Publications by authors named "Mari Hagiwara"

46 Publications

ACR Appropriateness Criteria® Imaging of Facial Trauma Following Primary Survey.

J Am Coll Radiol 2022 05;19(5S):S67-S86

Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

Maxillofacial trauma patients comprise a significant subset of patients presenting to emergency departments. Before evaluating for facial trauma, an emergency or trauma physician must perform a primary survey to ensure patient stabilization. Following this primary survey, this document discusses the following clinical scenarios for facial trauma: tenderness to palpation or contusion or edema over frontal bone (suspected frontal bone injury); pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia (suspected midface injury); visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis (suspected nasal bone injury); and trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth (suspected mandibular injury). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2022.02.013DOI Listing
May 2022

ACR Appropriateness Criteria® Sinonasal Disease: 2021 Update.

J Am Coll Radiol 2022 05;19(5S):S175-S193

Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

This article presents guidelines for initial imaging utilization in patients presenting with sinonasal disease, including acute rhinosinusitis without and with suspected orbital and intracranial complications, chronic rhinosinusitis, suspected invasive fungal sinusitis, suspected sinonasal mass, and suspected cerebrospinal fluid leak. CT and MRI are the primary imaging modalities used to evaluate patients with sinonasal disease. Given its detailed depiction of bony anatomy, CT can accurately demonstrate the presence of sinonasal disease, bony erosions, and anatomic variants, and is essential for surgical planning. Given its superior soft tissue contrast, MRI can accurately identify clinically suspected intracranial and intraorbital complications, delineate soft tissue extension of tumor and distinguish mass from obstructed secretions.The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2022.02.011DOI Listing
May 2022

Skull Base Tumor Mimics.

Neuroimaging Clin N Am 2022 May;32(2):327-344

Department of Radiology, NYU Langone Health, 222 East 41st Street, 5th Floor Radiology, New York, NY 10017, USA. Electronic address:

Many different benign and malignant processes affect the central skull base and petrous apices. Clinical evaluation and tissue sampling are difficult because of its deep location, leaving imaging assessment the primary means for lesion evaluation. Skull base lesions demonstrate a variety of confusing appearances on imaging, creating diagnostic dilemmas. It is important to be familiar with imaging appearances of common mimickers of malignant neoplasm in the skull base. This article familiarizes readers with imaging characteristics of various anatomic variants and benign pathologies that mimic malignant neoplasms, in hopes of increasing confidence of diagnosis, decreasing unnecessary procedures, and allaying patient fear.
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http://dx.doi.org/10.1016/j.nic.2022.02.001DOI Listing
May 2022

Imaging of Facial Reconstruction and Face Transplantation.

Neuroimaging Clin N Am 2022 Feb;32(1):255-269

Department of Radiology, NYU Langone Health, 222 East 41st Street, 5th Floor Radiology, New York, NY 10017, USA.

Pre- and postoperative imaging is increasingly used in plastic and reconstructive surgery for the evaluation of bony and soft tissue anatomy. Imaging plays an important role in preoperative planning. In the postoperative setting, imaging is used for the assessment of surgical positioning, bone healing and fusion, and for the assessment of early or delayed surgical complications. This article will focus on imaging performed for surgical reconstruction of the face, including orthognathic surgery, facial feminization procedures for gender dysphoria, and face transplantation.
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http://dx.doi.org/10.1016/j.nic.2021.08.011DOI Listing
February 2022

ACR Appropriateness Criteria® Parathyroid Adenoma.

J Am Coll Radiol 2021 11;18(11S):S406-S422

Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia.

Hyperparathyroidism is defined as excessive parathyroid hormone production. The diagnosis is made through biochemical testing, in which imaging has no role. However, imaging is appropriate for preoperative parathyroid gland localization with the intent of surgical cure. Imaging is particularly useful in the setting of primary hyperparathyroidism whereby accurate localization of a single parathyroid adenoma can facilitate minimally invasive parathyroidectomy. Imaging can also be useful to localize ectopic or supernumerary parathyroid glands and detail anatomy, which may impact surgery. This document summarizes the literature and provides imaging recommendations for hyperparathyroidism including primary hyperparathyroidism, recurrent or persistent primary hyperparathyroidism after parathyroid surgery, secondary hyperparathyroidism, and tertiary hyperparathyroidism. Recommendations include ultrasound, CT neck without and with contrast, and nuclear medicine parathyroid scans. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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http://dx.doi.org/10.1016/j.jacr.2021.08.013DOI Listing
November 2021

Central Retinal Artery Visualization with Cone-Beam CT Angiography.

Radiology 2022 02 16;302(2):419-424. Epub 2021 Nov 16.

From the Departments of Radiology (E.R., M.S., T.M.S., O.M., M.H., M.G.Y., P.K.N.), Neurology (M.S., S.Y., D.M.G., K.I., J.C.R., S.A., S.L.G.), Neurosurgery (E.N., P.K.N.), and Ophthalmology (J.C.R., I.B., E.K., S.L.G.), Bernard and Irene Schwartz Neurointerventional Section (E.R., M.S., P.K.N.), NYU Langone Health, 660 First Ave, 7th Floor, New York, NY 10016; Department of Neurology, Brown University, Providence, RI (S.Y.); and Department of Neurology, Duke University School of Medicine, Durham, NC (B.M.G.).

Background There are multiple tools available to visualize the retinal and choroidal vasculature of the posterior globe. However, there are currently no reliable in vivo imaging techniques that can visualize the entire retrobulbar course of the retinal and ciliary vessels. Purpose To identify and characterize the central retinal artery (CRA) using cone-beam CT (CBCT) images obtained as part of diagnostic cerebral angiography. Materials and Methods In this retrospective study, patients with catheter DSA performed between October 2019 and October 2020 were included if CBCT angiography included the orbit in the field of view. The CBCT angiography data sets were postprocessed with a small field-of-view volume centered in the posterior globe to a maximum resolution of 0.2 mm. The following were evaluated: CRA origin, CRA course, CRA point of penetration into the optic nerve sheath, bifurcation of the CRA at the papilla, visualization of anatomic variants, and visualization of the central retinal vein. Descriptive statistical analysis was performed. Results Twenty-one patients with 24 visualized orbits were included in the analysis (mean age, 55 years ± 15; 14 women). Indications for angiography were as follows: diagnostic angiography ( = 8), aneurysm treatment ( = 6), or other ( = 7). The CRA was identified in all orbits; the origin, course, point of penetration of the CRA into the optic nerve sheath, and termination in the papilla were visualized in all orbits. The average length of the intraneural segment was 10.6 mm (range, 7-18 mm). The central retinal vein was identified in six of 24 orbits. Conclusion Cone-beam CT, performed during diagnostic angiography, consistently demonstrated the in vivo central retinal artery, demonstrating excellent potential for multiple diagnostic and therapeutic applications. © RSNA, 2021
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http://dx.doi.org/10.1148/radiol.2021210520DOI Listing
February 2022

Neuroimaging of Dizziness and Vertigo.

Otolaryngol Clin North Am 2021 Oct 24;54(5):893-911. Epub 2021 Jul 24.

Department of Radiology, NYU Langone Health, 222 East 41st Street, 5th Floor Radiology, New York, NY 10017, USA. Electronic address:

Dizziness and vertigo are common symptoms in the primary care and emergency settings, resulting in a significant decrease in quality of life and a high cost burden to the US health care system. The etiology of these symptoms is difficult to elucidate owing to a wide range of diseases with overlapping manifestations. The broad differential diagnosis based on whether the disease process is central or peripheral is showcased. Each differential will be categorized into neoplastic, infectious or inflammatory, structural, traumatic, and iatrogenic causes. Computed tomography scans, MRI, and vascular imaging are frequently complimentary in providing diagnoses and guidance in management.
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http://dx.doi.org/10.1016/j.otc.2021.06.001DOI Listing
October 2021

Update on MRI for Oral Cavity.

Top Magn Reson Imaging 2021 Apr;30(2):85-96

Department of Radiology, NYU Langone Health, New York, NY.

Abstract: Magnetic resonance imaging (MRI) is the imaging modality of choice to evaluate the complex anatomy and pathology of the oral cavity. In this article, an overview of MRI findings of common benign lesions in the oral cavity including congenital, vascular, and inflammatory/infectious lesions will be reviewed. In addition, MRI findings of common benign and malignant oral cavity tumors will be presented.
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http://dx.doi.org/10.1097/RMR.0000000000000278DOI Listing
April 2021

Assessment of metastatic lymph nodes in head and neck squamous cell carcinomas using simultaneous F-FDG-PET and MRI.

Sci Rep 2020 11 27;10(1):20764. Epub 2020 Nov 27.

Department of Radiology, Center for Biomedical Imaging (CBI), Center for Advanced Imaging Innovation and Research (CAI2R), New York University School of Medicine, 660 First Avenue, New York, NY, 10016, USA.

In this study, we investigate the feasibility of using dynamic contrast enhanced magnetic resonance imaging (DCE-MRI), diffusion weighted imaging (DWI), and dynamic positron emission tomography (PET) for detection of metastatic lymph nodes in head and neck squamous cell carcinoma (HNSCC) cases. Twenty HNSCC patients scheduled for lymph node dissection underwent DCE-MRI, dynamic PET, and DWI using a PET-MR scanner within one week prior to their planned surgery. During surgery, resected nodes were labeled to identify their nodal levels and sent for routine clinical pathology evaluation. Quantitative parameters of metastatic and normal nodes were calculated from DCE-MRI (v, v, PS, F, K), DWI (ADC) and PET (K, K, k, k) to assess if an individual or a combination of parameters can classify normal and metastatic lymph nodes accurately. There were 38 normal and 11 metastatic nodes covered by all three imaging methods and confirmed by pathology. 34% of all normal nodes had volumes greater than or equal to the smallest metastatic node while 4 normal nodes had SUV > 4.5. Among the MRI parameters, the median v, F, PS, and K values of the metastatic lymph nodes were significantly lower (p = <0.05) than those of normal nodes. v and ADC did not show any statistical significance. For the dynamic PET parameters, the metastatic nodes had significantly higher k (p value = 8.8 × 10) and K (p value = 5.3 × 10) than normal nodes. K and k did not show any statistically significant difference. K had the best separation with accuracy = 0.96 (sensitivity = 1, specificity = 0.95) using a cutoff of K = 5.3 × 10 mL/cm/min, while k and volume had accuracy of 0.94 (sensitivity = 0.82, specificity = 0.97) and 0.90 (sensitivity = 0.64, specificity = 0.97) respectively. 100% accuracy can be achieved using a multivariate logistic regression model of MRI parameters after thresholding the data with K < 5.3 × 10 mL/cm/min. The results of this preliminary study suggest that quantitative MRI may provide additional value in distinguishing metastatic nodes, particularly among small nodes, when used together with FDG-PET.
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http://dx.doi.org/10.1038/s41598-020-77740-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695736PMC
November 2020

Tracking Spontaneous Vestibular Schwannoma Regression with Volumetric Measurements.

Laryngoscope 2021 05 26;131(5):E1647-E1652. Epub 2020 Oct 26.

Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A.

Objective: To characterize a series of patients with MRI evidence of spontaneous vestibular schwannoma (VS) regression.

Study Design: Retrospective case series.

Methods: Retrospective review between 2012 and 2020 from a single, tertiary-care center of all patients with an untreated, sporadic VS and spontaneous regression in volumetric tumor size over the course of observation. The main outcome measures included VS size and location, presenting symptoms, medication use, changes in pure-tone averages and word recognition scores.

Results: The 13 treatment-naïve patients (62% female, mean age 67.1 years) with spontaneous VS regression represented 3.9% of all patients undergoing observation with serial imaging during the study period. Median tumor size from initial MRI was 529.0 mm (range: 108 mm -13,180 mm ). The mean interval between MRI measurements was 5.5 years (SD 4.4 years). The average percent decrease in tumor size was 36.1% (SD 21.9%) and the average rate of volume decrease was 15.8 mm /yr (SD 25.4 mm /yr). Five patients were classified as having major regression, defined by a relative decrease in volume of >40%, while eight patients had minor regression (<40% relative volume reduction). No significant differences in initial tumor size, rate of regression, or audiometric changes were observed between the major and minor regression cohorts.

Conclusions: Patients with evidence of a spontaneously shrinking VS have a heterogeneous presentation. Due to the scarcity of this phenomenon, predicting which tumors will eventually undergo regression remains unclear. Employing volumetric measurements to compare serial MRI scans may improve the accuracy of detecting shrinking tumors.

Level Of Evidence: 4 Laryngoscope, 131:E1647-E1652, 2021.
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http://dx.doi.org/10.1002/lary.29201DOI Listing
May 2021

Oncogenes overexpressed in metastatic oral cancers from patients with pain: potential pain mediators released in exosomes.

Sci Rep 2020 09 7;10(1):14724. Epub 2020 Sep 7.

Bluestone Center for Clinical Research, New York University College of Dentistry, 421 First Avenue, Room 233W, New York, NY, 10010, USA.

Oral cancer patients experience pain at the site of the primary cancer. Patients with metastatic oral cancers report greater pain. Lack of pain identifies patients at low risk of metastasis with sensitivity = 0.94 and negative predictive value = 0.89. In the same cohort, sensitivity and negative predictive value of depth of invasion, currently the best predictor, were 0.95 and 0.92, respectively. Cancer pain is attributed to cancer-derived mediators that sensitize neurons and is associated with increased neuronal density. We hypothesized that pain mediators would be overexpressed in metastatic cancers from patients reporting high pain. We identified 40 genes overexpressed in metastatic cancers from patients reporting high pain (n = 5) compared to N0 cancers (n = 10) and normal tissue (n = 5). The genes are enriched for functions in extracellular matrix organization and angiogenesis. They have oncogenic and neuronal functions and are reported in exosomes. Hierarchical clustering according to expression of neurotrophic and axon guidance genes also separated cancers according to pain and nodal status. Depletion of exosomes from cancer cell line supernatant reduced nociceptive behavior in a paw withdrawal assay, supporting a role for exosomes in cancer pain. The identified genes and exosomes are potential therapeutic targets for stopping cancer and attenuating pain.
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http://dx.doi.org/10.1038/s41598-020-71298-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477576PMC
September 2020

Cavernous sinus lesions.

Clin Imaging 2020 Dec 18;68:71-89. Epub 2020 Jun 18.

NYU Langone Health, Department of Radiology, New York, NY, United States of America. Electronic address:

The cavernous sinus is a complex structure susceptible to a wide variety of vascular, neoplastic and inflammatory pathologies. Vascular pathologies include ICA aneurysms, carotid-cavernous fistulas, cavernous sinus thrombosis, and cavernous hemangioma. Neoplasms that involve the cavernous sinus include pituitary adenoma, meningioma, schwannoma, lymphoma, perineural tumor spread, metastases, and direct tumor invasion. Infectious and inflammatory diseases include Tolosa-Hunt syndrome, sarcoidosis, granulomatosis with polyangiitis, IgG-4 related disease and invasive fungal infections. In this article, we review the clinical and imaging findings of a number of pathologies involving the cavernous sinus, focusing on key features that can narrow the differential diagnosis and, in some cases, support a particular diagnosis.
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http://dx.doi.org/10.1016/j.clinimag.2020.06.029DOI Listing
December 2020

COVID-19-associated Diffuse Leukoencephalopathy and Microhemorrhages.

Radiology 2020 10 21;297(1):E223-E227. Epub 2020 May 21.

From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016.

Diffuse leukoencephalopathy and juxtacortical and/or callosal microhemorrhages were brain imaging features in critically ill patients with coronavirus disease 2019. Coronavirus disease 2019 (COVID-19) has been reported in association with a variety of brain imaging findings such as ischemic infarct, hemorrhage, and acute hemorrhagic necrotizing encephalopathy. Herein, the authors report brain imaging features in 11 critically ill patients with COVID-19 with persistently diminished mental status who underwent MRI between April 5 and April 25, 2020. These imaging features include confluent T2 hyperintensity and mild restricted diffusion in bilateral supratentorial deep and subcortical white matter (in 10 of 11 patients) and multiple punctate microhemorrhages in juxtacortical and callosal white matter (in seven of 11 patients). The authors also discuss potential pathogeneses.
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http://dx.doi.org/10.1148/radiol.2020202040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7507998PMC
October 2020

Adult rhabdomyoma presenting as thyroid nodule on fine-needle aspiration in patient with Birt-Hogg-Dubé syndrome: Case report and literature review.

Diagn Cytopathol 2020 Jun 18;48(6):576-580. Epub 2020 Mar 18.

Department of Pathology, NYU Langone Health, New York, New York, USA.

Extracardiac rhabdomyoma is an uncommon benign striated muscle tumor with a predilection for the head and neck region. However, it is extremely rare for extracardiac rhabdomyoma to present as a thyroid nodule. We report a case of rhabdomyoma diagnosed by thyroid fine-needle aspiration (FNA) in a patient with Birt-Hogg-Dubé (BHD) syndrome. A 60-year-old man with BHD syndrome presented for recurrent pneumothorax. Chest CT incidentally identified a thyroid nodule. Subsequent sonography confirmed a 4.44 × 2.28 × 2.82 cm solid, hypoechoic nodule with smooth margins in the right upper pole. Ultrasound-guided FNA revealed many clusters and scattered isolated large polygonal cells with abundant granular cytoplasm and small peripherally located nuclei. Vague striations in the cytoplasm were focally identified. No follicular cells or colloid was present. Immunocytochemistry on one direct smear slide demonstrated diffuse positivity for desmin, supporting muscular differentiation. Subsequent surgery identified an adult rhabdomyoma originating from the inferior constrictor muscle of the neck and anteriorly displacing the thyroid. Because the mass was intimately associated with the thyroid gland, it was initially mistaken for a thyroid nodule on ultrasound. Diagnosis of rhabdomyoma on FNA is challenging, especially when rhabdomyoma mimics a thyroid nodule on imaging. The differential diagnosis includes Hurthle cell neoplasm, granular cell tumor, colloid nodule, and normal striated skeletal muscle. Adequate radiologic data and familiarity with the cytologic features of rhabdomyoma are critical for an accurate diagnosis.
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http://dx.doi.org/10.1002/dc.24413DOI Listing
June 2020

Decreased Tongue Volume Post Radiation.

Ann Otol Rhinol Laryngol 2020 Aug 4;129(8):741-747. Epub 2020 Mar 4.

Department of Otolaryngology-Head and Neck Surgery, NYU Voice Center, New York University School of Medicine, New York, NY, USA.

Objectives: To evaluate volume changes within the tongue post chemoradiation therapy (CRT).

Study Design: Retrospective review.

Setting: Academic Medical Center.

Subjects And Methods: Subjects included 19 patients that received CRT as the primary treatment for tonsillar or hypopharynx squamous cell carcinoma. Tongue volumes were calculated by three raters from thin slice computed tomography images collected before treatment and up to 29 months post-CRT. Body mass index (BMI) was also collected at each time point.

Results: Inter-rater reliability was high with an ICC of 0.849 (95% CI = 0.773, 0.905). Linear mixed effects modeling showed a mean decrease of 0.45 cm (standard error of the mean [SEM] = 0.11) in tongue volume per month post-CRT ( < .001). However, the addition of BMI to the model was significant (χ (4) = 25.0,  < .001), indicating that BMI was a strong predictor of tongue volume, with a mean decrease of 1.75 cm (SEM = 0.49) in tongue volume per unit decrease in BMI ( < .001) and reducing the post-CRT effect on tongue volume decrease per month to 0.23 cm ( = .02). BMI significantly ( < .001) decreased by 0.11 units (SEM = 0.02) per month post radiation.

Conclusion: Tongue dysfunction and decreased tongue strength are significant contributors to the dysphagia that patients experience after receiving CRT. In this study, both tongue volume and BMI decreased post-CRT; therefore, BMI could potentially be used as a predictor of tongue volume post-CRT.
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http://dx.doi.org/10.1177/0003489420911668DOI Listing
August 2020

Preoperative Imaging for Facial Transplant: A Guide for Radiologists.

Radiographics 2019 Jul-Aug;39(4):1098-1107. Epub 2019 May 24.

From the Department of Radiology (V.P., M.H., Y.W.L., A.J.D., M.S.) and Hanjörg Wyss Department of Plastic Surgery (N.M.P., J.R.D.S., E.D.R.), New York University Langone Health, 550 First Ave, New York, NY 10016; Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md (C.W.S., A.S.M.); and Department of Radiology, MedStar Health, Baltimore, Md (A.S.M.).

Facial transplant (FT) is a viable option for patients with severe craniomaxillofacial deformities. Transplant imaging requires coordination between radiologists and surgeons and an understanding of the merits and limitations of imaging modalities. Digital subtraction angiography and CT angiography are critical to mapping vascular anatomy, while volume-rendered CT allows evaluation of osseous defects and landmarks used for surgical cutting guides. This article highlights the components of successful FT imaging at two institutions and in two index cases. A deliberate stepwise approach to performance and interpretation of preoperative FT imaging, which consists of the modalities and protocols described here, is essential to seamless integration of the multidisciplinary FT team. RSNA, 2019 See discussion on this article by Lincoln .
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http://dx.doi.org/10.1148/rg.2019180167DOI Listing
May 2020

Comparison of Skull Radiograph and Computed Tomography Measurements of Cochlear Implant Insertion Angles.

Otol Neurotol 2019 03;40(3):e298-e303

NYU School of Medicine, Department of Otolaryngology.

Background: Measurement of the angular depth of insertion (aDOI) of cochlear implant electrode arrays has numerous clinical and research applications. Plain-film radiographs are easily obtained intraoperatively and have been described as a means to calculate aDOI. CT imaging with 3D reformatting can also be used for this measurement, but is less conveniently obtained and requires higher radiation doses, a particular concern in pediatrics. The extent to which plain-film and 3D CT image-based measurements are representative of the true position of the electrode within the cochlea is unknown.

Methods: Cochlear implantation was performed on 10 cadaveric temporal bones. Five bones were implanted with perimodiolar electrodes (Contour Advance TM, Cochlear, Sydney, Australia) and five were implanted with lateral wall electrodes (Slim Straight, Cochlear). The insertion depths of the electrodes were varied. Each bone was imaged with a radiograph and CT. aDOI was measured for each bone in each imaging modality by a neurotologist and a neuroradiologist. To obtain a 'gold standard' estimate of aDOI, the implanted temporal bones were embedded in an epoxy resin and methodically sectioned at 100 μm intervals; histologic images were captured at each interval. A 3D stack of the images was compounded, and a MATLAB script used to calculate aDOI of the most apical electrode. Measurements in the three modalities (radiograph, CT, and histology) were then compared.

Results: The average aDOI across all bones was similar for all modalities: 423° for radiographs, 425° for CT scans, and 427° for histology, indicating that neither imaging modality resulted in large systematic errors. Using the histology-measured angles as a reference, the average error for CT-based measures (regardless of whether the error was in the positive or negative direction) was 12°, and that for radiograph-based measures was 15°. This small difference (12 vs 15° error) was not statistically significant.

Conclusion: Based on this cadaveric temporal bone model, both radiographs and CTs can provide reasonably accurate aDOI measurements. In this small sample, and as expected, the CT-based estimates were more accurate than the radiograph-based measurements. However, the difference was small and not statistically significant. Thus, the use of plain radiographs to calculate aDOI seems judicious whenever it is desired to prevent unnecessary radiation exposure and expense.
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http://dx.doi.org/10.1097/MAO.0000000000002121DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6548183PMC
March 2019

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

Effect of lapatinib on meningioma growth in adults with neurofibromatosis type 2.

J Neurooncol 2018 Sep 8;139(3):749-755. Epub 2018 Jun 8.

Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Introduction: Epidermal growth factor receptors EGFR and ErbB2 are overexpressed in schwannomas and meningiomas. Preclinical and clinical data indicate that lapatinib, an EGFR/ErbB2 inhibitor, has antitumor activity against vestibular schwannomas in neurofibromatosis type 2 (NF2) patients. Its antitumor activity against meningiomas, however, is unknown.

Methods: We conducted a retrospective review of patients with NF2 and progressive vestibular schwannomas treated on a phase 2 clinical trial with lapatinib (NCT00973739). We included patients with at least one volumetrically measurable meningioma (> 0.5 cm) who received at least five 28-day courses of treatment. Patients received lapatinib 1500 mg daily. Meningioma response was assessed using 3-dimensional MRI volumetrics. Progressive meningioma growth and response were defined as + 20 and - 20% change in tumor volume from baseline, respectively. Off-treatment was defined as any period > 5 months without lapatinib.

Results: Eight patients (ages: 20-58 years) who met criteria had 17 evaluable meningiomas with a combined volume of 61.35 cc at baseline, 61.17 cc during treatment, and 108.86 cc (+ 77.44% change) off-treatment, p = 0.0033. Median time on-treatment and off-treatment was 15.5 and 16.7 months, respectively. On-treatment mean and median annualized growth rates were 10.67 and 1.32%, respectively. Off-treatment mean and median annualized growth rates were 20.05 and 10.42%, respectively. The best volumetric response was - 26.1% after 23 months on lapatinib. Two tumors increased > 20% volumetrically on-treatment, compared to eight tumors off-treatment.

Conclusions: These data suggest that lapatinib may have growth-inhibitory effects on meningiomas in NF2 patients, and support prospective studies of lapatinib for NF2 patients with progressive meningiomas.
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http://dx.doi.org/10.1007/s11060-018-2922-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6126973PMC
September 2018

Dynamic Contrast-Enhanced MR Imaging in Head and Neck Cancer.

Magn Reson Imaging Clin N Am 2018 Feb 21;26(1):135-149. Epub 2017 Oct 21.

Department of Radiology and Medical Imaging, University of Virginia Health System, PO Box 800170, 1215 Lee Street, Charlottesville, VA 22908, USA. Electronic address:

Dynamic contrast-enhanced (DCE) MR imaging uses rapid sequential MR image acquisition before, during, and after intravenous contrast administration to elucidate information on the microvascular biologic function of tissues. The derived pharmacokinetic parameters provide useful information on tissue perfusion and permeability that may help to evaluate entities that otherwise appear similar by conventional imaging. When specifically applied to the evaluation of head and neck cancer, DCE-MR imaging may provide valuable information to help predict treatment response, discriminate between posttreatment changes and residual tumor, and discriminate between various head and neck neoplasms.
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http://dx.doi.org/10.1016/j.mric.2017.08.008DOI Listing
February 2018

Influence of clinical history on MRI interpretation of optic neuropathy.

Heliyon 2016 Sep 16;2(9):e00162. Epub 2016 Sep 16.

Department of Radiology, University of Virginia Health System, PO Box 800170, Charlottesville, VA 22908.

Background And Purpose: Clinical history is known to influence interpretation of a wide range of radiologic examinations. We sought to evaluate the influence of the clinical history on MRI interpretation of optic neuropathy.

Materials And Methods: 107 consecutive orbital MRI scans were retrospectively reviewed by three neuroradiologists. The readers independently evaluated the coronal STIR sequence for optic nerve hyperintensity and/or atrophy (yes/no) and the coronal post-contrast T1WI for optic nerve enhancement (yes/no). Readers initially evaluated the cases blinded to the clinical history. Following a two week washout period, readers again evaluated the cases with the clinical history provided. Inter-reader and reader-clinical radiologist agreement was assessed using Cohen's simple kappa coefficient.

Results: Intra-reader agreement, without and with provision of clinical history, was 0.564-0.716 on STIR and 0.270-0.495 on post-contrast T1WI. Inter-reader agreement was overall fair-moderate. On post-contrast T1WI, inter-reader agreement was significantly higher when the clinical history was provided (p = 0.001). Reader-clinical radiologist agreement improved with provision of the clinical history to the readers on both the STIR and post-contrast T1WI sequences.

Conclusions: In the MRI assessment of optic neuropathy, only modest levels of inter-reader agreement were achieved, even after provision of clinical history. Provision of clinical history improved inter-reader agreement, especially when assessing for optic nerve enhancement. These findings confirm the subjective nature of orbital MRI interpretation in cases of optic neuropathy, and point to the importance of an accurate clinical history. Of note, the accuracy of orbital MRI in the context of optic neuropathy was not assessed, and would require further investigation.
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http://dx.doi.org/10.1016/j.heliyon.2016.e00162DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035347PMC
September 2016

Potential Role of PET/MRI for Imaging Metastatic Lymph Nodes in Head and Neck Cancer.

AJR Am J Roentgenol 2016 Aug 10;207(2):248-56. Epub 2016 May 10.

1 Center for Advanced Imaging Innovation and Research, Department of Radiology, New York University School of Medicine, 660 First Ave, New York, NY 10016.

Objective: This article explores recent developments in PET and MRI, separately or combined, for assessing metastatic lymph nodes in patients with head and neck cancer.

Conclusion: The synergistic role of PET and MRI for imaging metastatic lymph nodes has not been fully explored. To facilitate the understanding of the areas that need further investigation, we discuss potential mechanisms and evidence reported so far, as well as future directions and challenges for continued development and clinical research.
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http://dx.doi.org/10.2214/AJR.16.16265DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5756667PMC
August 2016

Extrinsic Esophageal Compression by Cervical Osteophytes in Diffuse Idiopathic Skeletal Hyperostosis: A Contraindication to Transesophageal Echocardiography?

Echocardiography 2016 Feb 24;33(2):314-6. Epub 2015 Nov 24.

Leon H. Charney Division of Cardiology, New York University School of Medicine, New York, New York.

Contraindications to transesophageal echocardiography (TEE) include various esophageal pathologies, but compression of the esophagus by vertebral osteophytes is not listed in the current American Society of Echocardiography guidelines. We report a case of diffuse idiopathic skeletal hyperostosis (DISH) in an 81-year-old man who had incidentally been found to have extrinsic esophageal compression by cervical osteophytes prior to a proposed TEE. The incidence of esophageal perforation in patients with DISH and vertebral osteophytes is not well documented. We believe these patients are at increased risk of esophageal perforation during TEE, and thus, TEE may be relatively contraindicated in patients with DISH.
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http://dx.doi.org/10.1111/echo.13115DOI Listing
February 2016

Use of computed tomography to assess volume change after endoscopic orbital decompression for Graves' ophthalmopathy.

Am J Otolaryngol 2015 Nov-Dec;36(6):729-35. Epub 2015 Jun 23.

Department of Radiology, NYU School of Medicine, 660 First Avenue 2nd Floor, New York, NY, United States.

Background: Orbital decompression is frequently performed in the management of patients with sight-threatening and disfiguring Graves' ophthalmopathy. The quantitative measurements of the change in orbital volume after orbital decompression procedures are not definitively known. Furthermore, the quantitative effect of septal deviation on volume change has not been previously analyzed.

Objectives: To provide quantitative measurement of orbital volume change after medial and inferior endoscopic decompression and describe a straightforward method of measuring this change using open-source technologies. A secondary objective was to assess the effect of septal deviation on orbital volume change.

Methods: A retrospective review was performed on all patients undergoing medial and inferior endoscopic orbital decompression for Graves' ophthalmopathy at a tertiary care academic medical center. Pre-operative and post-operative orbital volumes were calculated from computed tomography (CT) data using a semi-automated segmenting technique and Osirix™, an open-source DICOM reader. Data were collected for pre-operative and post-operative orbital volumes, degree of septal deviation, time to follow-up scan, and individual patient Hertel scores.

Results: Nine patients (12 orbits) were imaged before and after decompression. Mean pre-operative orbital volume was 26.99 cm(3) (SD=2.86 cm(3)). Mean post-operative volume was 33.07 cm(3) (SD=3.96 cm(3)). The mean change in volume was 6.08 cm(3) (SD=2.31 cm(3)). The mean change in Hertel score was 4.83 (SD=0.75). Regression analysis of change in volume versus follow-up time to imaging indicates that follow-up time to imaging has little effect on change in volume (R=-0.2), and overall mean maximal septal deviation toward the operative side was -0.5mm. Negative values were attributed to deviation away form the operative site. A significant correlation was demonstrated between change in orbital volume and septal deviation distance site (R=0.66), as well as between change in orbital volume and septal deviation angle (R=0.67). Greater volume changes were associated with greater degree of septal deviation away from the surgical site, whereas smaller volume changes were associated with greater degree of septal deviation toward the surgical site.

Conclusion: A straightforward, semi-automated segmenting technique for measuring change in volume following endoscopic orbital decompression is described. This method proved useful in determining that a mean increase of approximately 6 cm in volume was achieved in this group of patients undergoing medial and inferior orbital decompression. Septal deviation appears to have an effect on the surgical outcome and should be considered during operative planning.
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http://dx.doi.org/10.1016/j.amjoto.2015.06.005DOI Listing
August 2016

Fungal Sinusitis.

Neuroimaging Clin N Am 2015 Nov 21;25(4):569-76. Epub 2015 Aug 21.

Department of Radiology, NYU School of Medicine, 660 First Avenue, 2nd Floor, New York, NY 10016, USA. Electronic address:

Fungal sinusitis is characterized into invasive and noninvasive forms. The invasive variety is further classified into acute, chronic and granulomatous forms; and the noninvasive variety into fungus ball and allergic fungal sinusitis. Each of these different forms has a unique radiologic appearance. The clinicopathologic and corresponding radiologic spectrum and differences in treatment strategies of fungal sinusitis make it an important diagnosis for clinicians and radiologists to always consider. This is particularly true of invasive fungal sinusitis, which typically affects immuno compromised patients and is associated with significant morbidity and mortality. Early diagnosis allows initiation of appropriate treatment strategies resulting in favorable outcome.
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http://dx.doi.org/10.1016/j.nic.2015.07.004DOI Listing
November 2015

Continuous Versus Sequential Acquisition Head Computed Tomography: A Phantom and Clinical Image Quality Comparative Study.

J Comput Assist Tomogr 2015 Nov-Dec;39(6):876-81

From the *Department of Radiology, New York University, Langone Medical Center, New York; and †Department of Radiology, North Shore Medical Center, Manhasset, NY.

Objective: Sequential computed tomography (CT) technique remains the most common protocol for CT evaluation of the head despite nearly universal adoption of continuous technique for all other body parts. This may be attributable to the belief by radiologists that this technique is superior to helical scanning uniquely for this indication. This study attempts to clarify the issue.

Methods: A phantom evaluation and a prospective randomized clinical image quality trial were performed comparing sequential and helical technique using the most current generation 128-row detector CT scanner.

Results: Phantom evaluation demonstrated equivalence between the 2 techniques for low-contrast resolution and line pair spatial discrimination. Continuous scanning provided the highest contrast-to-noise ratio. There was no significant difference between the 2 techniques regarding image quality except for cortical visualization at the cerebral hemispheres, which was subtly but significantly superior for sequential technique.

Conclusions: Head CT image quality for sequential and continuous techniques are virtually equivalent.
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http://dx.doi.org/10.1097/RCT.0000000000000289DOI Listing
February 2016

Evaluation of the orbit using contrast-enhanced radial 3D fat-suppressed T1 weighted gradient echo (Radial-VIBE) sequence.

Br J Radiol 2015 Oct 21;88(1054):20140863. Epub 2015 Jul 21.

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

Objective: Contrast-enhanced fat-suppressed T1 weighted (T1W) two-dimensional (2D) turbo spin echo (TSE) and magnetization-prepared gradient echo (MPRAGE) sequences with water excitation are routinely obtained to evaluate orbit pathology. However, these sequences can be marred by artefacts. The radial-volume-interpolated breath-hold examination (VIBE) sequence is a motion-robust fat-suppressed T1W sequence which has demonstrated value in paediatric and body imaging. The purpose of our study was to evaluate its role in assessing the orbit and to compare it with routinely acquired sequences.

Methods: A Health Insurance Portability and Accountability Act-compliant and institutional review board-approved retrospective study was performed in 46 patients (age range: 1-81 years) who underwent orbit studies on a 1.5-T MRI system using contrast-enhanced Radial-VIBE, MPRAGE and 2D TSE sequences. Two radiologists blinded to the sequence analysed evaluated multiple parameters of image quality including motion artefact, degree of fat suppression, clarity of choroidal enhancement, intraorbital vessels, extraocular muscles, optic nerves, brain parenchyma and evaluation of pathology. Each parameter was assessed on a 5-point scale, with a higher score indicating the more optimal examination. Mix model analysis of variance and interobserver variability were assessed.

Results: Radial-VIBE demonstrated superior quality (p < 0.001) for all orbit parameters when compared with MPRAGE and 2D TSE. Interobserver agreement demonstrated average fair-to-good agreement for degree of motion artefact (0.745), fat suppression (0.678), clarity of choroidal enhancement (0.688), vessels (0.655), extraocular muscles (0.675), optic nerves (0.518), brain parenchyma (0.710) and evaluation of pathology (0.590).

Conclusion: Radial-VIBE sequence demonstrates superior image quality when evaluating the orbits as compared with conventional MPRAGE and 2D TSE sequences.

Advances In Knowledge: Radial-VIBE employs unique non-Cartesian k-space sampling in a radial or spoke-wheel fashion which provides superior image quality improving diagnostic capability in the evaluation of the orbits.
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http://dx.doi.org/10.1259/bjr.20140863DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730962PMC
October 2015

Identification of endolymphatic hydrops in Ménière's disease utilizing delayed postcontrast 3D FLAIR and fused 3D FLAIR and CISS color maps.

Otol Neurotol 2014 Dec;35(10):e337-42

*Departments of Radiology and †Otolaryngology, New York University School of Medicine, New York, New York, U.S.A.; ‡Department of Otolaryngology, Temple University, Philadelphia, Pennsylvania, and §Department of Otolaryngology, Columbia University, New York, New York, U.S.A.

Objective: The preferential delayed enhancement of the perilymphatic space enables detection of the non-enhancing endolymphatic hydrops present in patients with Ménière's disease. The aim of this study was to evaluate the diagnostic utility of delayed postcontrast 3D FLAIR images and a color map of fused postcontrast FLAIR and constructive interference steady state (CISS) images in the identification of endolymphatic hydrops in patients with clinically diagnosed Ménière's disease.

Study Design: Case control, blinded study.

Setting: Tertiary referral center.

Patients: Ten patients with Ménière's disease and five volunteer controls.

Intervention: Diagnostic.

Main Outcome Measure: Two neuroradiologists blinded to the clinical history independently evaluated for the presence of endolymphatic hydrops on the images of both inner ears for test and control subjects. Both the standard gray-scale FLAIR images and the fused color map images were independently reviewed.

Results: The gray-scale 3D FLAIR images demonstrated 68.2% sensitivity and 97.4% specificity, and the fused color map images demonstrated 85.0% sensitivity and 88.9% specificity in the identification of endolymphatic hydrops in Ménière's disease. There was significant correlation between the gray-scale 3D FLAIR images and fused color map images with the categorization of involvement (p = 0.002). Inter-evaluator reliability was excellent (kappa = 0.83 for gray-scale images, kappa = 0.81 for fused color map).

Conclusion: Delayed 3D FLAIR and fused 3D FLAIR-CISS color map images of the inner ears after intravenous contrast administration are potentially useful diagnostic tools in the evaluation of patients with suspected Ménière's disease.
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http://dx.doi.org/10.1097/MAO.0000000000000585DOI Listing
December 2014

Contrast-enhanced radial 3D fat-suppressed T1-weighted gradient-recalled echo sequence versus conventional fat-suppressed contrast-enhanced T1-weighted studies of the head and neck.

AJR Am J Roentgenol 2014 Oct;203(4):883-9

1 All authors: Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, NYU Langone Medical Center, 660 First Ave, 2nd Fl, New York, NY 10016.

Objective: Traditional fat-suppressed T1-weighted spin-echo or turbo spin-echo (TSE) sequences (T1-weighted images) may be degraded by motion and pulsation artifacts in head-and-neck studies. Our purpose is to evaluate the role of a fat-suppressed T1-weighted 3D radial gradient-recalled echo sequence (radial-volumetric interpolated breath-hold examination [VIBE]) in the head and neck as compared with standard contrast-enhanced fat-suppressed T1-weighted images.

Materials And Methods: We retrospectively evaluated 21 patients (age range, 9-67 years) who underwent head-and-neck MRI at 1.5 T. Both contrast-enhanced radial-VIBE and conventional fat-suppressed TSE contrast-enhanced T1-weighted imaging were performed. Two radiologists evaluated multiple parameters of image quality, graded on a 5-point scale. Mixed-model analysis of variance and interobserver variability assessment were performed.

Results: The following parameters were scored as significantly better for the contrast-enhanced radial-VIBE sequence than for conventional contrast-enhanced T1-weighted imaging: overall image quality (p < 0.0001), degree of fat suppression (p = 0.006), mucosal enhancement (p = 0.004), muscle edge clarity (p = 0.049), vessel clarity (p < 0.0001), respiratory motion artifact (p = 0.002), pulsation artifact (p < 0.0001), and lesion edge sharpness (p = 0.004). Interobserver agreement in qualitative evaluation of the two sequences showed fair-to-good agreement for the following variables: overall image quality (intraclass correlation coefficient [ICC], 0.779), degree of fat suppression (ICC, 0.716), mucosal enhancement (ICC, 0.693), muscle edge clarity (ICC, 0.675), respiratory motion artifact (ICC, 0.516), lesion enhancement (ICC, 0.410), and lesion edge sharpness (ICC, 0.538). Excellent agreement was shown for vessel clarity (ICC, 0.846) and pulsation artifact (ICC, 0.808).

Conclusion: The radial-VIBE sequence is a viable motion-robust improvement on the conventional fat-suppressed T1-weighted sequence.
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http://dx.doi.org/10.2214/AJR.13.11729DOI Listing
October 2014
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