Publications by authors named "Melissa M Chen"

17 Publications

  • Page 1 of 1

Multidisciplinary Recommendations Regarding Post-Vaccine Adenopathy and Radiologic Imaging: Scientific Expert Panel.

Radiology 2021 Feb 24:210436. Epub 2021 Feb 24.

From Department of Radiology, Memorial Sloan Kettering Cancer Center, New York NY (A.S.B., R.P-J., M.E.H., K.N.F., K.M.G., A.T.L., R.Y., M.E.M., H.H., H.A.V.); Department of Radiology, Brigham and Women's Hospital, Boston MA (S.A.C., A.B.S.); Department of Imaging, Dana-Farber Cancer Institute, Boston MA (S.A.C., A.B.S.); Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston TX (M.M.C., M.H.); Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston TX (E.Y.H.); Department of Medical Oncology, Dana-Farber Cancer Institute, Boston MA (E.L.M.).

Vaccination-associated adenopathy is a frequent imaging finding after administration of COVID-19 vaccines that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. To help the medical community address this concern in the absence of studies and evidence-based guidelines, this paper offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States. According to these recommendations, some routine imaging examinations, such as those for screening, should be scheduled before or at least 6 weeks after the final vaccination dose to allow for any reactive adenopathy to resolve. However, there should be no delay of other clinically indicated imaging (e.g., for acute symptoms, short-interval treatment monitoring, urgent treatment planning or complications) due to prior vaccination. The vaccine should be administered on the side contralateral to the primary or suspected cancer, and both doses should be administered in the same arm. Vaccination information (date(s) administered, injection site(s), laterality, and type of vaccine) should be included in every pre-imaging patient questionnaire, and this information should be made readily available to interpreting radiologists. Clear and effective communication between patients, radiologists, referring physician teams and the general public should be considered of the highest priority when managing adenopathy in the setting of COVID-19 vaccination. Summary COVID-19-vaccination-related adenopathy is a frequent imaging finding that may lead to a diagnostic conundrum in patients with manifest or suspected cancer, in whom it may be indistinguishable from malignant nodal involvement. This special report offers recommendations developed by a multidisciplinary panel of experts from three of the leading tertiary care cancer centers in the United States.
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http://dx.doi.org/10.1148/radiol.2021210436DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7909071PMC
February 2021

Effect of brain normalization methods on the construction of functional connectomes from resting-state functional MRI in patients with gliomas.

Magn Reson Med 2021 Jul 2;86(1):487-498. Epub 2021 Feb 2.

Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Purpose: Spatial normalization is an essential step in resting-state functional MRI connectomic analysis with atlas-based parcellation, but brain lesions can confound it. Cost-function masking (CFM) is a popular compensation approach, but may not benefit modern normalization methods. This study compared three normalization methods with and without CFM and determined their impact on connectomic measures in patients with glioma.

Methods: Fifty patients with glioma were included. T -weighted images were normalized using three different methods in SPM12, with and without CFM, which were then overlaid on the ICBM152 template and scored by two neuroradiologists. The Dice coefficient of gray-matter correspondence was also calculated. Normalized resting-state functional MRI data were parcellated using the AAL90 atlas to construct an individual connectivity matrix and calculate connectomic measures. The R among the different normalization methods was calculated for the connectivity matrices and connectomic measures.

Results: The older method (Original) performed significantly worse than the modern methods (Default and DARTEL; P < .005 in observer ranking). The use of CFM did not significantly improve the normalization results. The Original method had lower correlation with the Default and DARTEL methods (R = 0.71-0.74) than Default with DARTEL (R = 0.96) in the connectivity matrix. The clustering coefficient appears to be the most, and modularity the least, sensitive connectomic measures to normalization performance.

Conclusion: The spatial normalization method can have an impact on resting-state functional MRI connectome and connectomic measures derived using atlas-based brain parcellation. In patients with glioma, this study demonstrated that Default and DARTEL performed better than the Original method, and that CFM made no significant difference.
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http://dx.doi.org/10.1002/mrm.28690DOI Listing
July 2021

The impending conversion factor crisis and neurointerventional practice.

J Neurointerv Surg 2021 Apr 30;13(4):301-303. Epub 2020 Nov 30.

Department of Radiology, Ochsner Medical System, New Orleans, Louisiana, USA.

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http://dx.doi.org/10.1136/neurintsurg-2020-017005DOI Listing
April 2021

Endovascular Selective Intra-Arterial Infusion of Mesenchymal Stem Cells Loaded With Delta-24 in a Canine Model.

Neurosurgery 2020 12;88(1):E102-E113

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.

Background: Delta-24-RGD, an oncolytic adenovirus, shows promise against glioblastoma. To enhance virus delivery, we recently demonstrated that human bone marrow-derived mesenchymal stem cells loaded with Delta-24-RGD (hMSC-D24) can eradicate glioblastomas in mouse models. There are no studies examining the safety of endovascular selective intra-arterial (ESIA) infusions of MSC-D24 in large animals simulating human clinical situations.

Objective: To perform canine preclinical studies testing the feasibility and safety of delivering increasing doses of hMSCs-D24 via ESIA infusions.

Methods: ESIA infusions of hMSC-D24 were performed in the cerebral circulation of 10 normal canines in the target vessels (internal carotid artery [ICA]/P1) via transfemoral approach using commercially available microcatheters. Increasing concentrations of hMSC-D24 or particles (as a positive control) were injected into 1 hemisphere; saline (negative control) was infused contralaterally. Toxicity (particularly embolic stroke) was assessed on postinfusion angiography, diffusion-weighted magnetic resonance imaging, clinical exam, and necropsy.

Results: ESIA injections were performed in the ICA (n = 7) or P1 (n = 3). In 2 animals injected with particles (positive control), strokes were detected by all assays. Of 6 canines injected with hMSC-D24 through the anterior circulation, escalating dose from 2 × 106 cells/20 mL to 1 × 108 cells/10 mL resulted in no strokes. Two animals had ischemic and hemorrhagic strokes after posterior cerebral artery catheterization. A survival experiment of 2 subjects resulted in no complications detected for 24-h before euthanization.

Conclusion: This novel study simulating ESIA infusion demonstrates that MSCs-D24 can be infused safely at least up to doses of 1 × 108 cells/10 mL (107 cells/ml) in the canine anterior circulation using commercially available microcatheters. These findings support a clinical trial of ESIA infusion of hMSCs-D24.
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http://dx.doi.org/10.1093/neuros/nyaa470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735865PMC
December 2020

Adult Primary Brain Neoplasm, Including 2016 World Health Organization Classification.

Neuroimaging Clin N Am 2021 Feb;31(1):121-138

Department of Radiology, Baylor College of Medicine, One Baylor Plaza, MS360, Houston, TX 77030, USA. Electronic address:

In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic features for the first time. Molecular markers add a level of objectivity that was previously missing for tumor categories heavily dependent on microscopic observation for pathologic diagnosis. This article provides a brief discussion of the major 2016 updates to the WHO CNS classification scheme and reviews typical MR imaging findings of adult primary CNS neoplasms, including diffuse infiltrating gliomas, ependymal tumors, neuronal/glioneuronal tumors, pineal gland tumors, meningiomas, nerve sheath tumors, solitary fibrous tumors, and lymphoma.
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http://dx.doi.org/10.1016/j.nic.2020.09.011DOI Listing
February 2021

The role of resting-state functional MRI for clinical preoperative language mapping.

Cancer Imaging 2020 Jul 11;20(1):47. Epub 2020 Jul 11.

Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Background: Task-based functional MRI (tb-fMRI) is a well-established technique used to identify eloquent cortex, but has limitations, particularly in cognitively impaired patients who cannot perform language paradigms. Resting-state functional MRI (rs-fMRI) is a potential alternative modality for presurgical mapping of language networks that does not require task performance. The purpose of our study is to determine the utility of rs-fMRI for clinical preoperative language mapping when tb-fMRI is limited.

Methods: We retrospectively reviewed 134 brain tumor patients who underwent preoperative fMRI language mapping. rs-fMRI was post-processed with seed-based correlation (SBC) analysis, when language tb-fMRI was limited. Two neuroradiologists reviewed both the tb-fMRI and rs-fMRI results. Six neurosurgeons retrospectively rated the usefulness of rs-fMRI for language mapping in their patients.

Results: Of the 134 patients, 49 cases had limited tb-fMRI and rs-fMRI was post-processed. Two neuroradiologists found rs-fMRI beneficial for functional language mapping in 41(84%) and 43 (88%) cases respectively; Cohen's kappa is 0.83, with a 95% confidence interval (0.61, 1.00). The neurosurgeons found rs-fMRI "definitely" useful in 26 cases (60%) and "somewhat" useful in 13 cases (30%) in locating potential eloquent language centers of clinical interest. Six unsuccessful rs-fMRI cases were due to: head motion (2 cases), nonspecific functionality connectivity outside the posterior language network (1 case), and an unknown system instability (3 cases).

Conclusions: This study is a proof of concept that shows SBC rs-fMRI may be a viable alternative for clinical language mapping when tb-fMRI is limited.
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http://dx.doi.org/10.1186/s40644-020-00327-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7353792PMC
July 2020

Computer-aided Detection of Brain Metastases in T1-weighted MRI for Stereotactic Radiosurgery Using Deep Learning Single-Shot Detectors.

Radiology 2020 05 17;295(2):407-415. Epub 2020 Mar 17.

From the Department of Imaging Physics (Z.Z., J.W.S., J.B.S., J.M.), Medical Physics Graduate Program, UTHealth Graduate School of Biomedical Sciences (J.W.S.), Department of Diagnostic Radiology (J.M.J., M.K.G., M.M.C.), Department of Radiation Physics (T.M.B.), Department of Radiation Oncology (Y.W., J.L.), and Department of Cancer Systems Imaging (M.D.P.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030.

Background Brain metastases are manually identified during stereotactic radiosurgery (SRS) treatment planning, which is time consuming and potentially challenging. Purpose To develop and investigate deep learning (DL) methods for detecting brain metastasis with MRI to aid in treatment planning for SRS. Materials and Methods In this retrospective study, contrast material-enhanced three-dimensional T1-weighted gradient-echo MRI scans from patients who underwent gamma knife SRS from January 2011 to August 2018 were analyzed. Brain metastases were manually identified and contoured by neuroradiologists and treating radiation oncologists. DL single-shot detector (SSD) algorithms were constructed and trained to map axial MRI slices to a set of bounding box predictions encompassing metastases and associated detection confidences. Performances of different DL SSDs were compared for per-lesion metastasis-based detection sensitivity and positive predictive value (PPV) at a 50% confidence threshold. For the highest-performing model, detection performance was analyzed by using free-response receiver operating characteristic analysis. Results Two hundred sixty-six patients (mean age, 60 years ± 14 [standard deviation]; 148 women) were randomly split into 80% training and 20% testing groups (212 and 54 patients, respectively). For the testing group, sensitivity of the highest-performing (baseline) SSD was 81% (95% confidence interval [CI]: 80%, 82%; 190 of 234) and PPV was 36% (95% CI: 35%, 37%; 190 of 530). For metastases measuring at least 6 mm, sensitivity was 98% (95% CI: 97%, 99%; 130 of 132) and PPV was 36% (95% CI: 35%, 37%; 130 of 366). Other models (SSD with a ResNet50 backbone, SSD with focal loss, and RetinaNet) yielded lower sensitivities of 73% (95% CI: 72%, 74%; 171 of 234), 77% (95% CI: 76%, 78%; 180 of 234), and 79% (95% CI: 77%, 81%; 184 of 234), respectively, and lower PPVs of 29% (95% CI: 28%, 30%; 171 of 581), 26% (95% CI: 26%, 26%; 180 of 681), and 13% (95% CI: 12%, 14%; 184 of 1412). Conclusion Deep-learning single-shot detector models detected nearly all brain metastases that were 6 mm or larger with limited false-positive findings using postcontrast T1-weighted MRI. © RSNA, 2020 See also the editorial by Kikinis and Wells in this issue.
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http://dx.doi.org/10.1148/radiol.2020191479DOI Listing
May 2020

Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors.

J Neurointerv Surg 2020 Feb 1;12(2):197-203. Epub 2019 Nov 1.

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA

Background: Malignant gliomas continue to have a poor clinical outcome with available therapies. In the past few years, new targeted biologic therapies have been studied, with promising results. However, owing to problems with ineffective IV delivery of these newer agents, an alternative, more direct delivery mechanism is needed. Simultaneously, advancements in neuroendovascular technology have allowed endovascular selective intra-arterial approaches to delivery. This method has the potential to increase drug delivery and selectively target tumor vasculature.

Objective: To review the history of IA therapy for brain tumors, prior failures and successes, the emergence of new technologies and therapies, and the future direction of this young field.

Methods: A comprehensive literature search of two databases (PubMed, Ovid Medline) was performed for several terms including 'brain tumor', 'glioma', and 'endovascular intra-arterial'. Forty-five relevant articles were identified via a systematic review following PRISMA guidelines. Additional relevant articles were selected for further in-depth review. Emphasis was given to articles discussing selective intra-arterial intracranial delivery using microcatheters.

Results: Endovascular intra-arterial therapy with chemotherapy has had mixed results, with currently active trials using temozolomide, cetuximab, and bevacizumab. Prior attempts at IA chemotherapy with older-generation medications did not surpass the efficacy of IV administration. Advances in neuro-oncology have brought to the forefront new targeted biologic therapies.

Conclusions: In this review, we discuss the emerging field of endovascular neuro-oncology, a field that applies modern neuroendovascular techniques to the delivery of new therapeutic agents to brain tumors. The development of targeted therapies for brain tumors has been concurrent with the development of microcatheter technology, which has made superselective distal intracranial arterial access feasible and safe.
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http://dx.doi.org/10.1136/neurintsurg-2019-015137DOI Listing
February 2020

Adult Primary Brain Neoplasm, Including 2016 World Health Organization Classification.

Radiol Clin North Am 2019 Nov 16;57(6):1147-1162. Epub 2019 Aug 16.

Department of Radiology, Baylor College of Medicine, One Baylor Plaza, MS360, Houston, TX 77030, USA. Electronic address:

In 2016, the World Health Organization (WHO) central nervous system (CNS) classification scheme incorporated molecular parameters in addition to traditional microscopic features for the first time. Molecular markers add a level of objectivity that was previously missing for tumor categories heavily dependent on microscopic observation for pathologic diagnosis. This article provides a brief discussion of the major 2016 updates to the WHO CNS classification scheme and reviews typical MR imaging findings of adult primary CNS neoplasms, including diffuse infiltrating gliomas, ependymal tumors, neuronal/glioneuronal tumors, pineal gland tumors, meningiomas, nerve sheath tumors, solitary fibrous tumors, and lymphoma.
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http://dx.doi.org/10.1016/j.rcl.2019.07.004DOI Listing
November 2019

Utility of subcategorization of atypia of undetermined significance/follicular lesion of undetermined significance category in ultrasound-guided thyroid fine-needle aspiration in a large referral cancer center.

J Am Soc Cytopathol 2019 Nov - Dec;8(6):309-316. Epub 2019 Aug 19.

Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address:

Introduction: Subclassification of atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) is encouraged in the Bethesda System. In our practice, we subclassified AUS/FLUS into 3 subcategories: atypical follicular cells of undetermined significance (ACUS) for cases with cytologic atypia; follicular lesion (FL) for cellular cases with follicular cells with-minimal or no atypia, arranged in a macro- and micro-follicular pattern with scant colloid; and indeterminate follicular lesion, favor benign (IFL-FB) for cases with few clusters of follicular cells without atypia associated with minimal or no colloid. The objective of our study was to evaluate the prevalence, clinical management, and risk of malignancy for each subcategory.

Materials And Methods: We retrospectively identified ultrasound-guided fine-needle aspiration (US-FNA) of thyroid cases that were subcategorized as ACUS, IFL-FB, and FL at our-institution during 2014-2016. The results of US-FNA were correlated with clinical outcome in the subsequent 2 years including repeat US-FNA, thyroid surgery, and clinical/imaging follow-up.

Results: Of 3207 thyroid US-FNA cases, 718 (22.4%) cases were included in the study. Of these 718 cases, 104 (14.5%) were subcategorized as ACUS, 166 (23.1%) as FL, and 448 (62.4%) as IFL-FB. The surgery rate was 39.4% (41 of 104) for ACUS, 13.6% (61 of 448) for IFL-FB, and 27.1% (45 of 166) for FL. The risk of malignancy (ROM) was 25% (26 of 104) for ACUS, and 2.9% (13 of 448) for IFL-FB, 6.0% (10 of 166) for FL. The surgery rate and ROM was significantly higher for ACUS in comparison to IFL-FB (P < 0.05) and FL (P < 0.05).

Conclusions: Subclassification of AUS/FLUS into 3 groups based on cytopathologic findings alone not only improved the triage of patients for subsequent clinical management but also effectively stratified the risk of malignancy.
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http://dx.doi.org/10.1016/j.jasc.2019.08.001DOI Listing
July 2020

Determining the Patient Complexity of Head CT Examinations: Implications for Proper Valuation of a Critical Imaging Service.

Curr Probl Diagn Radiol 2020 May - Jun;49(3):177-181. Epub 2019 May 10.

NYU Langone Health, New York, NY.

Purpose: The head-computed tomography (CT) exam code was recently identified by policy makers as having a potentially overvalued resource value units (RVU). A critical aspect in determining RVUs is the complexity of patients undergoing the service. This study evaluated the complexity of patients undergoing head-CT.

Methods: The 2017 Medicare PSPS Master File was used to identify the most common site for performing head-CT examinations. Given the most common location, the 5% Research Identifiable File, was then used to evaluate complexity of patients undergoing head CT on the same day as an emergency department (ED) visit based on the Evaluation & Management (E&M) "level" of these visits (1-least complex to 5-most complex patient) and the ICD-10 diagnosis coding associated with the billed head CT claims.

Results: 56.1% of head CT examinations were performed in the ED. Seventy percent of noncontrast exams performed in the ED were ordered in the most complex patient encounters (level 5 E&M visits). The most common ICD-10 code for head-CT without intravenous contrast billed with a level 5 E&M visit was "dizziness and giddiness," and for head-CT without and with intravenous contrast was "headache."

Conclusion: Head-CT is not only most frequently ordered in the ED, but also during the most complex ED visits, suggesting that the ICD-10 codes associated with such exams do not appropriately reflects patient complexity. The valuation process should also consider the complexity of associated billed patient encounters, as indicated by E&M visit levels.
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http://dx.doi.org/10.1067/j.cpradiol.2019.05.007DOI Listing
February 2021

Incidental detection of oropharyngeal cancer with fluciclovine PET.

Head Neck 2019 08 2;41(8):E141-E145. Epub 2019 May 2.

Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas.

Background: Fluorine-18-labeled 1-amino-3-fluorocyclobutane-1-carboxylic acid (fluciclovine) is a synthetic amino acid radiopharmaceutical initially developed to improve noninvasive diagnosis of gliomas and currently FDA approved for prostate cancer imaging. Although fluciclovine positron emission tomography (PET) has proven to be efficacious in detecting multiple types of cancer, its ability to detect oropharyngeal squamous cell carcinoma (OPSCC) is largely unknown.

Methods: We describe a case of incidental OPSCC detection with fluciclovine PET in a 66-year old male patient during workup for recurrent prostate adenocarcinoma.

Results: Fluciclovine PET detected a left base of tongue (BOT) lesion, which was subsequently confirmed as invasive SCC on surgical pathology.

Conclusion: Given these findings, we discuss potential future directions for research with fluciclovine to overcome some of the known limitations of [F]fluorodeoxyglucose in oncological imaging.
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http://dx.doi.org/10.1002/hed.25798DOI Listing
August 2019

Radiology Support, Communication, and Alignment Network and Its Role to Promote Health Equity in the Delivery of Radiology Care.

J Am Coll Radiol 2019 Apr;16(4 Pt B):638-643

Department of Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address:

Racial, ethnic, and socioeconomic disparities in radiological care have been well documented in both the emergency and outpatient setting. Health IT has the potential to facilitate equitable care across diverse populations. Ordering the appropriate study is the first step in the greater mission of improving access and equity for everyone. Radiology Support, Communication, and Alignment Network (R-SCAN) is an informatics-based solution using clinical decision support (CDS) to promote health equity through optimization in appropriate imaging utilization. R-SCAN and CDS may help combat the potential implicit bias of clinicians by providing evidence-based imaging guidelines at the point of care and ensure that patients will receive equitable and appropriate imaging regardless of ethnic and socioeconomic background. By fostering multidisciplinary collaboration between radiologists and referring clinicians, R-SCAN initiatives across the nation have demonstrated successful reductions in inappropriate imaging utilization, particularly in regions with vulnerable populations.
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http://dx.doi.org/10.1016/j.jacr.2018.12.044DOI Listing
April 2019

Evaluating Circulating Tumor DNA From the Cerebrospinal Fluid of Patients With Melanoma and Leptomeningeal Disease.

J Neuropathol Exp Neurol 2018 07;77(7):628-635

Department of Melanoma Medical Oncology.

Circulating tumor DNA (ctDNA) refers to tumor-derived cell-free DNA that circulates in body fluids. Fluid samples are easier to collect than tumor tissue, and are amenable to serial collection at multiple time points during the course of a patient's illness. Studies have demonstrated the feasibility of performing mutation profiling from blood samples in cancer patients. However, detection of ctDNA in the blood of patients with brain tumors is suboptimal. Cerebrospinal fluid (CSF) can be obtained via lumbar puncture or intraventricular catheter, and may be a suitable fluid to assess ctDNA in patients with brain tumors. We detected melanoma-associated mutations by droplet-digital PCR (ddPCR) and next-generation sequencing in ctDNA obtained from the CSF (CSF-ctDNA) of melanoma patients with leptomeningeal disease. There is a strong correlation between mutation detection by ddPCR, the presence of circulating tumor cells in CSF and abnormalities in the MRI. However, approximately 30% of CSF samples that were negative or indeterminate for the presence of tumor cells by microscopic examination were positive for CSF-ctDNA by ddPCR. Our results demonstrate that CSF is a suitable fluid for evaluating ctDNA and ddPCR is superior to CSF-cytology for analysis of CSF in melanoma patients with leptomeningeal disease.
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http://dx.doi.org/10.1093/jnen/nly046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6005029PMC
July 2018

Anterior Inferior Cerebellar Artery Strokes Based on Variant Vascular Anatomy of the Posterior Circulation: Clinical Deficits and Imaging Territories.

J Stroke Cerebrovasc Dis 2018 Apr 14;27(4):e59-e64. Epub 2017 Nov 14.

Diagnostic Radiology, MD Anderson Cancer Center, Houston, Texas.

We report imaging findings of 3 patients with anterior inferior cerebellar artery (AICA) infarcts who presented with atypical clinical findings of cerebellar strokes. AICA strokes are rare, and diagnosis can be difficult because of the high variability of the posterior circulation vascular anatomy. We describe the embryology and variant anatomy of AICA so that clinicians can understand and recognize the patterns of these infarcts.
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http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2017.10.007DOI Listing
April 2018

Extrauterine Pelvic Serous Carcinomas: Current Update on Pathology and Cross-sectional Imaging Findings.

Radiographics 2016 May-Jun;36(3):918-32

From the Departments of Radiology (V.S.K., F.S.A., M.M.C., K.N.C.) and Pathology (P.T.V.), University of Texas Health Science Center, 7703 Floyd Curl Dr, MS 7800, San Antonio, TX 78229; Department of Radiology, Mayo Clinic at Scottsdale, Scottsdale, Ariz (C.O.M.); and Department of Radiology, University of Texas MD Anderson Cancer Center, Houston, Tex (S.R.P.).

The spectrum of extrauterine pelvic serous carcinomas includes ovarian serous carcinoma, primary peritoneal serous carcinoma, and primary fallopian tube carcinoma. Ovarian serous carcinoma, the most common ovarian malignant epithelial neoplasm, consists of two distinct entities: high-grade and low-grade serous carcinomas. Primary peritoneal serous carcinoma and primary fallopian tube carcinoma are rare malignancies that share many characteristics of high-grade serous carcinomas. Recent advances in the genetics and molecular biology of gynecologic cancers have suggested a common origin of many extrauterine pelvic serous carcinomas from fallopian tube epithelium. With the exception of low-grade serous carcinomas, which arise from cortical inclusion cysts lined by tubal epithelium, most extrauterine pelvic serous carcinomas are believed to originate from serous tubal intraepithelial carcinomas and show similar clinical-biologic behaviors and natural histories. Indeed, the International Federation of Gynecology and Obstetrics Committee on Gynecologic Oncology recently recognized that these cancers should be considered collectively, with a common system of staging and management strategies for ovarian, primary peritoneal, and fallopian tube cancers. A paradigm shift has occurred in our understanding of the pathogenesis of extrauterine pelvic serous carcinomas that has the potential to change current strategies for screening, prevention, diagnosis, and management. Ultrasonography (US), computed tomography (CT), magnetic resonance imaging, and combined positron emission tomography and CT are pivotal in screening, initial diagnosis, and treatment follow-up; however, because of this paradigm shift, new radiologic techniques, such as contrast material-enhanced US and molecular US imaging, and various optical imaging techniques are being investigated as important screening and diagnostic tools. Because of evolving knowledge of genetic and molecular changes underlying the pathogenesis of extrauterine pelvic serous carcinomas, new targeted therapies are being developed to improve patient prognosis. (©)RSNA, 2016.
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http://dx.doi.org/10.1148/rg.2016150130DOI Listing
March 2017

Chest neoplasms with infectious etiologies.

World J Radiol 2011 Dec;3(12):279-88

Carlos S Restrepo, Melissa M Chen, Santiago Martinez-Jimenez, Jorge Carrillo, Catalina Restrepo, Department of Radiology, The University of Texas Health Science Center at San Antonio, Mail Code 7800, 7703 Floyd Curl Drive, San Antonio, TX 78229, United States.

A wide spectrum of thoracic tumors have known or suspected viral etiologies. Oncogenic viruses can be classified by the type of genomic material they contain. Neoplastic conditions found to have viral etiologies include post-transplant lymphoproliferative disease, lymphoid granulomatosis, Kaposi's sarcoma, Castleman's disease, recurrent respiratory papillomatosis, lung cancer, malignant mesothelioma, leukemia and lymphomas. Viruses involved in these conditions include Epstein-Barr virus, human herpes virus 8, human papillomavirus, Simian virus 40, human immunodeficiency virus, and Human T-lymphotropic virus. Imaging findings, epidemiology and mechanism of transmission for these diseases are reviewed in detail to gain a more thorough appreciation of disease pathophysiology for the chest radiologist.
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http://dx.doi.org/10.4329/wjr.v3.i12.279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3251813PMC
December 2011