Publications by authors named "Mingqian Huang"

47 Publications

Shoulder adhesive capsulitis in cancer patients undergoing positron emission tomography - computed tomography and the association with shoulder pain.

World J Radiol 2021 Oct;13(10):344-353

Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, United States.

Background: Adhesive capsulitis is a relatively common condition that can develop in cancer patients during treatment. Positron emission tomography - computed tomography (PET-CT) is routinely performed as a follow-up study in cancer patients after therapy. Being aware of PET-CT findings to suggest shoulder adhesive capsulitis may help to alert clinicians for the diagnosis of unsuspected shoulder capsulitis.

Aim: To assess the association of shoulder adhesive capsulitis with cancer/therapy type and symptoms in cancer patients undergoing PET-CT.

Methods: Our prospective study received Institutional Review Board approval. Written informed consent was obtained from all patients, who answered a questionnaire regarding shoulder pain/stiffness at the time of PET-CT study, between March 2015 and April 2019. Patients with advanced glenohumeral arthrosis, metastatic disease or other mass in the shoulder, or shoulder arthroplasty were excluded. Patterns of shoulder capsule 18F-fluorodeoxyglucose (FDG) uptake were noted. Standard Uptake Value (SUV)max and SUVmean values were measured at rotator interval (RI) and deltoid muscle in bilateral shoulders. Normalized SUV (SUV of RI/SUV of deltoid muscle) was also calculated. We assessed if SUV values are different between symptomatic and asymptomatic patients in both shoulders. Covariates were age, gender, and therapy type (surgery, chemotherapy, radiation). Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age, SUV measurements between symptomatic and asymptomatic patients. Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status, after adjusting for covariates. Statistical significance level was set at < 0.05.

Results: Of 252 patients initially enrolled for the study (mean age 66 years, 67 symptomatic), shoulder PET-CT data were obtained in 200 patients (52 were excluded due to exclusion criteria above). The most common cancer types were lymphoma ( = 61), lung ( = 54) and breast ( = 53). No significant difference was noted between symptomatic and asymptomatic patients in terms of age, gender, proportion of patients who had surgical therapy and radiation therapy. A proportion of patients who received chemotherapy was higher in patients who were asymptomatic in the right shoulder compared to those symptomatic in the right shoulder (65% 48%, = 0.012). No such difference was seen for the left shoulder. In both shoulders, SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders (Left SUVmax 2.0 1.6, SUVmean 1.6 1.3, both < 0.002; Right SUVmax 2.2 1.8, SUVmean 1.8 1.5, both < 0.01). For lung cancer patients, bilateral RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders. For other cancer patients, symptomatic patients had higher left RI SUVmax/mean than asymptomatic patients after adjustment.

Conclusion: In symptomatic patients metabolic activities in RI were higher than asymptomatic patients. Adhesive capsulitis should be considered in cancer patients with shoulder symptoms and positive FDG uptake in RI.
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http://dx.doi.org/10.4329/wjr.v13.i10.344DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567438PMC
October 2021

MRI Evaluation of Various Elbow, Forearm, and Wrist Neuropathies: A Pictorial Review.

Semin Musculoskelet Radiol 2021 Aug 27;25(4):617-627. Epub 2021 Oct 27.

Department of Radiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York.

Upper extremity entrapment neuropathies are common and can cause pain, sensory loss, and muscle weakness leading to functional disability. We conducted a retrospective review from January 2007 until March 2020 of the magnetic resonance imaging (MRI) features of intrinsic and extrinsic causes of wrist, forearm, and elbow neuropathies of 637 patients who received a diagnosis of neuropathy by means of clinical and electrodiagnostic testing. We discuss cases with varying intrinsic and extrinsic nerve pathologies, including postoperative examples, affecting the median, radial, and ulnar nerve.Our collection of cases demonstrates a diversity of intrinsic and extrinsic causative factors. Intrinsic pathologies include neuritis as well as tumors arising from the nerve. Extrinsic causes resulting in nerve entrapment include masses, acute and chronic posttraumatic cases, anatomical variants, inflammatory and crystal deposition, calcium pyrophosphate deposition disease, and dialysis-related amyloidosis. Finally, we review postsurgical cases, such as carpal tunnel release and ulnar nerve transposition.Although upper extremity neuropathies tend to have a typical clinical presentation, imaging, particularly MRI, plays a vital role in evaluating the etiology and severity of each neuropathy and ultimately helps guide clinical management.
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http://dx.doi.org/10.1055/s-0041-1729961DOI Listing
August 2021

Gene editing in a Myo6 semi-dominant mouse model rescues auditory function.

Mol Ther 2021 Jun 24. Epub 2021 Jun 24.

ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai 200031, China; Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China; NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai 200031, China. Electronic address:

Myosin VI(MYO6) is an unconventional myosin that is vital for auditory and vestibular function. Pathogenic variants in the human MYO6 gene cause autosomal-dominant or -recessive forms of hearing loss. Effective treatments for Myo6 mutation causing hearing loss are limited. We studied whether adeno-associated virus (AAV)-PHP.eB vector-mediated in vivo delivery of Staphylococcus aureus Cas9 (SaCas9-KKH)-single-guide RNA (sgRNA) complexes could ameliorate hearing loss in a Myo6 mouse model that recapitulated the phenotypes of human patients. The in vivo editing efficiency of the AAV-SaCas9-KKH-Myo6-g2 system on Myo6 is 4.05% on average in Myo6 mice, which was ∼17-fold greater than editing efficiency of Myo6 alleles. Rescue of auditory function was observed up to 5 months post AAV-SaCas9-KKH-Myo6-g2 injection in Myo6 mice. Meanwhile, shorter latencies of auditory brainstem response (ABR) wave I, lower distortion product otoacoustic emission (DPOAE) thresholds, increased cell survival rates, more regular hair bundle morphology, and recovery of inward calcium levels were also observed in the AAV-SaCas9-KKH-Myo6-g2-treated ears compared to untreated ears. These findings provide further reference for in vivo genome editing as a therapeutic treatment for various semi-dominant forms of hearing loss and other semi-dominant diseases.
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http://dx.doi.org/10.1016/j.ymthe.2021.06.015DOI Listing
June 2021

Epiphyseal Ewing Sarcoma in a skeletally mature patient: A case report and review of the literature.

Radiol Case Rep 2021 May 19;16(5):1191-1197. Epub 2021 Mar 19.

Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, 1468 Madison Ave, New York, NY, 10029, USA.

While Ewing sarcoma of bone is the second most common primary osseous malignancy in childhood where it typically involves the diaphysis or metadiaphyses of long bones of skeletally immature patients, primary epiphyseal involvement of the long bone in skeletally mature patients is rare with no cases reported in the literature to our knowledge, rendering this case the first of its kind. We present the first case of primary Ewing Sarcoma of the epiphyses of the long bones in a skeletally mature 20-year-old male patient. The patient initially presented with left knee stiffness and pain that was empirically treated with non-steroidal anti-inflammatory medications. His pain progressed despite treatment. An x-ray of the left knee was obtained 5 months later demonstrating an irregular lucent lesion in the medial femoral condyle. A subsequent MRI revealed an enhancing lesion in the medial femoral condyle, and when biopsied it was consistent with Ewing sarcoma (positive for gene rearrangement by fluorescence in situ hybridization). The lesion was resected surgically, and the patient underwent neoadjuvant chemotherapy with a good clinical outcome.
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http://dx.doi.org/10.1016/j.radcr.2021.02.049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8010574PMC
May 2021

Spontaneous osteonecrosis of the knee (SONK): The role of MR imaging in predicting clinical outcome.

J Orthop 2020 Nov-Dec;22:606-611. Epub 2020 Nov 19.

Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, New York, NY, USA.

Background/aim: We try to investigate the association between patterns of imaging findings in patients who had a diagnosis of subchondral fracture around the knee, formerly known as SONK and their clinical outcome.

Materials And Methods: We retrospectively identified 43 knees of 37 patients (28 males, 15 females) who had diagnosis of subchondral fractures around the knee. The mean age is 56-year-old (range 17-83). Musculoskeletal fellowship trained radiologist evaluated all 43 knee MRI in: 1)location of marrow edema 2)peri-osseous edema; 3) subchondral fracture line; 4) subchondral articular surface contour; 5)meniscal tear and extrusion; 6)adjacent soft tissue edema; 7) joint effusion. Independent clinical chart review was performed for clinical outcome with follow up time average of 13.3 months (range 0-88 months). Bad outcome was defined as worsening on imaging, continued complaint with surgical management and knee replacement or another episode of SONK. Chi-square analysis and Student's T tests were conducted to test the statistical significance of association between MR findings and outcomes. Statistical significance was set at p = 0.05 level.

Results: Of 43 knees, 6 patients had another episodes of SONK (14%), 11 patients were not improving or needed injection vs arthroscopy (26%), 4 patients required arthroplasty (9%), 22 patients had no negative outcome (51%). Gender, age, diabetic status, and location of the subchondral fracture show no influence on outcome. Worse outcome group had a significantly higher average BMI (31.7 vs. 28.0, P = 0.02). Positive change of subchondral articular surface contour is the only imaging finding with positive association with worse outcome (80% vs. 39.9%, P = 0.02). Presence of positive findings of above 3), 4), 5) and 6) had higher percentage of bad outcome (77.8%) compared to those with less positive findings (47.2%).

Conclusion: MR imaging findings may help at identifying SONK patient with potential risk of developing bad outcome.
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http://dx.doi.org/10.1016/j.jor.2020.11.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7718131PMC
November 2020

MRI features of pyoderma gangrenosum in a diabetic patient with ulcerative colitis: A case report and review of the literature.

Radiol Case Rep 2020 Dec 6;15(12):2540-2546. Epub 2020 Oct 6.

Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, 1468 Madison Ave, New York, NY 10029, USA.

Pyoderma gangrenosum (PG) is a rare noninfectious skin condition which clinical picture can overlap with that of the diabetic foot. Meticulous physical examination along with biopsy and magnetic resonance imaging (MRI) can make the distinction easier, saving the patients from undergoing a debilitating intervention. We report a case of pathologically proven PG in the right ankle region of a 55-year old male with known uncontrolled diabetes mellitus and inflammatory bowel disease. Radiographs revealed increased soft tissue density overlying the lateral melleolus of the right ankle. MRI showed a well-defined soft tissue mass with heterogeneously intrinsically high signal intensity on T1- and on T2-weighted images, and heterogeneous peripheral enhancement on fat-suppressed, contrast-enhanced T1-weighted images. Histologically, diffuse neutrophilic infiltrate throughout the dermis was present without micro-organisms. This is the first report of MRI findings of PG in the ankle. We also summarize the findings of previously reported cases of PG.
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http://dx.doi.org/10.1016/j.radcr.2020.09.038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7548426PMC
December 2020

Chinese expert consensus on the diagnosis of osteoporosis by imaging and bone mineral density.

Quant Imaging Med Surg 2020 Oct;10(10):2066-2077

Department of Spine Surgery, Beijing Jishuitan Hospital, Beijing, China.

With an aging society, osteoporosis is one of the most common diseases threatening the health of China's elderly population and is an issue that is raising increasing concern. Osteoporosis is characterized by bone loss and increased susceptibility to fragility fractures. Various imaging modalities such as X-ray, CT, MRI and nuclear medicine along with assessment of bone mineral density (BMD) play an important role in its diagnosis and management, and the treatment requires multidisciplinary teamwork. A lack of consensus in the approach to imaging and BMD measurement is hampering the quality of service and patient care in China. Therefore a panel of Chinese experts from the fields of radiology, orthopedics, endocrinology and nuclear medicine reviewed the international guidelines, consensus and literature with the most recent data from China and, taking account of current clinical practice in China, the panel reached this consensus to help guide the diagnosis of osteoporosis using imaging and BMD. This consensus report provides guidelines and standards for the imaging and BMD assessment of osteoporosis and criteria for the diagnosis of osteoporosis in China.
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http://dx.doi.org/10.21037/qims-2020-16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7495321PMC
October 2020

Direct Functional Protein Delivery with a Peptide into Neonatal and Adult Mammalian Inner Ear .

Mol Ther Methods Clin Dev 2020 Sep 30;18:511-519. Epub 2020 Jun 30.

ENT Institute and Otorhinolaryngology Department, Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai 200031, China.

The aim of this study was to study an antimicrobial peptide (AMP), aurein 1.2, which substantially increased protein delivery directly into multiple mammalian inner-ear cell types . Different concentrations of aurein 1.2 with superpositively charged GFP (+36 GFP) protein fused with Cre recombinase were delivered to postnatal day 1-2 (P1-2) and adult cochleae of Cre reporter transgenic mice with various delivery methods. By cochleostomy at different concentrations of aurein 1.2-+36 GFP (1 μM, 5 μM, 22.5 μM, and 50 μM, respectively), the tdTomato (tdT) expression was observed in outer hair cells (OHCs; 20.77%, 23.02%, 76.36%, and 92.47%, respectively) and inner hair cells (IHCs; 14.90%, 44.50%, 89.59%, and 96.13%, respectively) in the cochlea. The optimal concentration was 22.5 μM with the highest transfection efficiency and the lowest cytotoxicity. Wide-spread tdT signals were detected in the cochlear-supporting cells, utricular-supporting cells, auditory nerve, and spiral ligament in neonatal and adult mice. Compared to cochleostomy, injection through the round window membrane (RWM) also produced highly efficient tdT+ labeled cells with less cell loss. In summary, the peptide aurein 1.2 fused with +36 GFP dramatically expanded the target cells with increased efficiency in direct protein delivery in the inner ear. Aurein 1.2-+36 GFP has the potential to be developed as protein-based therapy in regeneration and genome editing in the mammalian inner ear.
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http://dx.doi.org/10.1016/j.omtm.2020.06.023DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7477795PMC
September 2020

Rhabdomyolysis as a manifestation of a severe case of COVID-19: A case report.

Radiol Case Rep 2020 Sep 7;15(9):1633-1637. Epub 2020 Jul 7.

Diagnostic, Molecular and Interventional Radiology, Mount Sinai Health System, 1468 Madison Ave, 10029, New York, NY, USA.

Since the outbreak of the ongoing pandemic of the novel coronavirus disease (COVID-19) in Wuhan, China, from December 2019, we have learned that multiple organs can be affected with the potential for various complications. Although myalgia is a frequent symptom in COVID-19 patients, no imaging findings of rhabdomyolysis have been featured in the literature. We report a case of presumed rhabdomyolysis in a 38-year-old male with COVID-19 based on the clinical presentation, laboratory results and radiological findings. By discussing the diagnostic rationale and reviewing the relevant literature we hope to advance the existing understanding of this disease and its effects on the musculoskeletal system.
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http://dx.doi.org/10.1016/j.radcr.2020.07.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7340044PMC
September 2020

Artificial intelligence-enabled rapid diagnosis of COVID-19 patients.

medRxiv 2020 Apr 17. Epub 2020 Apr 17.

For diagnosis of COVID-19, a SARS-CoV-2 virus-specific reverse transcriptase polymerase chain reaction (RT-PCR) test is routinely used. However, this test can take up to two days to complete, serial testing may be required to rule out the possibility of false negative results, and there is currently a shortage of RT-PCR test kits, underscoring the urgent need for alternative methods for rapid and accurate diagnosis of COVID-19 patients. Chest computed tomography (CT) is a valuable component in the evaluation of patients with suspected SARS-CoV-2 infection. Nevertheless, CT alone may have limited negative predictive value for ruling out SARS-CoV-2 infection, as some patients may have normal radiologic findings at early stages of the disease. In this study, we used artificial intelligence (AI) algorithms to integrate chest CT findings with clinical symptoms, exposure history, and laboratory testing to rapidly diagnose COVID-19 positive patients. Among a total of 905 patients tested by real-time RT-PCR assay and next-generation sequencing RT-PCR, 419 (46.3%) tested positive for SARS-CoV-2. In a test set of 279 patients, the AI system achieved an AUC of 0.92 and had equal sensitivity as compared to a senior thoracic radiologist. The AI system also improved the detection of RT-PCR positive COVID-19 patients who presented with normal CT scans, correctly identifying 17 of 25 (68%) patients, whereas radiologists classified all of these patients as COVID-19 negative. When CT scans and associated clinical history are available, the proposed AI system can help to rapidly diagnose COVID-19 patients.
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http://dx.doi.org/10.1101/2020.04.12.20062661DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274240PMC
April 2020

PET/MRI reveals ongoing metabolic activity in ACL grafts one year post-ACL reconstruction.

J Exp Orthop 2020 Jun 1;7(1):40. Epub 2020 Jun 1.

Orlin & Cohen Orthopedic Group, Zucker School of Medicine at Hofstra/Northwell School of Medicine, Hempstead, New York, USA.

Purpose: To use serial PET/MRI imaging to radiographically evaluate the metabolic activity of the ACL graft over the first post-operative year.

Methods: Six patients undergoing primary ACL reconstruction were recruited in this prospective study in an inpatient university hospital. All patients underwent femoral and tibial suspensory cortical fixation with quadrupled semitendinosus autograft hamstring ACL reconstruction by an orthopaedic surgeon. Simultaneous F-FDG PET and MRI of both the operative and non-operative knee was performed at three, six, and 12 months post-operatively. Quantification of the mean standardized uptake value (SUV) within the whole-knee, as well as tibial tunnel, femoral tunnel, and intra-articular graft regions of interest (ROIs).

Results: PET whole-knee activity was increased at all time-points post-operatively compared to the control, non-operative knee. Activity decreased over time, yet considerable generalized activity remained 1 year post-operatively, with relative intensity 34% percent higher than control. When the operative knee was divided into three whole-regions, there was greater activity in the tibia at three than 12 months, the femur at six than 12 months, and in the tibia compared to the intra-articular region at 3 months. When they were separated into sub-regions, results demonstrated greater activity closer to the joint surface.

Conclusions: PET/MRI evaluation of ACL graft reconstructions demonstrates evolving biologic activity within the graft and both tunnels. Focal areas of increased activity within the tunnels may indicate of ligamento-osseous morphologic changes. These data suggest that graft incorporation continues well beyond 1 year post-operatively.

Level Of Evidence: Level IV.
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http://dx.doi.org/10.1186/s40634-020-00258-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264087PMC
June 2020

Artificial intelligence-enabled rapid diagnosis of patients with COVID-19.

Nat Med 2020 08 19;26(8):1224-1228. Epub 2020 May 19.

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

For diagnosis of coronavirus disease 2019 (COVID-19), a SARS-CoV-2 virus-specific reverse transcriptase polymerase chain reaction (RT-PCR) test is routinely used. However, this test can take up to 2 d to complete, serial testing may be required to rule out the possibility of false negative results and there is currently a shortage of RT-PCR test kits, underscoring the urgent need for alternative methods for rapid and accurate diagnosis of patients with COVID-19. Chest computed tomography (CT) is a valuable component in the evaluation of patients with suspected SARS-CoV-2 infection. Nevertheless, CT alone may have limited negative predictive value for ruling out SARS-CoV-2 infection, as some patients may have normal radiological findings at early stages of the disease. In this study, we used artificial intelligence (AI) algorithms to integrate chest CT findings with clinical symptoms, exposure history and laboratory testing to rapidly diagnose patients who are positive for COVID-19. Among a total of 905 patients tested by real-time RT-PCR assay and next-generation sequencing RT-PCR, 419 (46.3%) tested positive for SARS-CoV-2. In a test set of 279 patients, the AI system achieved an area under the curve of 0.92 and had equal sensitivity as compared to a senior thoracic radiologist. The AI system also improved the detection of patients who were positive for COVID-19 via RT-PCR who presented with normal CT scans, correctly identifying 17 of 25 (68%) patients, whereas radiologists classified all of these patients as COVID-19 negative. When CT scans and associated clinical history are available, the proposed AI system can help to rapidly diagnose COVID-19 patients.
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http://dx.doi.org/10.1038/s41591-020-0931-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446729PMC
August 2020

Computed Tomography Features of Coronavirus Disease 2019 (COVID-19): A Review for Radiologists.

J Thorac Imaging 2020 Jul;35(4):211-218

Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, WI.

Coronavirus Disease 2019 (COVID-19) pneumonia has become a global pandemic. Although the rate of new infections in China has decreased, currently, 169 countries report confirmed cases, with many nations showing increasing numbers daily. Testing for COVID-19 infection is performed via reverse transcriptase polymerase chain reaction, but availability is limited in many parts of the world. The role of chest computed tomography is yet to be determined and may vary depending on the local prevalence of disease and availability of laboratory testing. A common but nonspecific pattern of disease with a somewhat predictable progression is seen in patients with COVID-19. Specifically, patchy ground-glass opacities in the periphery of the lower lungs may be present initially, eventually undergoing coalescence, consolidation, and organization, and ultimately showing features of fibrosis. In this article, we review the computed tomography features of COVID-19 infection. Familiarity with these findings and their evolution will help radiologists recognize potential COVID-19 and recognize the significant overlap with other causes of acute lung injury.
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http://dx.doi.org/10.1097/RTI.0000000000000527DOI Listing
July 2020

CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19).

Eur Radiol 2020 Aug 25;30(8):4407-4416. Epub 2020 Mar 25.

Radiology Department, The Fifth Affiliated Hospital of Sun Yat-sen University, 52 East Meihua Road, New Xiangzhou, Zhuhai, 519000, Guangdong Province, China.

Objectives: To explore the relationship between the imaging manifestations and clinical classification of COVID-19.

Methods: We conducted a retrospective single-center study on patients with COVID-19 from Jan. 18, 2020 to Feb. 7, 2020 in Zhuhai, China. Patients were divided into 3 types based on Chinese guideline: mild (patients with minimal symptoms and negative CT findings), common, and severe-critical (patients with positive CT findings and different extent of clinical manifestations). CT visual quantitative evaluation was based on summing up the acute lung inflammatory lesions involving each lobe, which was scored as 0 (0%), 1 (1-25%), 2 (26-50%), 3 (51-75%), or 4 (76-100%), respectively. The total severity score (TSS) was reached by summing the five lobe scores. The consistency of two observers was evaluated. The TSS was compared with the clinical classification. ROC was used to test the diagnosis ability of TSS for severe-critical type.

Results: This study included 78 patients, 38 males and 40 females. There were 24 mild (30.8%), 46 common (59.0%), and 8 severe-critical (10.2%) cases, respectively. The median TSS of severe-critical-type group was significantly higher than common type (p < 0.001). The ICC value of the two observers was 0.976 (95% CI 0.962-0.985). ROC analysis showed the area under the curve (AUC) of TSS for diagnosing severe-critical type was 0.918. The TSS cutoff of 7.5 had 82.6% sensitivity and 100% specificity.

Conclusions: The proportion of clinical mild-type patients with COVID-19 was relatively high; CT was not suitable for independent screening tool. The CT visual quantitative analysis has high consistency and can reflect the clinical classification of COVID-19.

Key Points: • CT visual quantitative evaluation has high consistency (ICC value of 0.976) among the observers. The median TSS of severe-critical type group was significantly higher than common type (p < 0.001). • ROC analysis showed the area under the curve (AUC) of TSS for diagnosing severe-critical type was 0.918 (95% CI 0.843-0.994). The TSS cutoff of 7.5 had 82.6% sensitivity and 100% specificity. • The proportion of confirmed COVID-19 patients with normal chest CT was relatively high (30.8%); CT was not a suitable screening modality.
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http://dx.doi.org/10.1007/s00330-020-06817-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095246PMC
August 2020

In vitro testicular organogenesis from human fetal gonads produces fertilization-competent spermatids.

Cell Res 2020 03 21;30(3):244-255. Epub 2020 Feb 21.

State Key Laboratory of Reproductive Medicine, Department of Histology and Embryology, Nanjing Medical University, 211166, Nanjing, Jiangsu, China.

Unlike most organs that mature during the fetal period, the male reproductive system reaches maturity only at puberty with the commencement of spermatogenesis. Robust modelling of human testicular organogenesis in vitro would facilitate research into mechanisms of and factors affecting human spermatogenic failure and male fertility preservation in prepubertal tumor patients. Here, we report successful recapitulation of human testicular organogenesis in vitro from fetal gonadal ridge. Our model displayed the formation of mature seminiferous epithelium and self-renewing spermatogonia. Remarkably, in vitro-derived haploid spermatids have undergone meiotic recombination, and showed increased genetic diversity as indicated by genetic analysis. Moreover, these spermatids were able to fertilize oocytes and support subsequent blastocyst formation. The in vitro testicular organogenesis system described here will play an important role in elucidating the regulation of human testis development and maintaining male fertility in prepubertal cancer patients.
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http://dx.doi.org/10.1038/s41422-020-0283-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054335PMC
March 2020

Chest CT Findings in Coronavirus Disease-19 (COVID-19): Relationship to Duration of Infection.

Radiology 2020 06 20;295(3):200463. Epub 2020 Feb 20.

Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A.B., M.H., Y.Y., A.J., M.C); BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY (X.M); Department of Diagnostic, Molecular and Interventional Radiology, and BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York (Z.A.F); Department of Radiology, The First Affiliated Hospital of Nanchang University, NanChang, JiangXi, China (N.Z); Department of Radiology, West China Hospital, Sichuan University, Chengdu Sichuan, China (K.D); Department of Radiology, The Second Affiliated Hospital of Zhejiang University School Medicine, Hangzhou, China (B.L); Department of Radiology, Nanxishan Hospital, Guangxi Zhuang Autonomous Region, China (X.Z); Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, New Xiangzhou, Zhuhai, Guangdong Province, China (K.L., S.L., H.S).

In this retrospective study, chest CTs of 121 symptomatic patients infected with coronavirus disease-19 (COVID-19) from four centers in China from January 18, 2020 to February 2, 2020 were reviewed for common CT findings in relationship to the time between symptom onset and the initial CT scan (i.e. early, 0-2 days (36 patients), intermediate 3-5 days (33 patients), late 6-12 days (25 patients)). The hallmarks of COVID-19 infection on imaging were bilateral and peripheral ground-glass and consolidative pulmonary opacities. Notably, 20/36 (56%) of early patients had a normal CT. With a longer time after the onset of symptoms, CT findings were more frequent, including consolidation, bilateral and peripheral disease, greater total lung involvement, linear opacities, "crazy-paving" pattern and the "reverse halo" sign. Bilateral lung involvement was observed in 10/36 early patients (28%), 25/33 intermediate patients (76%), and 22/25 late patients (88%).
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http://dx.doi.org/10.1148/radiol.2020200463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7233369PMC
June 2020

CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV).

Radiology 2020 04 4;295(1):202-207. Epub 2020 Feb 4.

From the Department of Diagnostic, Molecular, and Interventional Radiology (M.C., A.B., M.H., Z.A.F., A.J.) and BioMedical Engineering and Imaging Institute (X.M., Y.Y., Z.A.F.), Icahn School of Medicine at Mount Sinai, New York, NY; Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, China (N.Z., X.Z.); Department of Radiology, The Affiliated Hospital of Qingdao University, Qingdao, China (J.C., W.X.); and Guangdong Provincial Key Laboratory of Biomedical Imaging, Department of Radiology, The Fifth Affiliated Hospital, Sun Yat-sen University, 52 East Meihua Rd, New Xiangzhou, Zhuhai, Guangdong Province, China, 519000 (K.L., S.L., H.S.).

In this retrospective case series, chest CT scans of 21 symptomatic patients from China infected with the 2019 novel coronavirus (2019-nCoV) were reviewed, with emphasis on identifying and characterizing the most common findings. Typical CT findings included bilateral pulmonary parenchymal ground-glass and consolidative pulmonary opacities, sometimes with a rounded morphology and a peripheral lung distribution. Notably, lung cavitation, discrete pulmonary nodules, pleural effusions, and lymphadenopathy were absent. Follow-up imaging in a subset of patients during the study time window often demonstrated mild or moderate progression of disease, as manifested by increasing extent and density of lung opacities.
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http://dx.doi.org/10.1148/radiol.2020200230DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194022PMC
April 2020

Ex vivo cell-based CRISPR/Cas9 genome editing for therapeutic applications.

Biomaterials 2020 03 10;234:119711. Epub 2020 Jan 10.

Department of Biomedical Engineering, Tufts University, Medford, MA, 02155, USA. Electronic address:

The recently developed CRISPR/Cas9 technology has revolutionized the genome engineering field. Since 2016, increasing number of studies regarding CRISPR therapeutics have entered clinical trials, most of which are focusing on the ex vivo genome editing. In this review, we highlight the ex vivo cell-based CRISPR/Cas9 genome editing for therapeutic applications. In these studies, CRISPR/Cas9 tools were used to edit cells in vitro and the successfully edited cells were considered as therapeutics, which can be introduced into patients to treat diseases. Considering a large number of previous reviews have been focused on the CRISPR/Cas9 delivery methods and materials, this review provides a different perspective, by mainly introducing the targeted conditions and design strategies for ex vivo CRISPR/Cas9 therapeutics. Brief descriptions of the history, functionality, and applications of CRISPR/Cas9 systems will be introduced first, followed by the design strategies and most significant results from previous research that used ex vivo CRISPR/Cas9 genome editing for the treatment of conditions or diseases. The last part of this review includes general information about the status of CRISPR/Cas9 therapeutics in clinical trials. We also discuss some of the challenges as well as the opportunities in this research area.
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http://dx.doi.org/10.1016/j.biomaterials.2019.119711DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035593PMC
March 2020

Renewed proliferation in adult mouse cochlea and regeneration of hair cells.

Nat Commun 2019 12 4;10(1):5530. Epub 2019 Dec 4.

Department of Otolaryngology-Head and Neck Surgery, Graduate Program in Speech and Hearing Bioscience and Techology and Program in Neuroscience, Harvard Medical School, Boston, MA, 02115, USA.

The adult mammalian inner ear lacks the capacity to divide or regenerate. Damage to inner ear generally leads to permanent hearing loss in humans. Here, we present that reprogramming of the adult inner ear induces renewed proliferation and regeneration of inner ear cell types. Co-activation of cell cycle activator Myc and inner ear progenitor gene Notch1 induces robust proliferation of diverse adult cochlear sensory epithelial cell types. Transient MYC and NOTCH activities enable adult supporting cells to respond to transcription factor Atoh1 and efficiently transdifferentiate into hair cell-like cells. Furthermore, we uncover that mTOR pathway participates in MYC/NOTCH-mediated proliferation and regeneration. These regenerated hair cell-like cells take up the styryl dye FM1-43 and are likely to form connections with adult spiral ganglion neurons, supporting that Myc and Notch1 co-activation is sufficient to reprogram fully mature supporting cells to proliferate and regenerate hair cell-like cells in adult mammalian auditory organs.
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http://dx.doi.org/10.1038/s41467-019-13157-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6892913PMC
December 2019

Bone microarchitectural parameters can detect oxytocin induced changes prior to bone density on mitigating bone deterioration in rabbit osteoporosis model using micro-CT.

BMC Musculoskelet Disord 2019 Nov 23;20(1):560. Epub 2019 Nov 23.

Department of Radiology, Stony Brook Medicine, Stony Brook, New York, 11794, USA.

Background: This study is aimed to determine the efficacy of X-Ray Microtomography (micro-CT) in predicting oxytocin (OT) treatment response in rabbit osteoporosis(OP) model.

Methods: Sixty-five rabbits were randomly divided into three groups: control group, ovariectomy (OVX) -vehicle and OVX-oxytocin group. The controls underwent sham surgery. OVX-vehicle and OVX-oxytocin groups were subjected to bilateral OVX. The rabbits in OVX-oxytocin group were injected with oxytocin. In the 0th, 4th, 8th, 10th and 12th weeks post OVX operation, bone mineral density (BMD) and bone micro-architectural parameters were measured in three groups.

Results: Bone mineral density (BMD), bone volume fraction (BV/TV), Trabecular Number (Tb.N), and Trabecular Thickness (Tb.Th) decreased, while Trabecular Spacing (Tb.Sp) and Structure Model Index (SMI) increased overtime in all the three groups. In OVX-oxytocin group, the bone deterioration tendency is slowing down compared with that of the OVX-vehicle group. The BMD of the OVX-oxytocin group was significantly lower than those in the OVX-vehicle group at 12th week (P = 0.017). BV/TV and Tb.Sp in OVX-oxytocin group changed significantly from 8th week (P = 0.043) and 12th week (P = 0.014), which is earlier than that of BMD and other bone micro-architectural parameters.

Conclusion: BV/TV and Tb.Sp changed prior to BMD and other bone micro-architectural parameters with oxytocin intervention, which indicate that they are more sensitive markers for predicting early osteoporosis and treatment monitoring when using micro-CT to evaluate osteoporosis rabbit model.
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http://dx.doi.org/10.1186/s12891-019-2861-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6875040PMC
November 2019

Fatty infiltration of paraspinal muscles is associated with bone mineral density of the lumbar spine.

Arch Osteoporos 2019 10 15;14(1):99. Epub 2019 Oct 15.

Department of Radiology, Stony Brook Medicine, Stony Brook, NY, USA.

A total of 88 subjects were enrolled to investigate the relationship between paraspinal muscle fatty infiltration and lumbar bone mineral density (BMD) using chemical shift encoding-based water-fat MRI and quantitative computed tomography (QCT), respectively. A moderate inverse correlation between paraspinal muscle proton density fat fraction and lumbar QCT-BMD was found with age, sex, and BMI controlled.

Purpose: To investigate the relationship between paraspinal muscle fatty infiltration and lumbar bone mineral density (BMD).

Methods: A total of 88 subjects were enrolled in this study (52 females, 36 males; age, 46.6 ± 14.2 years old; BMI, 23.2 ± 3.49 kg/m). Proton density fat fractions (PDFF) of paraspinal muscles (erector spinae, multifidus, and psoas) were measured at L2/3, L3/4, and L4/5 levels using chemical shift encoding-based water-fat MRI. Quantitative computed tomography (QCT) was used to assess BMD of L1, L2, and L3. The differences in paraspinal muscle PDFF among subjects with normal bone density, osteopenia, and osteoporosis were tested using one-way ANOVA. The relationship between paraspinal muscle PDFF and QCT-BMD was analyzed using linear regression with age, sex, and BMI variables.

Results: PDFF of the erector spinae, multifidus, and psoas of subjects with normal bone density were all significantly less than those with osteopenia and those with osteoporosis (all p < 0.001). There was an inverse correlation between paraspinal muscle PDFF and BMD after controlling for age, sex, and BMI (standardized beta coefficient, - 0.21~- 0.29; all p < 0.05).

Conclusions: Paraspinal muscle fatty infiltration increased while lumbar BMD decreased after adjusting for age, sex, and BMI. Paraspinal muscles and vertebrae are interacting tissues. Paraspinal muscle fatty infiltration may be a marker of low lumbar BMD. Chemical shift imaging is an efficient and fast quantitative method and can be easily added to the clinical protocol to measure paraspinal muscle PDFF when the patient underwent the routine lumbar MRI with low-back pain.
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http://dx.doi.org/10.1007/s11657-019-0639-5DOI Listing
October 2019

Gender Differences in Article Citations by Authors from American Institutions in Major Radiology Journals.

Cureus 2019 Aug 3;11(8):e5313. Epub 2019 Aug 3.

Radiology, Stony Brook University Hospital, Stony Brook, USA.

Objective To investigate gender difference patterns in article citations, by first and last authors, in four radiology journals. Materials and methods Articles by authors published in four major radiology journals from 1984, 1994, 2004, and 2014 were categorized into 12 subspecialties. The number of citations, references used, co-authors, and length of the article (number of pages) were documented. The genders of first/last authors were determined. Data were analyzed using chi-square and logistic regression. Results The gender of the first author was determined in 2679 articles and that of the last author in 2717 articles. Over the selected years, 1984 to 2014, female first authorship grew from 13.0% to 31.5% (p<0.001), and female last authorship grew from 9.3% to 22.1% (p<0.001). Primary female authorship papers were cited less often as compared to males (OR 0.9972, 95% CI: 0.9948-0.9996, p=0.021), after adjusting for publication year and subspecialty. Across most subspecialties, female first authorship received fewer citations. In 1984, primary female authorship papers received on average 28.9 citations versus males at 39.1; in 1994, 50.4 versus 60.8; in 2004, 41.5 versus 44.4; and in 2014, 7.0 versus 7.8. The mean difference in the number of citations received by male and female first authors decreased from 10.47±6.09 in 1984 and 9.49±7.12 in 1994 to 1.93±5.63 in 2004 and 0.79±0.39 in 2014. However, there was no statistical difference demonstrated in article citations between male and female last authorship (OR 0.9990, 95% CI: 0.9966-1.0013, p=0.392). Conclusions Primary female authorship garnered fewer citations than men, despite the increasing frequency of authorships. However, this differential in the number of citations is narrowing.
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http://dx.doi.org/10.7759/cureus.5313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6773454PMC
August 2019

Development of a Scoring Tool for Chronic Nonbacterial Osteomyelitis Magnetic Resonance Imaging and Evaluation of its Interrater Reliability.

J Rheumatol 2020 05 1;47(5):739-747. Epub 2019 Oct 1.

From the Seattle Children's Hospital, Department of Pediatrics, and Department of Radiology, University of Washington; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen; The Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital and University of Southern Denmark, Odense, Denmark; Department of Diagnostic and Interventional Radiology, University Hospital of Ulm, Ulm, Germany; Department of Radiology, Stony Brook University Hospital, Stony Brook, New York; Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA; Department of Medical Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Radiology, Christian Medical College and Hospital, Vellore, India; Department of Imaging, Bambino Gesù Children's Hospital, Institute for Research and Health Care (IRCCS), Rome, Italy; Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia; Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.

Objective: Serial magnetic resonance imaging (MRI) examinations are often needed in chronic nonbacterial osteomyelitis (CNO) to determine the objective response to treatment. Our objectives in this study were (1) to develop a consensus-based MRI scoring tool for clinical and research use in CNO; and (2) to evaluate interrater reliability and agreement using whole-body (WB)-MRI from children with CNO.

Methods: Eleven pediatric radiologists discussed definitions and grading of signal intensity, size of signal abnormality within bone marrow, and associated features on MRI through monthly conference calls and a consensus meeting, using a nominal group technique in July 2017. WB-MRI scans from children with CNO were deidentified for training reading and an interrater reliability study. The reading by each radiologist was conducted in a randomized order. Interrater reliability for abnormal signal and severity were assessed using free-marginal κ statistics.

Results: Radiologists reached a consensus on grading CNO-specific MRI findings and on describing bone units based on anatomy. A total of 45 sets of WB-MRI scans, including 4 sets of non-CNO MRI examinations, were selected for the final reading. The mean κ of each category of bones was > 0.7 with majority > 0.9 demonstrating substantial/almost perfect interrater reliability of readings among radiologists. The agreement on signal intensity and the size of signal abnormality within the most commonly affected bones (femur and tibia) were lower than those of other bones.

Conclusion: The chronic nonbacterial osteomyelitis magnetic resonance imaging scoring (CROMRIS) tool is a comprehensive standardized scoring tool for MRI in children with CNO. Our interrater study demonstrated good interrater reliability and agreement of readings.
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http://dx.doi.org/10.3899/jrheum.190186DOI Listing
May 2020

Abbreviated quantitative UTE imaging in anterior cruciate ligament reconstruction.

BMC Musculoskelet Disord 2019 Sep 14;20(1):426. Epub 2019 Sep 14.

Department of Radiology, Stony Brook University, HSC Level 4, Room 120, Stony Brook, NY, 11794, USA.

Background: Existing ultrashort echo time magnetic resonance imaging (UTE MRI) methods require prohibitively long acquisition times (~ 20-40 min) to quantitatively assess the clinically relevant fast decay T* component in ligaments and tendons. The purpose of this study was to evaluate the feasibility and clinical translatability of a novel abbreviated quantitative UTE MRI paradigm for monitoring graft remodeling after anterior cruciate ligament (ACL) reconstruction.

Methods: Eight patients who had Graftlink™ hamstring autograft reconstruction were recruited for this prospective study. A 3D double-echo UTE sequence at 3.0 Tesla was performed at 3- and 6-months post-surgery. An abbreviated UTE MRI paradigm was established based on numerical simulations and in vivo validation from healthy knees. This proposed approach was used to assess the T* for fast decay component ([Formula: see text]) and bound water signal fraction (f) of ACL graft in regions of interest drawn by a radiologist.

Results: Compared to the conventional bi-exponential model, the abbreviated UTE MRI paradigm achieved low relative estimation bias for [Formula: see text] and f over a range of clinically relevant values for ACL grafts. A decrease in [Formula: see text] of the intra-articular graft was observed in 7 of the 8 ACL reconstruction patients from 3- to 6-months (- 0.11 ± 0.16 ms, P = 0.10). Increases in [Formula: see text] and f from 3- to 6-months were observed in the tibial intra-bone graft ([Formula: see text]: 0.19 ± 0.18 ms, P < 0.05; Δf: 4% ± 4%, P < 0.05). Lower [Formula: see text] (- 0.09 ± 0.11 ms, P < 0.05) was observed at 3-months when comparing the intra-bone graft to the graft/bone interface in the femoral tunnel. The same comparisons at the 6-months also yielded relatively lower [Formula: see text] (- 0.09 ± 0.12 ms, P < 0.05).

Conclusion: The proposed abbreviated 3D UTE MRI paradigm is capable of assessing the ACL graft remodeling process in a clinically translatable acquisition time. Longitudinal changes in [Formula: see text] and f of the ACL graft were observed.
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http://dx.doi.org/10.1186/s12891-019-2811-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6745079PMC
September 2019

In vivo evaluation of human patellar tendon microstructure and microcirculation with diffusion MRI.

J Magn Reson Imaging 2020 03 12;51(3):780-790. Epub 2019 Aug 12.

Department of Radiology, Stony Brook University, Stony Brook, New York, USA.

Background: Patellar tendon (PT) microstructure integrity and microcirculation status play a crucial role in the progression of tendinopathy and tendon repair.

Purpose: To assess the feasibility and robustness of stimulated-echo based diffusion-weighted MRI with readout-segmented echo-planar imaging (ste-RS-EPI) for noninvasive assessment of microstructure and microcirculation of human PT.

Study Type: Prospective.

Subjects: Fifteen healthy volunteers.

Field Strength/sequence: PT diffusion tensor imaging (DTI) and intravoxel incoherent motion (IVIM) were acquired with an ste-RS-EPI protocol on a 3T MRI scanner.

Assessment: Subjects were positioned with their PT at the magic angle. DTI-derived parameters including axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), and fractional anisotropy (FA) were estimated with b-values of 0 and 800 s/mm and 12 diffusion directions. IVIM-derived parameters, f , D* × f , V , and D* × V were assessed in the central-third and the outer-two thirds of the PT with b-values of 0, 20, 30, 60, 80, 120, 200, 400, and 600 s/mm in three orthogonal directions.

Statistical Tests: Paired t-tests were used to evaluate differences in IVIM parameters between the central-third and outer-two thirds regions of the patellar tendon. Paired t-tests and within-subject coefficient of variation were used to assess the intra- and intersession reproducibility of PT DTI and IVIM parameters.

Results: DTI parameters for healthy PT were 1.54 ± 0.09 × 10 mm /s, 1.01 ± 0.05 × 10 mm /s, 1.18 ± 0.06 × 10 mm /s, and 0.30 ± 0.04 for AD, RD, MD, and FA, respectively. Significantly higher (P < 0.05) IVIM parameters f and D* × f were observed in the outer-two thirds (6.1% ± 2.4% and 95.2 ± 49.6, respectively) compared with the central-third (3.8% ± 2.3% and 48.6 ± 35.2, respectively) of the PT.

Data Conclusion: Diffusion MRI of PT with an ste-RS-EPI protocol is clinically feasible. Both DTI- and IVIM-derived parameters of the PT demonstrated good test-retest reproducibility and interrater reliability.

Level Of Evidence: 2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2020;51:780-790.
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http://dx.doi.org/10.1002/jmri.26898DOI Listing
March 2020

Prediction of Abnormal Bone Density and Osteoporosis From Lumbar Spine MR Using Modified Dixon Quant in 257 Subjects With Quantitative Computed Tomography as Reference.

J Magn Reson Imaging 2019 02 3;49(2):390-399. Epub 2018 Nov 3.

Department of Radiology, Stony Brook Medicine, Stony Brook, New York, USA.

Background: Bone marrow fat increases when bone mass decreases, which could be attributed to the fact that adipogenesis competes with osteogenesis. Bone marrow fat has the potential to predict abnormal bone density and osteoporosis.

Purpose: To investigate the predictive value of using vertebral bone marrow fat fraction(BMFF) obtained from modified Dixon(mDixon) Quant in the determination of abnormal bone density and osteoporosis.

Study Type: Prospective.

Population: 257 subjects (age: 20-79 years old; BMI: 16.6-32.9 kg/m ;181 females,76 males) without known spinal tumor, history of trauma, dysplasia, spinal surgery or hormone therapy.

Field Strength/sequence: 3.0T/mDixon.

Assessment: BMFF was measured at the L1, L2 and L3 vertebral body on fat fraction maps of the lumbar spine. Bone mineral density (BMD) was obtained using quantitative computed tomography, which served as the reference standard.

Statistical Tests: The BMFF between the three groups (normal bone density, osteopenia and osteoporosis) was tested using one-way analysis of variance in SPSS. The correlation and partial correlation of BMFF and BMD were analyzed before and after controlling for age, sex and BMI. Logistic regression analysis using independent training and validation data was conducted to evaluate the performance of predicting abnormal BMD or osteoporosis using BMFF.

Results: There was a significant difference in vertebral BMFF between the three groups (P < 0.001). Moderate inverse correlation was found between vertebral BMFF and BMD after controlling age, sex and BMI (r = -0.529; P < 0.001). The mean area under the curve, sensitivity, specificity and negative predictive value (NPV) for predicting abnormal bone density were 0.940, 0.877, 0.896, and 0.890, respectively. The corresponding results for predicting subjects with osteoporosis were 0.896, 0.848, 0.853, and 0.969, respectively. DATA CONCLUSION: mDixon Quant is a fast, simple, noninvasive and nonionizing method to access vertebral BMFF and has a high predictive power for identifying abnormal bone density and osteoporosis.

Level Of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:390-399.
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http://dx.doi.org/10.1002/jmri.26233DOI Listing
February 2019

Correlation of bone marrow cellularity and metabolic activity in healthy volunteers with simultaneous PET/MR imaging.

Skeletal Radiol 2019 Apr 7;48(4):527-534. Epub 2018 Sep 7.

Department of Radiology, Stony Brook University, Stony Brook, NY, USA.

Objective: To evaluate the correlation between bone marrow cellularity (BMC) and metabolic activity in healthy subjects and to see whether yellow marrow is indeed metabolically quiescent. Because metabolic activity can be assumed to reflect vascularity, we assessed the relationship between regional metabolic activity and geographic frequency of metastases as noted in the literature.

Materials And Methods: Two hundred and twenty locations (ten in each side of the pelvis and proximal femur) were evaluated in 11 consecutive healthy volunteers with simultaneous PET/MR. BMC was calculated through precise water-fat fraction quantification with a 6-echo gradient echo. We analyzed correlations between cellularity and SUVr, age, and R2*. We also looked at the relation between our results and the reported prevalence of metastases.

Results: There was moderate but statistically significant correlation between BMC and metabolic activity (r = 0.636, p < 0.0001). Interestingly, the iliac and sacrum had higher metabolic activity relative to cellularity, whereas the femoral neck and lesser trochanter showed lower SUVr than other regions with the similar cellularity. The relatively lower metabolic status of the femoral neck conflicted with its reported high frequency of metastasis. Excluding regions with almost no remaining red marrow, cellularity showed inverse relationship with age (r = 0.476, p < 0.0001) and direct relationship with R2* (r = 0.532, p < 0.0010).

Conclusions: Metabolic activity of bone marrow was largely dependent on BMC while yellow marrow seems metabolically quiescent. The discrepancy between the assumed vascularity as determined by metabolic activity and reported sites of metastasis suggested that the process of bone metastasis may not depend entirely on vascularity.
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http://dx.doi.org/10.1007/s00256-018-3058-6DOI Listing
April 2019

Intravoxel incoherent motion (IVIM) imaging in human achilles tendon.

J Magn Reson Imaging 2018 12 9;48(6):1690-1699. Epub 2018 May 9.

Department of Radiology, Stony Brook University, Stony Brook, New York, USA.

Background: Limited microcirculation has been implicated in Achilles tendinopathy and may affect healing and disease progression. Existing invasive and noninvasive approaches to evaluate tendon microcirculation lack sensitivity and spatial coverage.

Purpose: To develop a novel Achilles tendon intravoxel incoherent motion (IVIM) MRI protocol to overcome the limitations from low tendon T /T * value and low intratendinous blood volume and blood velocity to evaluate tendon microcirculation.

Study Type: Prospective.

Subjects: Sixteen healthy male participants (age 31.0 ± 2.1) were recruited.

Field Strength/sequence: A stimulated echo readout-segmented echo planar imaging (ste-RS-EPI) IVIM sequence at 3.0T.

Assessment: The feasibility of the proposed ste-RS-EPI IVIM protocol combined with Achilles tendon magic angle effect was evaluated. The sensitivity of the protocol was assessed by an exercise-induced intratendinous hemodynamic response in healthy participants. The vascular origin of the observed IVIM signal was validated by varying the diffusion mixing time and echo time.

Statistical Tests: Two-tailed t-tests were used to evaluate differences (P < 0.05 was considered significant).

Results: Consistent with known tendon hypovascularity, the midportion Achilles tendon at baseline showed significantly lower IVIM-derived perfusion fraction (f ) (3.1 ± 0.9%) compared to the proximal and distal Achilles tendon (6.0 ± 1.8% and 6.1 ± 2.0%, respectively; P < 0.01). Similarly, the midportion Achilles tendon exhibited significantly lower baseline blood flow index (D*×f ) (40.9 ± 19.2, 18.3 ± 5.3, and 32.0 ± 9.4 in proximal, midportion, and distal Achilles tendon, respectively; P < 0.01). Eccentric heel-raise exercise led to ∼2 times increase of Achilles tendon blood flow in healthy participants. Consistent with its vascular origin, the estimated f demonstrated a high dependency to IVIM protocol parameters, while the T /T -corrected absolute intratendinous microvascular blood volume fraction (V ) did not vary.

Data Conclusion: Achilles tendon ste-RS-EPI IVIM noninvasively assessed baseline values and exercise-induced changes to tendon microcirculation in healthy tendon.

Level Of Evidence: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;48:1690-1699.
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http://dx.doi.org/10.1002/jmri.26182DOI Listing
December 2018

Diffusion tensor imaging of human Achilles tendon by stimulated echo readout-segmented EPI (ste-RS-EPI).

Magn Reson Med 2018 12 6;80(6):2464-2474. Epub 2018 May 6.

Department of Radiology, Stony Brook University, Stony Brook, New York.

Purpose: Healing, regeneration, and remodeling of the injured Achilles tendon are associated with notable changes in tendon architecture. However, assessing Achilles microstructural properties with conventional diffusion tension imaging (DTI) remains a challenge because of very short T / T 2 * values of the tendon. Hence, the objective of this study was to develop a novel Achilles tendon DTI protocol for a non-invasive investigation of the changes of microstructural integrity in tendinopathy.

Methods: A novel stimulated echo readout-segmented EPI (ste-RS-EPI) DTI sequence was proposed to achieve a TE of ∼14-20 ms for typical b-values of 400-800 s/mm on clinical 3T MRI scanners. To further boost tendon MR signal, the Achilles was positioned at the magic angle (∼55 °) with respect to the scanner B field. The sensitivity of the developed protocol was evaluated in 19 healthy participants and 6 patients with clinically confirmed tendinopathy.

Results: Compared to spin echo RS-EPI DTI protocol, ste-RS-EPI provided an ∼100-200% increase in Achilles MR signal. Tendinopathic Achilles demonstrated a high degree of microstructural disruption based on DTI tractography analysis, with significantly lower (P < 0.05) axial diffusivity (1.20 ± 0.19 vs. 1.39 ± 0.10 × 10 mm /s), radial diffusivity (0.72 ± 0.11 vs. 0.81 ± 0.08 × 10 mm /s), and mean diffusivity (0.87 ± 0.14 vs. 1.00 ± 0.07 × 10 mm /s), but no significant difference in fractional anisotropy (0.38 ± 0.04 vs. 0.38 ± 0.05; P = 0.86).

Conclusion: Achilles tendon ste-RS-EPI DTI can non-invasively detect the tendinopathy-induced changes to microstructural integrity, consistent with the disruption of collagen arrangement and increased cellularity. This study demonstrated the robustness and sensitivity of the proposed protocol in Achilles tendinopathy.
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http://dx.doi.org/10.1002/mrm.27220DOI Listing
December 2018

Predictors of Pain and Discomfort Associated with CT Arthrography of the Shoulder.

Acad Radiol 2018 12 30;25(12):1603-1608. Epub 2018 Apr 30.

Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, 157 Xiwu Road, Xi'an, Shaanxi, 710004, P.R. China. Electronic address:

Rationale And Objectives: The objective of this study was to investigate predictors of pain associated with computed tomographic arthrography of the shoulder.

Materials And Methods: Before shoulder arthrography, all participants were assessed with the Hospital Anxiety and Depression Scale (HADS) and the World Health Organization Quality of Life Short Version Instrument (WHOQOL-BREF). The participants were nonrandomized into two groups: the anesthesia group, who underwent prior local infiltration anesthesia before shoulder arthrography, and the nonanesthesia group, who did not undergo prior local infiltration anesthesia. The pain levels at intraprocedure, at 1, 2, 6, and 12 hours, and at 1 and 2 days after injection were assessed by using a visual analog scale. Univariate and multivariate generalized linear model analyses were conducted.

Results: Sixty participants in the anesthesia group and 60 participants in the nonanesthesia group were included. The pain level at intraprocedure (3.37 ± 1.94 in the anesthesia group and 3.20 ± 1.34 in the nonanesthesia group) was the highest of the whole pain course. The psychological domain (P = .0013) of WHOQOL-BREF, gender (P = .042), body mass index (P = .0001), and the total number of reinsertion and redirection of needle (P< .0001) were independent predictors of arthrography-related pain.

Conclusions: The pain associated with shoulder computed tomographic arthrography depends on the psychological domain of WHOQOL-BREF, gender, body mass index, and the total number of reinsertion and redirection of needle.
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http://dx.doi.org/10.1016/j.acra.2018.04.003DOI Listing
December 2018
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