Publications by authors named "James S Babb"

314 Publications

Can an Artificial Intelligence Decision Aid Decrease False-Positive Breast Biopsies?

Ultrasound Q 2020 Dec 28;37(1):10-15. Epub 2020 Dec 28.

Department of Radiology, New York University Grossman School of Medicine, New York, NY.

Abstract: This study aimed to evaluate the effect of an artificial intelligence (AI) support system on breast ultrasound diagnostic accuracy.In this Health Insurance Portability and Accountability Act-compliant, institutional review board-approved retrospective study, 200 lesions (155 benign, 45 malignant) were randomly selected from consecutive ultrasound-guided biopsies (June 2017-January 2019). Two readers, blinded to clinical history and pathology, evaluated lesions with and without an Food and Drug Administration-approved AI software. Lesion features, Breast Imaging Reporting and Data System (BI-RADS) rating (1-5), reader confidence level (1-5), and AI BI-RADS equivalent (1-5) were recorded. Statistical analysis was performed for diagnostic accuracy, negative predictive value, positive predictive value (PPV), sensitivity, and specificity of reader versus AI BI-RADS. Generalized estimating equation analysis was used for reader versus AI accuracy regarding lesion features and AI impact on low-confidence score lesions. Artificial intelligence effect on false-positive biopsy rate was determined. Statistical tests were conducted at a 2-sided 5% significance level.There was no significant difference in accuracy (73 vs 69.8%), negative predictive value (100% vs 98.5%), PPV (45.5 vs 42.4%), sensitivity (100% vs 96.7%), and specificity (65.2 vs 61.9; P = 0.118-0.409) for AI versus pooled reader assessment. Artificial intelligence was more accurate than readers for irregular shape (74.1% vs 57.4%, P = 0.002) and less accurate for round shape (26.5% vs 50.0%, P = 0.049). Artificial intelligence improved diagnostic accuracy for reader-rated low-confidence lesions with increased PPV (24.7% AI vs 19.3%, P = 0.004) and specificity (57.8% vs 44.6%, P = 0.008).Artificial intelligence decision support aid may help improve sonographic diagnostic accuracy, particularly in cases with low reader confidence, thereby decreasing false-positives.
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http://dx.doi.org/10.1097/RUQ.0000000000000550DOI Listing
December 2020

Clinical feasibility of 2D dynamic sagittal HASTE flexion-extension imaging of the cervical spine for the assessment of spondylolisthesis and cervical cord impingement.

Eur J Radiol 2021 Jan 27;134:109447. Epub 2020 Nov 27.

NYU Langone Orthopedic Hospital, Department of Radiology, Division of Musculoskeletal Radiology, 301 E 17th St, New York, NY, 10003, United States.

Purpose: To assess the utility of a 2D dynamic HASTE sequence in assessment of cervical spine flexion-extension, specifically (1) comparing dynamic spondylolisthesis to radiographs and (2) assessing dynamic contact upon or deformity of the cord.

Methods: Patients with a dynamic flexion-extension sagittal 2D HASTE sequence in addition to routine cervical spine sequences were identified. Static and dynamic listhesis was first determined on flexion-extension radiographs reviewed in consensus. Blinded assessment of the dynamic HASTE sequence was independently performed by 2 radiologists for (1) listhesis and translation during flexion-extension and (2) dynamic spinal cord impingement (cord contact or deformity between neutral, flexion and extension).

Results: 32 scans in 32 patients (9 males, 23 females) met inclusion criteria acquired on 1.5 T (n = 15) and 3 T (n = 17) scanners. The mean acquisition time was 51.8 s (range 20-95 seconds). Dynamic translation was seen in 14 patients on flexion-extension radiographs compared to 12 (reader 1) and 13 (reader 2) patients on HASTE, with 90.6 % agreement (K = 0.83; p = 0.789). In all cases dynamic listhesis was ≤3 mm translation with one patient showing dynamic listhesis in the range 4-6 mm. Four cases (13 %) demonstrated deformity of the cord between flexion-extension, not present in the neutral position. For cord impingement there was strong inter-reader agreement (K = 0.93) and the paired sample Wilcoxon signed rank test found no significant difference between the impingement scores of the two readers (p = 0.787).

Conclusions: A sagittal dynamic flexion-extension HASTE sequence provides a rapid addition to standard MRI cervical spine protocols, which may useful for assessment of dynamic spondylolisthesis and cord deformity.
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http://dx.doi.org/10.1016/j.ejrad.2020.109447DOI Listing
January 2021

Non-invasive quantification of inflammation, axonal and myelin injury in multiple sclerosis.

Brain 2021 Feb;144(1):213-223

Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

The aim of this study was to determine the feasibility of diffusion basis spectrum imaging in multiple sclerosis at 7 T and to investigate the pathological substrates of tissue damage in lesions and normal-appearing white matter. To this end, 43 patients with multiple sclerosis (24 relapsing-remitting, 19 progressive), and 21 healthy control subjects were enrolled. White matter lesions were classified in T1-isointense, T1-hypointense and black holes. Mean values of diffusion basis spectrum imaging metrics (fibres, restricted and non-restricted fractions, axial and radial diffusivities and fractional anisotropy) were measured from whole brain white matter lesions and from both lesions and normal appearing white matter of the corpus callosum. Significant differences were found between T1-isointense and black holes (P ranging from 0.005 to <0.001) and between lesions' centre and rim (P < 0.001) for all the metrics. When comparing the three subject groups in terms of metrics derived from corpus callosum normal appearing white matter and T2-hyperintense lesions, a significant difference was found between healthy controls and relapsing-remitting patients for all metrics except restricted fraction and fractional anisotropy; between healthy controls and progressive patients for all metrics except restricted fraction and between relapsing-remitting and progressive multiple sclerosis patients for all metrics except fibres and restricted fractions (P ranging from 0.05 to <0.001 for all). Significant associations were found between corpus callosum normal-appearing white matter fibres fraction/non-restricted fraction and the Symbol Digit Modality Test (respectively, r = 0.35, P = 0.043; r = -0.35, P = 0.046), and between black holes radial diffusivity and Expanded Disability Status Score (r = 0.59, P = 0.002). We showed the feasibility of diffusion basis spectrum imaging metrics at 7 T, confirmed the role of the derived metrics in the characterization of lesions and normal appearing white matter tissue in different stages of the disease and demonstrated their clinical relevance. Thus, suggesting that diffusion basis spectrum imaging is a promising tool to investigate multiple sclerosis pathophysiology, monitor disease progression and treatment response.
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http://dx.doi.org/10.1093/brain/awaa381DOI Listing
February 2021

Global brain volume and N-acetyl-aspartate decline over seven decades of normal aging.

Neurobiol Aging 2021 Feb 28;98:42-51. Epub 2020 Oct 28.

Department of Radiology, Center for Advanced Imaging Innovation and Research (CAI(2)R), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University Grossman School of Medicine, New York, NY, USA. Electronic address:

We characterize the whole-brain N-acetyl-aspartate (WBNAA) and brain tissue fractions across the adult lifespan and test the hypothesis that, despite age-related atrophy, neuronal integrity (reflected by WBNAA) is preserved in normal aging. Two-hundred-and-seven participants: 133 cognitively intact older adults (73.6 ± 7.4 mean ± standard deviation, range: 60-90 year old) and 84 young (37.9 ± 11, range: 21-59 year old) were scanned with proton magnetic resonance spectroscopy and T-weighted MRI. Their WBNAA, fractional brain parenchyma, and gray and white matter volumes (fBPV, fGM, and fWM) were compared and modeled as functions of age and sex. Compared with young, older-adults' WBNAA was lower by ~35%, and fBPV, fGM and fWM were lower by ~10%. Linear regressions found 0.5%/year WBNAA and 0.2%/year fBPV and fGM declines, whereas fWM rose to age ~40 years, and declined thereafter. fBPV and fGM were 1.8% and 4% higher in women, with no sex decline rates difference. We conclude that contrary to our hypothesis, atrophy was accompanied by WBNAA decline. Across the entire age range, women's brains showed less atrophy than men's. Formulas to estimate WBNAA and brain tissue fractions in healthy adults are provided to help differentiate normal from abnormal aging.
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http://dx.doi.org/10.1016/j.neurobiolaging.2020.10.024DOI Listing
February 2021

Gadoxetate disodium-enhanced MRI: Assessment of arterial phase artifacts and hepatobiliary uptake in a large series.

Eur J Radiol 2020 Nov 28;132:109313. Epub 2020 Sep 28.

BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address:

Purpose: To report the quality of gadoxetate disodium MRI in a large series by assessing the prevalence of: 1) arterial phase (AP) artifacts and its predictive factors, 2) decreased hepatic contrast uptake during the hepatobiliary phase (HBP).

Methods: This retrospective single center study included 851 patients (M/F:537/314, mean age: 63y) with gadoxetate disodium MRI. The MRI protocol included unenhanced, dual arterial [early and late arterial phases (AP)], portal venous, transitional and hepatobiliary phases. Three radiologists graded dynamic images using a 5-scale score (1: no motion, 5: severe, nondiagnostic) for assessment of transient severe motion (TSM, defined as a score ≥4 during at least one AP with a score ≤3 during other phases). HBP uptake was assessed using a 3-scale score (based on portal vein/hepatic signal). The association between demographic, clinical and acquisition parameters with TSM was tested in uni- and multivariate logistic regression.

Results: TSM was observed in 103/851 patients (12.1 %): 83 (9.8 %) in one AP and 20 (2.3 %) in both APs. A score of 5 (nondiagnostic) was assigned in 7 patients in one AP (0.8 %) and none in both. Presence of TSM was significantly associated with age (p = 0.002) and liver disease (p = 0.033) in univariate but not in multivariate analysis (p > 0.05). No association was found between acquisition parameters and TSM occurrence. Limited or severely limited HBP contrast uptake was observed in 87 patients (10.2 %), and TSM was never associated with severely limited HBP contrast uptake.

Conclusion: TSM was present in approximately 12 % of gadoxetate disodium MRIs, rarely on both APs (2.3 %), and was poorly predicted. TSM was never associated with severely limited HBP contrast uptake.
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http://dx.doi.org/10.1016/j.ejrad.2020.109313DOI Listing
November 2020

Three-dimensional MRI Bone Models of the Glenohumeral Joint Using Deep Learning: Evaluation of Normal Anatomy and Glenoid Bone Loss.

Radiol Artif Intell 2020 Sep 9;2(5):e190116. Epub 2020 Sep 9.

Department of Radiology, Hospital do Coração (HCOR) and Teleimagem, Rua Desembargador Eliseu Guilherme 53, 7th Floor, São Paulo, SP, Brazil 04004-030 (T.C.R.); Department of Radiology, NYU Langone Medical Center, New York, NY (C.M.D., E.F.A., S.G.); Department of Radiology, McGill University Health Centre, Montreal, Canada (N.G.); and Department of Radiology, New York University School of Medicine, New York, NY (J.S.B., J.D.).

Purpose: To use convolutional neural networks (CNNs) for fully automated MRI segmentation of the glenohumeral joint and evaluate the accuracy of three-dimensional (3D) MRI models created with this method.

Materials And Methods: Shoulder MR images of 100 patients (average age, 44 years; range, 14-80 years; 60 men) were retrospectively collected from September 2013 to August 2018. CNNs were used to develop a fully automated segmentation model for proton density-weighted images. Shoulder MR images from an additional 50 patients (mean age, 33 years; range, 16-65 years; 35 men) were retrospectively collected from May 2014 to April 2019 to create 3D MRI glenohumeral models by transfer learning using Dixon-based sequences. Two musculoskeletal radiologists performed measurements on fully and semiautomated segmented 3D MRI models to assess glenohumeral anatomy, glenoid bone loss (GBL), and their impact on treatment selection. Performance of the CNNs was evaluated using Dice similarity coefficient (DSC), sensitivity, precision, and surface-based distance measurements. Measurements were compared using matched-pairs Wilcoxon signed rank test.

Results: The two-dimensional CNN model for the humerus and glenoid achieved a DSC of 0.95 and 0.86, a precision of 95.5% and 87.5%, an average precision of 98.6% and 92.3%, and a sensitivity of 94.8% and 86.1%, respectively. The 3D CNN model, for the humerus and glenoid, achieved a DSC of 0.95 and 0.86, precision of 95.1% and 87.1%, an average precision of 98.7% and 91.9%, and a sensitivity of 94.9% and 85.6%, respectively. There was no difference between glenoid and humeral head width fully and semiautomated 3D model measurements ( value range, .097-.99).

Conclusion: CNNs could potentially be used in clinical practice to provide rapid and accurate 3D MRI glenohumeral bone models and GBL measurements. © RSNA, 2020.
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http://dx.doi.org/10.1148/ryai.2020190116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7529433PMC
September 2020

Male Breast Cancer Risk Assessment and Screening Recommendations in High-Risk Men Who Undergo Genetic Counseling and Multigene Panel Testing.

Clin Breast Cancer 2021 Feb 25;21(1):e74-e79. Epub 2020 Jul 25.

Department of Radiology, New York University, New York, NY. Electronic address:

Background: Emerging data suggest screening mammography may be effective in detecting breast cancer early in high-risk men. We evaluated current screening recommendations as a risk management strategy in men at elevated risk for breast cancer.

Patients And Methods: This institutional review board-approved, Health Insurance Portability and Accountability Act (HIPAA)-compliant study reviewed consecutive men who underwent genetic counseling and multigene panel testing (MGPT) for breast cancer risk assessment at our institution between 2012 and 2018. Patient risk factors, test indications, and MGPT outcomes were recorded, then correlated with screening recommendations by either clinical breast examination or screening mammography. Recommendation consistency among practitioners was evaluated. Patient adherence to screening mammography (defined as undergoing screening mammography as recommended) was assessed. Statistical analysis was performed at the 2-sided 5% significance level.

Results: A total of 414 asymptomatic men underwent both genetic counseling and MGPT (mean age, 47 years; range, 18-91 years) for breast cancer risk assessment. Of this group, 18 (4.3%) of 414 had a personal history of breast cancer, and 159 (38.4%) of 414 had a family history of breast cancer before MGPT. Among 112 men with positive MGPT results, BRCA1/2 mutations were the most common (56.3%, 63/112). Most BRCA mutation carriers (80.9%, 51/63) were recommended clinical breast examination only. Only 5.9% (2/34) BRCA2 and 10.3% (3/29) BRCA1 carriers were recommended screening mammograms (7.9%, 5/63 of all BRCA carriers). Among men with a personal history of breast cancer, only 9 (50%) of 18 were recommended screening mammograms. Overall adherence to screening mammogram in men was 71.4% (10/14), which ultimately yielded two cancers. Breast cancer screening recommendations varied widely among practitioners, with some recommending clinical breast examination only, and others also recommending mammography.

Conclusion: Men who are found to be at an elevated risk for breast cancer after undergoing genetic counseling and testing currently receive relatively inconsistent screening recommendations.
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http://dx.doi.org/10.1016/j.clbc.2020.07.014DOI Listing
February 2021

Outcomes assessment in intrahepatic cholangiocarcinoma using qualitative and quantitative imaging features.

Cancer Imaging 2020 Jul 3;20(1):43. Epub 2020 Jul 3.

Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY, 10029-6574, USA.

Background: To assess the performance of imaging features, including radiomics texture features, in predicting histopathologic tumor grade, AJCC stage, and outcomes [time to recurrence (TTR) and overall survival (OS)] in patients with intrahepatic cholangiocarcinoma (ICC).

Methods: Seventy-three patients (26 M/47F, mean age 63y) with pre-operative imaging (CT, n = 37; MRI, n = 21; CT and MRI, n = 15] within 6 months of resection were included in this retrospective study. Qualitative imaging traits were assessed by 2 observers. A 3rd observer measured tumor apparent diffusion coefficient (ADC), enhancement ratios (ERs), and Haralick texture features. Blood biomarkers and imaging features were compared with histopathology (tumor grade and AJCC stage) and outcomes (TTR and OS) using log-rank, generalized Wilcoxon, Cox proportional hazards regression, and Fisher exact tests.

Results: Median TTR and OS were 53.9 and 79.7 months. ICC recurred in 64.4% (47/73) of patients and 46.6% (34/73) of patients died. There was fair accuracy for some qualitative imaging features in the prediction of worse tumor grade (maximal AUC of 0.68 for biliary obstruction on MRI, p = 0.032, observer 1) and higher AJCC stage (maximal AUC of 0.73 for biliary obstruction on CT, p = 0.002, observer 2; and AUC of 0.73 for vascular involvement on MRI, p = 0.01, observer 2). Cox proportional hazards regression analysis showed that CA 19-9 [hazard ratio (HR) 2.44/95% confidence interval (CI) 1.31-4.57/p = 0.005)] and tumor size on imaging (HR 1.13/95% CI 1.04-1.22/p = 0.003) were significant predictors of TTR, while CA 19-9 (HR 4.08/95% CI 1.75-9.56, p = 0.001) and presence of metastatic lymph nodes at histopathology (HR 2.86/95% CI 1.35-6.07/p = 0.006) were significant predictors of OS. On multivariable analysis, satellite lesions on CT (HR 2.79/95%CI 1.01-7.15/p = 0.032, observer 2), vascular involvement on MRI (HR 0.10/95% CI 0.01-0.85/p = 0.032, observer 1), and texture feature MRI variance (HR 0.55/95% CI 0.31-0.97, p = 0.040) predicted TTR once adjusted for the independent predictors CA 19-9 and tumor size on imaging. Several qualitative and quantitative features demonstrated associations with TTR, OS, and AJCC stage at univariable analysis (range: HR 0.35-19; p < 0.001-0.045), however none were predictive of OS at multivariable analysis when adjusted for CA 19-9 and metastatic lymph nodes (p > 0.088).

Conclusions: There was reasonable accuracy in predicting tumor grade and higher AJCC stage in ICC utilizing certain qualitative and quantitative imaging traits. Serum CA 19-9, tumor size, presence of metastatic lymph nodes, and qualitative imaging traits of satellite lesions and vascular involvement are predictors of patient outcomes, along with a promising predictive ability of certain quantitative texture features.
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http://dx.doi.org/10.1186/s40644-020-00323-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333305PMC
July 2020

Gadoxetate-enhanced abbreviated MRI is highly accurate for hepatocellular carcinoma screening.

Eur Radiol 2020 Nov 25;30(11):6003-6013. Epub 2020 Jun 25.

BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.

Objectives: The primary objective was to compare the performance of 3 different abbreviated MRI (AMRI) sets extracted from a complete gadoxetate-enhanced MRI obtained for hepatocellular carcinoma (HCC) screening. Secondary objective was to perform a preliminary cost-effectiveness analysis, comparing each AMRI set to published ultrasound performance for HCC screening in the USA.

Methods: This retrospective study included 237 consecutive patients (M/F, 146/91; mean age, 58 years) with chronic liver disease who underwent a complete gadoxetate-enhanced MRI for HCC screening in 2017 in a single institution. Two radiologists independently reviewed 3 AMRI sets extracted from the complete exam: non-contrast (NC-AMRI: T2-weighted imaging (T2wi)+diffusion-weighted imaging (DWI)), dynamic-AMRI (Dyn-AMRI: T2wi+DWI+dynamic T1wi), and hepatobiliary phase AMRI (HBP-AMRI: T2wi+DWI+T1wi during the HBP). Each patient was classified as HCC-positive/HCC-negative based on the reference standard, which consisted in all available patient data. Diagnostic performance for HCC detection was compared between sets. Estimated set characteristics, including historical ultrasound data, were incorporated into a microsimulation model for cost-effectiveness analysis.

Results: The reference standard identified 13/237 patients with HCC (prevalence, 5.5%; mean size, 33.7 ± 30 mm). Pooled sensitivities were 61.5% for NC-AMRI (95% confidence intervals, 34.4-83%), 84.6% for Dyn-AMRI (60.8-95.1%), and 80.8% for HBP-AMRI (53.6-93.9%), without difference between sets (p range, 0.06-0.16). Pooled specificities were 95.5% (92.4-97.4%), 99.8% (98.4-100%), and 94.9% (91.6-96.9%), respectively, with a significant difference between Dyn-AMRI and the other sets (p < 0.01). All AMRI methods were effective compared with ultrasound, with life-year gain of 3-12 months against incremental costs of US$ < 12,000.

Conclusions: NC-AMRI has limited sensitivity for HCC detection, while HBP-AMRI and Dyn-AMRI showed excellent sensitivity and specificity, the latter being slightly higher for Dyn-AMRI. Cost-effectiveness estimates showed that AMRI is effective compared with ultrasound.

Key Points: • Comparison of different abbreviated MRI (AMRI) sets reconstructed from a complete gadoxetate MRI demonstrated that non-contrast AMRI has low sensitivity (61.5%) compared with contrast-enhanced AMRI (80.8% for hepatobiliary phase AMRI and 84.6% for dynamic AMRI), with all sets having high specificity. • Non-contrast and hepatobiliary phase AMRI can be performed in less than 14 min (including set-up time), while dynamic AMRI can be performed in less than 17 min. • All AMRI sets were cost-effective for HCC screening in at-risk population in comparison with ultrasound.
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http://dx.doi.org/10.1007/s00330-020-07014-1DOI Listing
November 2020

Prediction of Total Knee Replacement and Diagnosis of Osteoarthritis by Using Deep Learning on Knee Radiographs: Data from the Osteoarthritis Initiative.

Radiology 2020 09 23;296(3):584-593. Epub 2020 Jun 23.

From the Courant Institute of Mathematical Sciences (K.L., K.C.) and Center for Data Science (B.Z., J.T., Y.S., K.J.G., K.C.), New York University, New York, NY; The Bernard and Irene Schwartz Center for Biomedical Imaging (K.J.G., J.S.B., C.M.D.) and Department of Radiology (K.J.G., J.S.B., G.C., C.M.D.), New York University Langone Health, 660 1st Ave, New York, NY 10016.

Background The methods for assessing knee osteoarthritis (OA) do not provide enough comprehensive information to make robust and accurate outcome predictions. Purpose To develop a deep learning (DL) prediction model for risk of OA progression by using knee radiographs in patients who underwent total knee replacement (TKR) and matched control patients who did not undergo TKR. Materials and Methods In this retrospective analysis that used data from the OA Initiative, a DL model on knee radiographs was developed to predict both the likelihood of a patient undergoing TKR within 9 years and Kellgren-Lawrence (KL) grade. Study participants included a case-control matched subcohort between 45 and 79 years. Patients were matched to control patients according to age, sex, ethnicity, and body mass index. The proposed model used a transfer learning approach based on the ResNet34 architecture with sevenfold nested cross-validation. Receiver operating characteristic curve analysis and conditional logistic regression assessed model performance for predicting probability and risk of TKR compared with clinical observations and two binary outcome prediction models on the basis of radiographic readings: KL grade and OA Research Society International (OARSI) grade. Results Evaluated were 728 participants including 324 patients (mean age, 64 years ± 8 [standard deviation]; 222 women) and 324 control patients (mean age, 64 years ± 8; 222 women). The prediction model based on DL achieved an area under the receiver operating characteristic curve (AUC) of 0.87 (95% confidence interval [CI]: 0.85, 0.90), outperforming a baseline prediction model by using KL grade with an AUC of 0.74 (95% CI: 0.71, 0.77; < .001). The risk for TKR increased with probability that a person will undergo TKR from the DL model (odds ratio [OR], 7.7; 95% CI: 2.3, 25; < .001), KL grade (OR, 1.92; 95% CI: 1.17, 3.13; = .009), and OARSI grade (OR, 1.20; 95% CI: 0.41, 3.50; = .73). Conclusion The proposed deep learning model better predicted risk of total knee replacement in osteoarthritis than did binary outcome models by using standard grading systems. © RSNA, 2020 See also the editorial by Richardson in this issue.
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http://dx.doi.org/10.1148/radiol.2020192091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434649PMC
September 2020

Diffusion MRI biomarkers of white matter microstructure vary nonmonotonically with increasing cerebral amyloid deposition.

Neurobiol Aging 2020 05 23;89:118-128. Epub 2020 Jan 23.

Department of Radiology, New York University School of Medicine, New York, NY, USA. Electronic address:

Beta amyloid (Aβ) accumulation is the earliest pathological marker of Alzheimer's disease (AD), but early AD pathology also affects white matter (WM) integrity. We performed a cross-sectional study including 44 subjects (23 healthy controls and 21 mild cognitive impairment or early AD patients) who underwent simultaneous PET-MR using 18F-Florbetapir, and were categorized into 3 groups based on Aβ burden: Aβ- [mean mSUVr ≤1.00], Aβi [1.00 < mSUVr <1.17], Aβ+ [mSUVr ≥1.17]. Intergroup comparisons of diffusion MRI metrics revealed significant differences across multiple WM tracts. Aβi group displayed more restricted diffusion (higher fractional anisotropy, radial kurtosis, axonal water fraction, and lower radial diffusivity) than both Aβ- and Aβ+ groups. This nonmonotonic trend was confirmed by significant continuous correlations between mSUVr and diffusion metrics going in opposite direction for 2 cohorts: pooled Aβ-/Aβi and pooled Aβi/Aβ+. The transient period of increased diffusion restriction may be due to inflammation that accompanies rising Aβ burden. In the later stages of Aβ accumulation, neurodegeneration is the predominant factor affecting diffusion.
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http://dx.doi.org/10.1016/j.neurobiolaging.2020.01.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314576PMC
May 2020

Supraspinatus muscle shear wave elastography (SWE): detection of biomechanical differences with varying tendon quality prior to gray-scale morphologic changes.

Skeletal Radiol 2020 May 6;49(5):731-738. Epub 2019 Dec 6.

Department of Radiology, Division of Musculoskeletal Radiology, NYU Langone Health, 301 East 17th Street, 6th Floor, New York, NY, 10003, USA.

Objective: The purpose of this study was to determine whether SWE can detect biomechanical changes in the supraspinatus muscle that occur with increasing supraspinatus tendon abnormality prior to morphologic gray-scale changes.

Materials And Methods: An IRB approved, HIPAA compliant retrospective study of shoulder ultrasounds from 2013-2018 was performed. The cohort consisted of 88 patients (mean age 55 ± 15 years old) with 110 ultrasounds. Images were acquired in longitudinal orientation to the supraspinatus muscle with shear wave velocity (SWV) point quantification. The tendon and muscle were graded in order of increasing tendinosis/tear (1-4 scale) and increasing fatty infiltration (0-3 scale). Mixed model analysis of variance, analysis of covariance, and Spearman rank correlation were used for statistical analysis.

Results: There was no statistically significant age or sex dependence for supraspinatus muscle SWV (p = 0.314, 0.118, respectively). There was no significant correlation between muscle SWV and muscle or tendon grade (p = 0.317, 0.691, respectively). In patients with morphologically normal muscle on gray-scale ultrasound, there were significant differences in muscle SWV when comparing tendon grade 3 with grades 1, 2, and 4 (p = 0.018, 0.025, 0.014, respectively), even when adjusting for gender and age (p = 0.044, 0.028, 0.018, respectively). Pairwise comparison of tendon grades other than those mentioned did not achieve statistical significance (p > 0.05).

Conclusion: SWE can detect biomechanical differences within the supraspinatus muscle that are not morphologically evident on gray-scale ultrasound. Specifically, supraspinatus tendon partial tears with moderate to severe tendinosis may correspond to biomechanically distinct muscle properties compared to both lower grades of tendon abnormality and full-thickness tears.
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http://dx.doi.org/10.1007/s00256-019-03334-6DOI Listing
May 2020

Hepatocellular carcinoma detection in liver cirrhosis: diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast vs. gadoxetic acid.

Eur Radiol 2020 Feb 31;30(2):1020-1030. Epub 2019 Oct 31.

Department of Radiology, Body MRI, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, 1470 Madison Avenue, New York, NY, 10029, USA.

Objectives: To evaluate the diagnostic performance of contrast-enhanced CT vs. MRI with extracellular contrast agents (EC-MRI) vs. MRI with gadoxetic acid (EOB-MRI) for HCC detection in patients with liver cirrhosis using liver explant as the reference. The additional value of hepatobiliary phase (HBP) post Gadoxetic acid was also assessed.

Methods: Two-hundred seventy-seven consecutive patients who underwent liver transplantation over a 9 year period and imaging within 90 days of were retrospectively included. Imaging consisted in CT (n = 100), EC-MRI (n = 77) and EOB-MRI (n = 100), the latter subdivided into dynamic EOB-MRI and full EOB-MRI (dynamic+HBP). Three radiologists retrospectively categorized lesions ≥ 1 cm using the LI-RADSv2017 algorithm. Dynamic EOB-MRI was re-evaluated with the addition of HBP. Results were correlated with explant pathology.

Results: Pathology demonstrated 265 HCCs (mean size 2.1 ± 1.4 cm) in 177 patients. Per-patient sensitivities were 86.3% for CT, 89.5% for EC-MRI, 92.8% for dynamic EOB-MRI and 95.2% for full EOB-MRI (pooled reader data), with a significant difference between CT and dynamic/full EOB-MRI (p = 0.032/0.002), and between EC-MRI and full EOB-MRI (p = 0.047). Per-lesion sensitivities for CT, EC-MRI, dynamic EOB-MRI and full EOB-MRI were 59.5%,78.5%,69.7% and 76.8%, respectively, with a significant difference between MRI groups and CT (p-range:0.001-0.04), and no difference between EC-MRI and dynamic EOB-MRI (p = 0.949). For HCCs 1-1.9 cm, sensitivities were 34.4%, 64.6%, 57.3% and 67.3%, respectively, with all MRI groups significantly superior to CT (p ≤ 0.01) and full EOB-MRI superior to dynamic EOB-MRI (p = 0.002).

Conclusions: EOB-MRI outperforms CT and EC-MRI for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. MRI methods outperform CT for detection of HCCs 1-1.9 cm.

Key Points: • MRI is superior to CT for HCC detection in patients with liver cirrhosis. • EOB-MRI outperforms CT and MRI using extracellular contrast agents (EC-MRI) for per-patient HCC detection sensitivity, and is equivalent to EC-MRI for per-lesion sensitivity. • The addition of hepatobiliary phase images improves HCC detection when using gadoxetic acid.
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http://dx.doi.org/10.1007/s00330-019-06458-4DOI Listing
February 2020

Diffusion kurtosis imaging of gray matter in schizophrenia.

Cortex 2019 12 29;121:201-224. Epub 2019 Aug 29.

Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA; Sackler Institute of Graduate Biomedical Sciences, New York University School of Medicine, New York, NY, USA.

Prior postmortem studies have shown gray matter (GM) microstructural abnormalities in schizophrenia. However, few studies to date have examined GM microstructural integrity in schizophrenia in vivo. Here, we employed diffusion kurtosis imaging (DKI) to test for differences in GM microstructure in eighteen schizophrenia (SZ) patients versus nineteen healthy controls (HC). GM microstructure was characterized in each participant using DKI-derived metrics of mean kurtosis (MK) and mean diffusivity (MD). Individual T1-weighted images were used to create subject-specific cortically-labelled regions of interest (ROIs) of the four cortical lobes and sixty-eight cortical GM regions delineated by the Desikan-Killiany atlas, and to derive the associated cortical thickness and area measures. The derived ROIs were also registered to the diffusion space of each subject and used to generate region-specific mean MK and MD values. We additionally administered the Wisconsin Card Sorting Test (WCST), Stroop test, and Trail Making Test part B (Trails-B) to test the relationship between GM metrics and executive function in SZ. We found significantly increased MK and MD in SZ compared to HC participants in the temporal lobe, sub-lobar temporal cortical regions (fusiform, inferior temporal, middle temporal and temporal pole), and posterior cingulate cortex after correcting for multiple comparisons. Correlational analyses revealed significant associations of MK and MD with executive function scores derived from the WCST, Stroop, and Trails-B tests, along with an inverse relationship between MK and MD and cortical thickness and area. A hierarchical multiple linear regression analysis showed that up to 85% of the inter-subject variability in cognitive function in schizophrenia measured by the WCST could be explained by MK in combination with either GM thickness or area. MK and MD appear to be sensitive to GM microstructural pathology in schizophrenia and may provide useful biomarkers of abnormal cortical microstructure in this disorder.
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http://dx.doi.org/10.1016/j.cortex.2019.08.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7556324PMC
December 2019

Breast Cancer Screening in High-Risk Men: A 12-year Longitudinal Observational Study of Male Breast Imaging Utilization and Outcomes.

Radiology 2019 11 17;293(2):282-291. Epub 2019 Sep 17.

From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., J.S.B., L.M., S.L.H.); New York University School of Medicine, New York, NY (J.E.G., T.K.Y.); and Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (J.S.B., L.M.).

Background Male breast cancer incidence is rising. There may be a potential role in selective screening in men at elevated risk for breast cancer, but the effectiveness of such screening remains unexplored. Purpose To evaluate patterns of male breast imaging utilization, to determine high-risk screening outcomes, and to delineate risk factors associated with cancer diagnosis. Materials and Methods This retrospective study reviewed consecutive male breast imaging examinations over a 12-year period (between 2005-2017). Examination indications, biopsy recommendations, and pathologic results were correlated with patient characteristics. Fisher exact test, Mann-Whitney test, Spearman correlation, and logistic regression were used for statistical analysis. Results A total of 1869 men (median age, 55 years; range, 18-96 years) underwent 2052 examinations yielding 2304 breast lesions and resulting in 149 (6.5%) biopsies in 133 men; 41 (27.5%) were malignant and 108 (72.5%) were benign. There were 1781 (86.8%) diagnostic and 271 (13.2%) screening examinations. All men undergoing screening had personal or family history of breast cancer and/or genetic mutations. There was a significant increase in the number of examinations in men relative to the number of examinations in women over time (Spearman correlation, = 0.85; < .001). Five node-negative cancers resulted from screening mammography, yielding a cancer detection rate of 18 per 1000 examinations (95% confidence interval [CI]: 7, 41), with cancers diagnosed on average after 4 person-years of screening (range, 1-10 person-years). Mammographic screening sensitivity, specificity, and positive predictive value of biopsy were 100% (95% CI: 50%, 100%), 95.0% (95% CI: 93.1%, 98%), and 50% (95% CI: 22.2%, 77.8%). Older age ( < .001), Ashkenazi descent ( < .001), genetic mutations ( = .006), personal history ( < .001), and first-degree family history ( = .03) were associated with breast cancer. Non-first-degree family history was not associated with cancer ( = .09). Conclusion There is potential benefit in screening men at high risk for developing breast cancer. Such screening may have increased over time. © RSNA, 2019.
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http://dx.doi.org/10.1148/radiol.2019190971DOI Listing
November 2019

A New Method for Cartilage Evaluation in Femoroacetabular Impingement Using Quantitative T2 Magnetic Resonance Imaging: Preliminary Validation against Arthroscopic Findings.

Cartilage 2019 Aug 27:1947603519870852. Epub 2019 Aug 27.

1 Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, NY, USA.

Objective: The outcome of arthroscopic treatment for femoroacetabular impingement (FAI) depends on the preoperative status of the hip cartilage. Quantitative T2 can detect early biochemical cartilage changes, but its routine implementation is challenging. Furthermore, intrinsic T2 variability between patients makes it difficult to define a threshold to identify cartilage lesions. To address this, we propose a normalized T2-index as a new method to evaluate cartilage in FAI.

Design: We retrospectively analyzed magnetic resonance imaging (MRI) data of 18 FAI patients with arthroscopically confirmed cartilage defects. Cartilage T2 maps were reconstructed from multi-spin-echo 3-T data using the echo-modulation-curve (EMC) model-based technique. The central femoral cartilage, assumed healthy in early-stage FAI, was used as the normalization reference to define a T2-index. We investigated the ability of the T2-index to detect surgically confirmed cartilage lesions.

Results: The average T2-index was 1.14 ± 0.1 and 1.13 ± 0.1 for 2 separated segmentations. Using T2-index >1 as the threshold for damaged cartilage, accuracy was 88% and 100% for the 2 segmentations. We found moderate intraobserver repeatability, although separate segmentations yielded comparable accuracy. Damaged cartilage could not be identified using nonnormalized average T2 values.

Conclusions: This preliminary study confirms the importance of normalizing T2 values to account for interpatient variability and suggests that the T2-index is a promising biomarker for the detection of cartilage lesions in FAI. Future work is needed to confirm that combining T2-index with morphologic MRI and other quantitative biomarkers could improve cartilage assessment in FAI.
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http://dx.doi.org/10.1177/1947603519870852DOI Listing
August 2019

Dynamic Contrast-Enhanced MRI Evaluation of Pathologic Complete Response in Human Epidermal Growth Factor Receptor 2 (HER2)-Positive Breast Cancer After HER2-Targeted Therapy.

Acad Radiol 2020 05 20;27(5):e87-e93. Epub 2019 Aug 20.

Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY 10016; Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, New York, New York.

Rationale And Objectives: Pathologic complete response (pCR) in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer after HER2-targeted therapy correlates increased disease-free survival and decreased mastectomy rates. The aim of this study was to explore tumor shrinkage patterns and initial tumor enhancement with pCR in HER2-positive breast cancer.

Materials And Methods: This was an institutional review board-approved retrospective analysis of 51 HER2 positive breast cancer patients with breast MRI both pre- and post-HER2-targeted therapy. Initial enhancement ratio (IER, initial enhancement percentage over baseline at first postcontrast imaging), pattern of tumor shrinkage, and Dynamic contrast enhanced (DCE)-MRI imaging features were assessed. Wilcoxon rank, Spearman correlation, Fisher's exact, and Mann-Whitney tests were used to correlate MRI imaging features with pCR. IER reader agreement was evaluated by intraclass correlation. Binary logistic regression was used to evaluate multivariate associations with pCR.

Results: 56.9% (29/51) of patients had pCR at surgery. Concentric tumor shrinkage pattern was associated with pCR (p = 0.001, Area under the curve (AUC) 0.778): accuracy 80.4%, specificity 96.6%, and sensitivity of 59.1%. There was no association with pCR and imaging response as defined by RECIST criteria (p = 0.169), pretreatment IER (Reader 1 (R1) p = 0.665, Reader 2 (R2) p = 0.766), or lesion size (p = 0.69). IER was associated with axillary metastases (R1 p = 0.016, R2 < 0.001) and ki-67 (R1 r = 0.52, p = 0.008, R2 r = -0.44, p = 0.028).

Conclusion: The shrinkage pattern of HER2-positive tumors after targeted therapy may be associated with pCR. There was no association between IER and pCR. Future studies evaluating the correlation of shrinkage patterns to texture radiomics are of interest.
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http://dx.doi.org/10.1016/j.acra.2019.07.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7416507PMC
May 2020

City Patterns of Screening Mammography Uptake and Disparity across the United States.

Radiology 2019 10 20;293(1):151-157. Epub 2019 Aug 20.

From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016.

Background Although previous studies have focused on rural disparities in the use of screening mammography, city-level use throughout the United States has not been well evaluated even though more than 30 million women live in the 500 largest cities. Purpose To evaluate disparities in the city-level use of screening mammography and to identify factors that have an impact on screening utilization. Materials and Methods This retrospective study used data from large publicly available databases, the American Community Survey and Robert Wood Johnson Foundation 500 Cities Project, which includes screening mammography utilization data from the Behavioral Risk Factor Surveillance System. Databases were searched from January to March 2018. The use of screening mammography was evaluated at the city level by census region and division by using the Mann-Whitney test. Univariable Spearman rank correlation and multivariable regression analysis were performed to determine the impact of factors on screening use, including population size, health-related variables (use of Papanicolaou test, obesity), income variables (median household income, poverty status, health insurance), and race. Results Overall mean city-level screening mammography use rate was 77.7% (range, 62.8%-88.9%). The highest mean utilization occurred in coastal cities, with the highest overall utilization in the New England area (82.7%). The lowest utilization rate was in Mountain states (73.6%). City-level utilization showed a positive correlation with Papanicolaou test use ( = 0.75, < .001), median household income ( = 0.44, < .001), and percentage Asian population ( = 0.38, < .001) and a negative correlation with obesity ( = -0.36, < .001), the lack of health insurance ( = -0.44, < .001), and poverty ( = -0.30, < .001). Multivariable analysis showed the strongest independent predictors of utilization to be percentage of women screened with the Papanicolaou test, Asian race, private insurance, and census division ( = 68%). Conclusion Disparities in the utilization of preventive health care services exist at the large city level, with the highest use in New England cities and lowest in Mountain cities. Predictors of higher than average utilization include census division and percentage of inhabitants who are up to date with the Papanicolaou test, are of Asian race, and have private insurance. © RSNA, 2019.
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http://dx.doi.org/10.1148/radiol.2019190647DOI Listing
October 2019

Transthoracic Needle Biopsy of Pulmonary Nodules: Meteorological Conditions and the Risk of Pneumothorax and Chest Tube Placement.

J Clin Med 2019 May 22;8(5). Epub 2019 May 22.

Department of Radiology, Division of Vascular and Interventional Radiology, NYU Langone School of Medicine, New York, NY 10016, USA.

The purpose of this paper is to evaluate whether meteorological variables influence rates of pneumothorax and chest tube placement after percutaneous transthoracic needle biopsy (PTNB) of pulmonary nodules. A retrospective review of 338 consecutive PTNBs of pulmonary nodules at a single institution was performed. All procedures implemented a coaxial approach, using a 19-gauge outer guide needle for access and a 20-gauge core biopsy gun with or without a small-gauge aspiration needle for tissue sampling. Correlation between age, sex, smoking history, lesion size, meteorological variables, and frequency of complications were evaluated. Fisher exact, trend and tests were used to evaluate the relationship between each factor and rates of pneumothorax and chest tube placement. A value of less than 0.05 was considered to indicate a statistically significant difference. Pneumothorax occurred in 115 of 338 patients (34%). Chest tube placement was required in 30 patients (8.9%). No significant relationship was found between pneumothorax rate and age ( = 0.172), sex ( = 0.909), smoking history ( = 0.819), or lesion location ( = 0.765). The presence or absence of special weather conditions did not correlate with the rate of pneumothorax ( = 0.241) or chest tube placement ( = 0.213). The mean atmospheric temperature ( = 0.619) and degree of humidity ( = 0.858) also did not correlate with differences in the rate of pneumothorax. Finally, mean atmospheric pressure on the day of the procedure demonstrated no correlation with the rate of pneumothorax ( = 0.277) or chest tube placement ( = 0.767). In conclusion, no correlation is demonstrated between the occurrence of pneumothorax after PTNB of pulmonary nodules and the studied meteorological variables.
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http://dx.doi.org/10.3390/jcm8050727DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572625PMC
May 2019

Quantitative multivoxel proton MR spectroscopy for the identification of white matter abnormalities in mild traumatic brain injury: Comparison between regional and global analysis.

J Magn Reson Imaging 2019 11 13;50(5):1424-1432. Epub 2019 Mar 13.

Center for Advanced Imaging Innovation and Research (CAI2R), Bernard and Irene Schwartz Center for Biomedical Imaging, New York University School of Medicine, Department of Radiology, New York, New York, USA.

Background: 3D brain proton MR spectroscopic imaging ( H MRSI) facilitates simultaneous metabolic profiling of multiple loci, at higher, sub-1 cm , spatial resolution than single-voxel H MRS with the ability to separate tissue-type partial volume contribution(s).

Purpose: To determine if: 1) white matter (WM) damage in mild traumatic brain injury (mTBI) is homogeneously diffuse, or if specific regions are more affected; 2) partial-volume-corrected, structure-specific H MRSI voxel averaging is sensitive to regional WM metabolic abnormalities.

Study Type: Retrospective cross-sectional cohort study.

Population: Twenty-seven subjects: 15 symptomatic mTBI patients, 12 matched controls.

Field Strength/sequence: 3T using 3D H MRSI over a 360-cm volume of interest (VOI) centered over the corpus callosum, partitioned into 480 voxels, each 0.75 cm .

Assessment: N-acetyl-aspartate (NAA), creatine, choline, and myo-inositol concentrations estimated in predominantly WM regions: body, genu, and splenium of the corpus callosum, corona radiata, frontal, and occipital WM.

Statistical Tests: Analysis of covariance (ANCOVA) to compare patients with controls in terms of regional concentrations. The effect sizes (Cohen's d) of the mean differences were compared across regions and with previously published global data obtained with linear regression of the WM over the entire VOI in the same dataset.

Results: Despite patients' global VOI WM NAA being significantly lower than the controls', no regional differences were observed for any metabolite. Regional NAA comparisons, however, were all unidirectional (patients' NAA concentrations < controls') within a narrow range: 0.3 ≤ Cohen's d ≤ 0.6.

Data Conclusion: Since the patient group was symptomatic and exhibiting global WM NAA deficits, these findings suggest: 1) diffuse axonal mTBI damage; that is 2) below the H MRSI detection threshold in small regions. Therefore, larger, ie, more sensitive, single-voxel H MRS, placed anywhere in WM regions, may be well suited for mTBI H MRS studies, given that these results are confirmed in other cohorts.

Level Of Evidence: 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;50:1424-1432.
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http://dx.doi.org/10.1002/jmri.26718DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6744359PMC
November 2019

Quantitative magnetic resonance evaluation of the trigeminal nerve in familial dysautonomia.

Clin Auton Res 2019 08 19;29(4):469-473. Epub 2019 Feb 19.

Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA.

Purpose: Familial dysautonomia (FD) is a rare autosomal recessive disease that affects the development of sensory and autonomic neurons, including those in the cranial nerves. We aimed to determine whether conventional brain magnetic resonance imaging (MRI) could detect morphologic changes in the trigeminal nerves of these patients.

Methods: Cross-sectional analysis of brain MRI of patients with genetically confirmed FD and age- and sex-matched controls. High-resolution 3D gradient-echo T1-weighted sequences were used to obtain measurements of the cisternal segment of the trigeminal nerves. Measurements were obtained using a two-reader consensus.

Results: Twenty pairs of trigeminal nerves were assessed in ten patients with FD and ten matched controls. The median (interquartile range) cross-sectional area of the trigeminal nerves in patients with FD was 3.5 (2.1) mm, compared to 5.9 (2.0) mm in controls (P < 0.001). No association between trigeminal nerve area and age was found in patients or controls.

Conclusions: Using conventional MRI, the caliber of the trigeminal nerves was significantly reduced bilaterally in patients with FD compared to controls, a finding that appears to be highly characteristic of this disorder. The lack of correlation between age and trigeminal nerve size supports arrested neuronal development rather than progressive atrophy.
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http://dx.doi.org/10.1007/s10286-019-00593-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697601PMC
August 2019

MRI, arthroscopic and histopathologic cross correlation in biceps tenodesis specimens with emphasis on the normal appearing proximal tendon.

Clin Imaging 2019 Mar - Apr;54:126-132. Epub 2019 Jan 7.

NYU Langone Orthopedic Hospital, Department of Radiology, 301 E 17th St, New York, NY 10003, United States of America.

Purpose: To correlate the histopathologic appearances of resected long head of the biceps tendon (LHBT) specimens following biceps tenodesis, with pre-operative MRI and arthroscopic findings, with attention to the radiologically normal biceps.

Material And Methods: Retrospective analysis of patients who had undergone preoperative MRI, subsequent arthroscopic subpectoral tenodesis for SLAP tears and histopathologic inspection of the excised sample between 2013 and 16. Those with a normal MRI appearance or mildly increased intrasubstance signal were independently analyzed by 2 blinded radiologists. A blinded orthopedic surgeon and pathologist reviewed all operative imaging and pathologic slides, respectively.

Results: Twenty-three LHBT resected samples were identified on MRI as either normal (Reader 1 n = 15; Reader 2 n = 14) or demonstrating low-grade increased signal (Reader 1 n = 8; Reader 2 n = 9). Of these, 86.9% demonstrated a histopathological abnormality. 50% of samples with histopathological abnormality demonstrated normal appearance on MRI. The most common reported histopathology finding was myxoid degeneration (73.9%) and fibrosis (52.2%). The most common arthroscopic abnormality was fraying (18.2%) and erythema (13.6%). Utilizing histopathology as the gold standard, the two radiologists demonstrated a sensitivity of 35.0% v 42.9%, specificity of 66.7% v 100%, PPV of 87.5% v 100%, and NPV of 13.3% v 14.3%. Corresponding arthroscopic inspection demonstrated a sensitivity of 31.6%, specificity of 66.6%, PPV 85.7% and NPV of 13.3%. There was moderate agreement between the two radiologists, κ = 0.534 (95% CI, 0.177 to 0.891), p = 0.01.

Conclusion: Histopathological features of low grade tendinosis including mainly myxoid degeneration and fibrosis are frequently occult on MR imaging.
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http://dx.doi.org/10.1016/j.clinimag.2019.01.001DOI Listing
May 2019

Rapid Radial T and T Mapping of the Hip Articular Cartilage With Magnetic Resonance Fingerprinting.

J Magn Reson Imaging 2019 09 24;50(3):810-815. Epub 2018 Dec 24.

Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA.

Background: Quantitative MRI can detect early changes in cartilage biochemical components, but its routine clinical implementation is challenging.

Purpose: To introduce a novel technique to measure T and T along radial sections of the hip for accurate and reproducible multiparametric quantitative cartilage assessment in a clinically feasible scan time.

Study Type: Reproducibility, technical validation.

Subjects/phantom: A seven-compartment phantom and three healthy volunteers.

Field Strength/sequence: A novel MR pulse sequence that simultaneously measures proton density (PD), T , and T at 3 T was developed. Automatic positioning and semiautomatic cartilage segmentation were implemented to improve consistency and simplify workflow.

Assessment: Intra- and interscanner variability of our technique was assessed over multiple scans on three different MR scanners.

Statistical Tests: For each scan, the median of cartilage T and T over six radial slices was calculated. Restricted maximum likelihood estimation of variance components was used to estimate intrasubject variances reflecting variation between results from the two scans using the same scanner (intrascanner variance) and variation among results from the three scanners (interscanner variance).

Results: The estimation error for T and T with respect to reference standard measurements was less than 3% on average for the phantom. The average interscanner coefficient of variation was 1.5% (1.2-1.9%) and 0.9% (0.0-3.7%) for T and T , respectively, in the seven compartments of the phantom. Total scan time in vivo was 7:13 minutes to obtain PD, T , and T maps along six radial hip sections at 0.6 × 0.6 × 4.0 mm voxel resolution. Interscanner variability for the in vivo study was 1.99% and 5.46% for T and T , respectively. in vivo intrascanner variability was 1.15% for T and 3.24% for T .

Data Conclusion: Our method, which includes slice positioning, model-based parameter estimation, and cartilage segmentation, is highly reproducible. It could enable employing quantitative hip cartilage evaluation for longitudinal and multicenter studies.

Level Of Evidence: 1 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2019;50:810-815.
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http://dx.doi.org/10.1002/jmri.26615DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591100PMC
September 2019

Different Relationship Between Systolic Blood Pressure and Cerebral Perfusion in Subjects With and Without Hypertension.

Hypertension 2019 01;73(1):197-205

From the Center for Brain Health, Department of Psychiatry (L.G., W.T., E.P., A.D., Y.L., C.R., J.C., R.S.O., T.B., E.T., P.H., M.J.d.L.), New York University (NYU) School of Medicine, New York.

Although there is an increasing agreement that hypertension is associated with cerebrovascular compromise, relationships between blood pressure (BP) and cerebral blood flow are not fully understood. It is not known what BP level, and consequently what therapeutic goal, is optimal for brain perfusion. Moreover, there is limited data on how BP affects hippocampal perfusion, a structure critically involved in memory. We conducted a cross-sectional (n=445) and longitudinal (n=185) study of adults and elderly without dementia or clinically apparent stroke, who underwent clinical examination and brain perfusion assessment (age 69.2±7.5 years, 62% women, 45% hypertensive). Linear models were used to test baseline BP-blood flow relationship and to examine how changes in BP influence changes in perfusion. In the entire group, systolic BP (SBP) was negatively related to cortical (β=-0.13, P=0.005) and hippocampal blood flow (β=-0.12, P=0.01). Notably, this negative relationship was apparent already in subjects without hypertension. Hypertensive subjects showed a quadratic relationship between SBP and hippocampal blood flow (β=-1.55, P=0.03): Perfusion was the highest in subjects with mid-range SBP around 125 mm Hg. Longitudinally, in hypertensive subjects perfusion increased with increased SBP at low baseline SBP but increased with decreased SBP at high baseline SBP. Cortical and hippocampal perfusion decrease with increasing SBP across the entire BP spectrum. However, in hypertension, there seems to be a window of mid-range SBP which maximizes perfusion.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.118.11233DOI Listing
January 2019

Diffusional kurtosis imaging of the corpus callosum in autism.

Mol Autism 2018 13;9:62. Epub 2018 Dec 13.

1Department of Radiology, New York University School of Medicine, New York, NY USA.

Background: The corpus callosum is implicated in the pathophysiology of autism spectrum disorder (ASD). However, specific structural deficits and underlying mechanisms are yet to be well defined.

Methods: We employed diffusional kurtosis imaging (DKI) metrics to characterize white matter properties within five discrete segments of the corpus callosum in 17 typically developing (TD) adults and 16 age-matched participants with ASD without co-occurring intellectual disability (ID). The DKI metrics included axonal water fraction () and intra-axonal diffusivity (), which reflect axonal density and caliber, and extra-axonal radial (RD) and axial (AD) diffusivities, which reflect myelination and microstructural organization of the extracellular space. The relationships between DKI metrics and processing speed, a cognitive feature known to be impaired in ASD, were also examined.

Results: ASD group had significantly decreased callosal and ( = .01 and  = .045), particularly in the midbody, isthmus, and splenium. Regression analysis showed that variation in DKI metrics, primarily in the mid and posterior callosal regions explained up to 70.7% of the variance in processing speed scores for TD ( = .001) but not for ASD ( > .05).

Conclusion: Decreased DKI metrics suggested that ASD may be associated with axonal deficits such as reduced axonal caliber and density in the corpus callosum, especially in the mid and posterior callosal areas. These data suggest that impaired interhemispheric connectivity may contribute to decreased processing speed in ASD participants.
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http://dx.doi.org/10.1186/s13229-018-0245-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6293510PMC
January 2019

Segmentation of the Proximal Femur from MR Images using Deep Convolutional Neural Networks.

Sci Rep 2018 11 7;8(1):16485. Epub 2018 Nov 7.

Department of Radiology, New York University School of Medicine, New York, NY, 10016, USA.

Magnetic resonance imaging (MRI) has been proposed as a complimentary method to measure bone quality and assess fracture risk. However, manual segmentation of MR images of bone is time-consuming, limiting the use of MRI measurements in the clinical practice. The purpose of this paper is to present an automatic proximal femur segmentation method that is based on deep convolutional neural networks (CNNs). This study had institutional review board approval and written informed consent was obtained from all subjects. A dataset of volumetric structural MR images of the proximal femur from 86 subjects were manually-segmented by an expert. We performed experiments by training two different CNN architectures with multiple number of initial feature maps, layers and dilation rates, and tested their segmentation performance against the gold standard of manual segmentations using four-fold cross-validation. Automatic segmentation of the proximal femur using CNNs achieved a high dice similarity score of 0.95 ± 0.02 with precision = 0.95 ± 0.02, and recall = 0.95 ± 0.03. The high segmentation accuracy provided by CNNs has the potential to help bring the use of structural MRI measurements of bone quality into clinical practice for management of osteoporosis.
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http://dx.doi.org/10.1038/s41598-018-34817-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220200PMC
November 2018

Discrepancy Rates and Clinical Impact of Imaging Secondary Interpretations: A Systematic Review and Meta-Analysis.

J Am Coll Radiol 2018 Sep 18;15(9):1222-1231. Epub 2018 Jul 18.

Department of Radiology, NYU Langone Health, New York, New York; Department of Population Health, NYU Langone Health, New York, New York.

Purpose: To conduct a meta-analysis of studies investigating discrepancy rates and clinical impact of imaging secondary interpretations and to identify factors influencing these rates.

Methods: EMBASE and PubMed databases were searched for original research investigations reporting discrepancy rates for secondary interpretations performed by radiologists for imaging examinations initially interpreted at other institutions. Two reviewers extracted study information and assessed study quality. Meta-analysis was performed.

Results: Twenty-nine studies representing a total of 12,676 imaging secondary interpretations met inclusion criteria; 19 of these studies provided data specifically for oncologic imaging examinations. Primary risks of bias included availability of initial interpretations, other clinical information, and reference standard before the secondary interpretation. The overall discrepancy rate of secondary interpretations compared with primary interpretations was 32.2%, including a 20.4% discrepancy rate for major findings. Secondary interpretations were management changing in 18.6% of cases. Among discrepant interpretations with an available reference standard, the secondary interpretation accuracy rate was 90.5%. The overall discrepancy rates by examination types were 28.3% for CT, 31.2% for MRI, 32.7% for oncologic imaging, 43.8% for body imaging, 39.9% for breast imaging, 34.0% for musculoskeletal imaging, 23.8% for neuroradiologic imaging, 35.5% for pediatric imaging, and 19.7% for trauma imaging.

Conclusion: Most widely studied in the context of oncology, imaging secondary interpretations commonly result in discrepant interpretations that are management changing and more accurate than initial interpretations. Policymakers should consider these findings as they consider the value of, and payment for, secondary imaging interpretations.
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http://dx.doi.org/10.1016/j.jacr.2018.05.037DOI Listing
September 2018

Accelerated Internal Auditory Canal Screening Magnetic Resonance Imaging Protocol With Compressed Sensing 3-Dimensional T2-Weighted Sequence.

Invest Radiol 2018 12;53(12):742-747

Center for Advanced Imaging Innovation and Research (CAI2R), New York University Langone School of Medicine, New York, NY.

Background And Purpose: High-resolution T2-weighted sequences are frequently used in magnetic resonance imaging (MRI) studies to assess the cerebellopontine angle and internal auditory canal (IAC) in sensorineural hearing loss patients but have low yield and lengthened examinations. Because image content in the Wavelet domain is sparse, compressed sensing (CS) that uses incoherent undersampling of k-space and iterative reconstruction can accelerate MRI acquisitions. We hypothesized that an accelerated CS T2 Sampling Perfection with Application optimized Contrasts using different flip angle Evolution (SPACE) sequence would produce acceptable diagnostic quality for IAC screening protocols.

Material And Methods: Seventy-six patients underwent 3 T MRI using conventional SPACE and a CS T2 SPACE prototype sequence for screening the IACs were identified retrospectively. Unilateral reconstructions for each sequence were separated, then placed into mixed folders for independent, blinded review by 3 neuroradiologists during 2 sessions 4 weeks apart. Radiologists reported if a lesion was present. Motion and visualization of specific structures were rated using ordinal scales. McNemar, Wilcoxon, Cohen κ, and Mann-Whitney U tests were performed for accuracy, equivalence, and interrater and intrarater reliability.

Results: T2 SPACE using CS reconstruction reduced scan time by 80% to 50 seconds and provided 98.7% accuracy for IAC mass detection by 3 raters. Radiologists preferred conventional images (0.7-1.0 reduction on 5-point scale, P < 0.001), but rated CS SPACE acceptable. The 95% confidence for reduction in any cerebellopontine angle, IAC, or fluid-filled inner ear structure assessment with CS SPACE did not exceed 0.5.

Conclusions: Internal auditory canal screening MRI protocols can be performed using a 5-fold accelerated T2 SPACE sequence with compressed sensing while preserving diagnostic image quality and acceptable lesion detection rate.
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http://dx.doi.org/10.1097/RLI.0000000000000499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6317869PMC
December 2018

Correlation of benign incidental findings seen on whole-body PET-CT with knee MRI: patterns of F-FDG avidity, intra-articular pathology, and bone marrow edema lesions.

Skeletal Radiol 2018 Dec 21;47(12):1651-1660. Epub 2018 Jun 21.

Department of Nuclear Medicine, NYU Langone Medical Center, 560 1st Avenue, New York, NY, 10016, USA.

Objectives: To correlate patterns of F-FDG uptake on whole-body PET-CT with MR findings and compare the degree of FDG activity between symptomatic and asymptomatic knees.

Materials And Methods: Retrospective database query was performed using codes for knee MRI as well as whole-body PET-CT. Patients with malignant disease involving the knee or hardware were excluded. Patients who had both studies performed within 1 year between 2012 and 2017 were included for analysis. Knee joint osteoarthrosis, meniscal and ligamentous integrity, presence of joint effusion, and synovitis were assessed and recorded. Bone marrow edema lesions (BMELs) were identified, segmented, and analyzed using volumetric analysis. SUVmax was assessed over the suprapatellar joint space, intercondylar notch and Hoffa's fat pad. Symptomatic and asymptomatic knees were compared in patients with unilateral symptoms.

Results: Twenty-two cases (20 patients) with mean age 63.3 years (range, 36-91 years) were included. Two patients had bilateral pain. The most FDG avid regions in both symptomatic and asymptomatic knees were the intercondylar notch (SUVmax = 1.84 vs. 1.51), followed by suprapatellar pouch (SUVmax = 1.74 vs. 1.29) and Hoffa's fat pad (SUVmax = 1.01 vs. 0.87). SUVmax was significantly associated with cartilage loss (mean modified Outerbridge score) (r = 0.60, p = 0.003) and degree of synovitis (r = 0.48, p = 0023). Overall, mean SUVmax was significantly higher in the presence of a meniscal tear (1.83 ± 0.67 vs. 1.22 ± 0.40, p = 0.030). Nine patients had BMELs (volume: range = 0.6-27.8, mean = 7.79) however there was no significant association between BMEL volume and SUVmax.

Conclusions: Higher FDG activity correlates with intra-articular derangement and the intercondylar notch represents the most metabolically active region of the knee.
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http://dx.doi.org/10.1007/s00256-018-3001-xDOI Listing
December 2018

Stylus/tablet user input device for MRI heart wall segmentation: efficiency and ease of use.

Eur Radiol 2018 Nov 2;28(11):4586-4597. Epub 2018 May 2.

Department of Radiology, NYU Langone Medical Center, New York, NY, 10016, USA.

Objectives: To determine whether use of a stylus user input device (UID) would be superior to a mouse for CMR segmentation.

Methods: Twenty-five consecutive clinical cardiac magnetic resonance (CMR) examinations were selected. Image analysis was independently performed by four observers. Manual tracing of left (LV) and right (RV) ventricular endocardial contours was performed twice in 10 randomly assigned sessions, each session using only one UID. Segmentation time and the ventricular function variables were recorded. The mean segmentation time and time reduction were calculated for each method. Intraclass correlation coefficients (ICC) and Bland-Altman plots of function variables were used to assess intra- and interobserver variability and agreement between methods. Observers completed a Likert-type questionnaire.

Results: The mean segmentation time (in seconds) was significantly less with the stylus compared to the mouse, averaging 206±108 versus 308±125 (p<0.001) and 225±140 versus 353±162 (p<0.001) for LV and RV segmentation, respectively. The intra- and interobserver agreement rates were excellent (ICC≥0.75) regardless of the UID. There was an excellent agreement between measurements derived from manual segmentation using different UIDs (ICC≥0.75), with few exceptions. Observers preferred the stylus.

Conclusion: The study shows a significant reduction in segmentation time using the stylus, a subjective preference, and excellent agreement between the methods.

Key Points: • Using a stylus for MRI ventricular segmentation is faster compared to mouse • A stylus is easier to use and results in less fatigue • There is excellent agreement between stylus and mouse UIDs.
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http://dx.doi.org/10.1007/s00330-018-5435-xDOI Listing
November 2018