;20(8). Epub 2019 Apr 15.

Department of Neurosurgery, University of Alabama at Birmingham, 1060 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35223, USA.

Protein SUMOylation is a dynamic post-translational modification which is involved in a diverse set of physiologic processes throughout the cell. Of note, SUMOylation also plays a role in the pathobiology of a myriad of cancers, one of which is glioblastoma (GBM). Accordingly, herein, we review core aspects of SUMOylation as it relates to GBM and in so doing highlight putative methods/modalities capable of therapeutically engaging the pathway for treatment of this deadly neoplasm.
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http://dx.doi.org/10.3390/ijms20081853DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6514907PMC
April 2019

"Code-Stroke" CT Perfusion; Challenges and Pitfalls.

Acad Radiol 2019 11 14;26(11):1565-1579. Epub 2019 Jan 14.

Resident of Radiology, Department of Neuroradiology, University of Alabama at Birmingham, Birmingham, Alabama; Department of Neuroradiology; University of Alabama at Birmingham, Birmingham, Alabama.

Rationale And Objectives: Regarding the most recent ischemic stroke treatment guideline, perfusion imaging has been recommended up to 24 hours after initial symptoms of brain infarction. Patients with a significant amount of salvageable peri-infarct ischemia and no contraindications benefit from delayed thrombolysis and intra-arterial thrombectomy. This approach causes increasingly more CT perfusion to be done in the subacute phase of ischemic stroke. CT perfusion findings in this "subacute phase" are slightly different from "hyper-acute" ischemic stroke. The interpreting radiologist must be confident in reporting the CT perfusion study in an urgent setting since these studies are under the umbrella of "code-stroke" and should be read in minutes. In addition, results of the CT perfusion have a critical effect on the patient's outcome and misinterpretation can be fatal in that underestimation of the salvageable ischemia excludes the patient from potential effective treatment. Underestimation of infarct volume may cause unnecessary thrombolysis/thrombectomy and potentially fatal intracranial hemorrhage.

Materials And Methods: In this review, we are trying to explain the basic concept of "code-stroke" CT perfusion, typical findings, and pitfalls in a practical way.
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http://dx.doi.org/10.1016/j.acra.2018.12.013DOI Listing
November 2019

Luxury perfusion: A paradoxical finding and pitfall of CT perfusion in subacute infarction of brain.

Radiol Case Rep 2019 Jan 1;14(1):6-9. Epub 2018 Oct 1.

Department of Radiology, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA.

In the context of recent guidelines for stroke management, application of computed tomographic perfusion (CTP) is anticipated to increase, especially within 6-24 hours after stroke onset. There are commercially available software packages to help to detect the infarct core and the penumbra, however, the results of these software are not always straightforward that might cause incorrect CTP interpretation. We present here a case of acute ischemic stroke in which the CTP software misinterpreted the results by labeling the normal hemisphere as infarction and ischemia due to luxury perfusion of the infarcted hemisphere. Awareness of laterality of the patient's symptoms and the understanding of functioning of perfusion analysis software is necessary to avoid this pitfall.
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http://dx.doi.org/10.1016/j.radcr.2018.08.031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6168926PMC
January 2019

Spinal canal meningioma mimicking posterior fossa ischemia on CT perfusion: A CT perfusion pitfall.

Authors:
Houman Sotoudeh

Radiol Case Rep 2018 Oct 1;13(5):1069-1071. Epub 2018 Jun 1.

Neuroradiology Department, University of Alabama at Birmingham, JTN 333, 619 19th St S, Birmingham, AL 35294, USA.

The recent approach to treat acute stroke is to extend treatment window in patients with salvageable peri-infarct ischemia which increases the application of the perfusion imaging, specifically computed tomography perfusion (CTP). In this paper, I am presenting a case of left middle cerebral artery infarction which was evaluated by CTP under "code stroke." The patient had an incidental spinal canal meningioma which was out of field of view in CTP but mimicked right cerebellar ischemia on CTP. Although ischemia has been previously reported within the peripheral parenchymal edema surrounding a meningioma, in this patient there was no evidence of edema in the right cerebellum on magnetic resonance imaging. I believe the CTP findings are secondary to steal phenomena at right vertebral artery or compression upon the venous plexus. Recently, by using modern computed tomography scanners, it is common to cover the entire brain in CTP. The emergency radiologist should be aware of this pitfall that spinal canal pathologies which are out of field of view can mimic posterior fossa ischemia.
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http://dx.doi.org/10.1016/j.radcr.2018.04.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137824PMC
October 2018

Pretreatment Evaluation of Glioma.

Neuroimaging Clin N Am 2016 Nov 3;26(4):567-580. Epub 2016 Sep 3.

Division of Neuroradiology, Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Electronic address:

Glioma is considered the most common type of primary central nervous system (CNS) tumor. Imaging is crucial for diagnosis, characterization, grading, and therapeutic planning of CNS gliomas. Along with a brief description of conventional computed tomography and magnetic resonance imaging techniques, this article reviews the ever-developing role of modern imaging techniques in preoperative management of CNS gliomas. It discusses current clinical applications, promising features, and limitations of each imaging method.
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http://dx.doi.org/10.1016/j.nic.2016.06.006DOI Listing
November 2016

Clinical application of PET/MRI in oncology.

J Magn Reson Imaging 2016 08 23;44(2):265-76. Epub 2016 Mar 23.

Edward Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.

Hybrid imaging with integrated positron emission tomography (PET) and magnetic resonance imaging (MRI) combines the advantages of the high-resolution anatomic data from MRI and functional imaging data from PET, and has the potential to improve the diagnostic evaluation of various types of cancers. The clinical oncologic applications of this newest hybrid imaging technology are evolving and substantial efforts are underway to define the role of PET/MRI in routine clinical use. The current published literature suggests that PET/MRI may play an important role in the evaluation of patients with certain types of malignancies, involving anatomic locations such as the pelvis and the liver. The purpose of this article is to review the current published PET/MRI literature in specific body oncologic applications. In addition, PET/MRI protocols and some of the technical issues of this hybrid imaging will be briefly discussed. J. Magn. Reson. Imaging 2016;44:265-276.
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http://dx.doi.org/10.1002/jmri.25161DOI Listing
August 2016
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