Publications by authors named "Yin Xi"

234 Publications

Correlation of the Imaging Features of Femoroacetabular Impingement Syndrome With Clinical Findings and Patient Functional Scores.

Orthopedics 2021 Jul-Aug;44(4):e577-e582. Epub 2021 Jul 1.

The relationship among the severity of the imaging features of femoroacetabular impingement syndrome (FAIS), patient symptoms, and function has not been elucidated. Understanding this relationship helps to improve the prognostic value of imaging. The goal of this study was to examine the correlation of clinical findings, patient pain, and function with severity, as measured with radiographic and 3-dimensional magnetic resonance imaging (3D-MRI). Data collected prospectively through a longitudinally maintained hip database were reviewed, and 37 hips from 31 patients were included. All patients were examined by an experienced orthopedic surgeon, and preoperative radiographs and 3D-MRI were obtained. Preoperatively, the patients completed validated patient-reported outcome measures (PROMs). Mean±SD alpha angles were 69.4°±10.3°, 70.0°±10.3°, 70.6°±8.4°, and 74.8°±9.2° at 12 o'clock, 1 o'clock, 2 o'clock, and 3 o'clock, respectively. Mean lateral center edge angle was 30.1°±5.3°. The authors did not observe a statistically significant correlation between PROMs and the features measured by radiographs and 3D-MRI (>.05). In this subset of prospectively imaged patients with FAIS, the authors did not find a correlation between the severity of symptoms measured by PROMs and features on radiographs and 3D-MRI. The severity of dysfunction is multifactorial, and anatomic severity, as measured radiographically and with 3D-MRI, may not correlate with symptoms. Further investigation is necessary to address the sources of patient pain. [. 2021;44(4):e577-e582.].
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http://dx.doi.org/10.3928/01477447-20210618-20DOI Listing
July 2021

Visceral Adipose Tissue Volumetrics Inform Odds of Treatment Response and Risk of Subsequent Surgery in IBD Patients Starting Antitumor Necrosis Factor Therapy.

Inflamm Bowel Dis 2021 Jul 22. Epub 2021 Jul 22.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Texas at Austin Dell Medical School, Austin,  TX, USA.

Background: Data describing the effect of obesity on antitumor necrosis factor (anti-TNF) treatment response are inconsistent. Visceral adipose tissue (VAT) is a superior marker of adiposity to body mass index. However, its effect on treatment response is unclear. We aimed to evaluate the effect of VAT on anti-TNF treatment response.

Methods: Inflammatory bowel disease (IBD) patients starting anti-TNF agents between January 1, 2009, and July 31, 2019, were included. 3-dimensional measurements of VAT volume and visceral fat index (visceral:subcutaneous adipose tissue ratio; VFI) were obtained from computed tomography (CT) scans. Subjects were categorized by predefined volume cutoffs (<1500cm3, 1500-2999cm3, ≥3000cm3) and VFI (<0.33, 0.33-0.66, ≥0.67). Primary outcomes included a composite treatment response end point at 6 and 12 months. Secondary outcomes were surgery at 6 and 12 months. Multivariable logistic regression was used to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results: The final cohort included 176 patients. No significant differences in treatment response at 6 months was observed. At 12 months, compared with volume <1500cm3, patients with volume 1500-2999cm3 had higher odds of response (aOR, 3.52; 95% CI, 1.16-10.71; P = .023), whereas volume ≥3000cm3 did not. Compared with VFI<0.33, VFI ≥0.67 had higher odds of surgery at 6 (aOR, 48.22; 95% CI, 4.73-491.57; P = .023) and 12 months (aOR, 20.94; 95% CI, 3.14-139.67; P = .004). Post hoc analysis suggested VAT may affect drug pharmacokinetics.

Conclusions: We found VAT volume is associated with anti-TNF treatment response in a nondose dependent manner, and VFI may inform risk of surgery after anti-TNF initiation. If confirmed by prospective studies, VAT volumetrics are potentially useful biomarkers to inform IBD treatment decisions.
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http://dx.doi.org/10.1093/ibd/izab167DOI Listing
July 2021

Association of Clear Cell Likelihood Score on MRI and Growth Kinetics of Small Solid Renal Masses on Active Surveillance.

AJR Am J Roentgenol 2021 Jul 21. Epub 2021 Jul 21.

Department of Radiology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390.

The lack of validated imaging markers to characterize biologic aggressiveness of small renal masses (SRMs; cT1a, ≤4 cm) hinders medical decision making amongst available initial management strategies. To explore the association of the clear cell likelihood score (ccLS) on MRI with growth rates and progression of SRMs. This retrospective study included consecutive SRMs assigned a ccLS on clinical MRI examinations performed between June 2016 and November 2019 at an academic tertiary-care medical center or its affiliated safety net hospital system. The ccLS scores the likelihood that the SRM represents clear cell renal cell carcinoma (ccRCC) from 1 (very unlikely) to 5 (very likely). The ccLS was extracted from clinical reports. Tumor size measurements were extracted from available prior and follow-up cross-sectional imaging examinations, through June 2020. Serial tumor size measurements were fit to linear and exponential growth curves. Estimated growth rates were grouped by the assigned ccLS. Tumor progression was defined by development of large size (>4 cm in at least two measurements) and/or rapid growth (doubling of volume within 1 year). Differences among ccLS groups were evaluated using Kruskal-Wallis tests. Correlation between ccLS and growth rate were evaluated by Spearman correlation (ρ). Growth rates of 386 SRMs (100 ccLS1-2, 75 ccLS3, and 211 ccLS4-5) from 339 patients (median age 65 years; 198 men, 141 women) were analyzed. Median follow-up was 1.16 years. The ccLS was correlated with growth rates by size (ρ=0.19, p<.001; ccLS4-5: 9%/year, ccLS1-2: 5%/year, p<.001) and by volume (ρ=0.136, p=.008; ccLS4-5: 29%/year, ccLS1-2: 16%/year, p<.001). Disease progression (observed in 49 SRMs) was not significantly associated with ccLS group (p=.61). Two patients (0.6%) developed metastases during active surveillance (AS): one ccLS1 that was a type 2 papillary renal cell carcinoma and one ccLS4 that was ccRCC. Growth is associated with ccLS in SRMs, with higher ccLS correlating with faster growth. The non-invasive clear cell likelihood score (ccLS), derived from MRI, correlates with growth rate of SRMs and may help guide personalized management. SRMs with lower ccLS may be considered for AS, whereas SRMs with higher ccLS may warrant earlier intervention.
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http://dx.doi.org/10.2214/AJR.21.25979DOI Listing
July 2021

Osseous Tumor Reporting and Data System-Multireader Validation Study.

J Comput Assist Tomogr 2021 Jul 13. Epub 2021 Jul 13.

From the Department of Radiology, UT Southwestern Medical Center, Dallas, TX Department of Orthopedic Surgery, UT Southwestern Medical Center, Dallas, TX Department of Population and Data Sciences UT Southwestern Medical Center, Dallas, TX.

Objective: To develop and validate an Osseous Tumor Reporting and Data System (OT-RADS) with the hypothesis that the proposed guideline is reliable and assists in separating benign from malignant osseous tumors with a good area under the curve, and that could assist further patient management.

Methods: In this multireader cross-sectional validation study, an agreement was reached for OT-RADS categories based on previously described magnetic resonance imaging features and consensus of expert musculoskeletal radiologists. World Health Organization classification was used, and a wide spectrum of benign and malignant osseous tumors was evaluated. Magnetic resonance imaging categories were as follows: OT-RADS 0-incomplete imaging; OT-RADS I-negative; OT-RADS II-definitely benign; OT-RADS III-probably benign; OT-RADS IV-suspicious for malignancy or indeterminate; OT-RADS V-highly suggestive of malignancy; and OT-RADS VI-known biopsy-proven malignancy or recurrent malignancy in the tumor bed. Four blinded readers categorized each tumor according to OT-RADS classification. Intraclass correlation (ICC) and Conger κ were used. Diagnostic performance measures including area under the receiver operating curve were reported. Osseous Tumor Reporting and Data System was dichotomized as benign (I-III) and malignant (IV and V) for calculating sensitivity and specificity.

Results: Interreader agreement for OT-RADS (ICC = 0.78) and binary distinction of benign versus malignant (κ = 0.67) were good to excellent, while agreement for individual tumor feature characteristics were poor to fair (ICC = 0.25-0.36; κ = 0.16-0.39). The sensitivities, specificities, and area under the receiver operating curve of the readers ranged from 0.93-1.0, 0.71-0.86, and 0.92-0.97, respectively.

Conclusions: Osseous Tumor Reporting and Data System lexicon is reliable and helps stratify tumors into benign and malignant categories. It can be practically used by radiologists to guide patient management, improve multidisciplinary communications, and potentially impact outcomes.
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http://dx.doi.org/10.1097/RCT.0000000000001184DOI Listing
July 2021

The EGFR-P38 MAPK axis up-regulates PD-L1 through miR-675-5p and down-regulates HLA-ABC via hexokinase-2 in hepatocellular carcinoma cells.

Cancer Commun (Lond) 2021 Jan 1;41(1):62-78. Epub 2021 Jan 1.

Laboratory of Endocrinology and Metabolism, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, 510623, P. R. China.

Background: Immunotherapy has been shown to be a promising strategy against human cancers. A better understanding of the immune regulation in hepatocellular carcinoma (HCC) could help the development of immunotherapy against HCC. The epidermal growth factor receptor (EGFR) signaling is frequently activated in HCC and plays important roles in tumorigenesis. However, its role in HCC immunity is still largely unknown. This study aimed to investigate the impact of EGFR signaling on programmed death-ligand 1 (PD-L1) and human leukocyte antigen class-I (HLA-I) expression in HCC cells and its underlying mechanisms.

Methods: The expression of phosphorylated EGFR (p-EGFR), PD-L1, and HLA-I (HLA-ABC) in HCC specimens was detected by immunohistochemistry, and their correlations were analyzed. PD-L1 and HLA-ABC expression in EGFR-activated HCC cells were detected by quantitative real-time PCR, Western blotting, and flow cytometry, and T cell-mediated lysis was performed to test the immunosuppressive effects of PD-L1 and HLA-ABC alterations in HCC cells. Furthermore, the underlying mechanisms of EGFR activation-induced PD-L1 up-regulation and HLA-ABC down-regulation were explored by animal experiments, luciferase reporter assay, and gene gain- and loss-of-function studies.

Results: p-EGFR was positively correlated with PD-L1 and negatively correlated with HLA-ABC expression in HCCs. EGFR activation by its ligand EGF up-regulated PD-L1 and down-regulated HLA-ABC in HCC cells, which was functionally important and could be abolished by the EGFR inhibitor, gefitinib, both in vitro and in vivo. Mechanistically, enhanced P38 mitogen-activated protein kinase (MAPK) activation down-regulated microRNA-675-5p (miR-675-5p) and up-regulated glycolysis-related enzyme hexokinase 2 (HK2); miR-675-5p down-regulation enhanced the stability of PD-L1 mRNA probably via the 3'-untranslated region (3'-UTR) of PD-L1 and thereby caused PD-L1 accumulation, and HK2 up-regulation enhanced aerobic glycolysis and mediated a decrease in HLA-ABC.

Conclusions: The EGFR-P38 MAPK axis could up-regulate PD-L1 through miR-675-5p and down-regulate HLA-ABC via HK2 in HCC cells. Our study reveals a novel signaling network that may cause immune suppression in HCC and suggests that EGFR signaling can be targeted for HCC immunotherapy.
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http://dx.doi.org/10.1002/cac2.12117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7819566PMC
January 2021

Deciphering Intratumoral Molecular Heterogeneity in Clear Cell Renal Cell Carcinoma with a Radiogenomics Platform.

Clin Cancer Res 2021 Jul 1. Epub 2021 Jul 1.

Department of Radiology, The University of Texas Southwestern Medical Center

Purpose: Intratumoral heterogeneity (ITH) challenges the molecular characterization of clear cell renal cell carcinoma (ccRCC) and is a confounding factor for therapy selection. Most approaches to evaluate ITH are limited by two-dimensional tissue analyses. Dynamic Contrast Enhanced Magnetic Resonance Imaging (DCE-MRI) can noninvasively assess the spatial landscape of entire tumors in their natural milieu. To assess the potential of DCE-MRI, we developed a vertically-integrated radiogenomics co-localization approach for multi-region tissue acquisition and analyses. We investigated the potential of spatial imaging features to predict molecular subtypes using histopathologic and transcriptome correlatives.

Experimental Design: We report the results of a prospective study of 49 patients with ccRCC who underwent DCE-MRI prior to nephrectomy. Surgical specimens were sectioned to match the MRI acquisition plane. RNA sequencing data from multi-region tumor sampling (80 samples) were correlated with percent enhancement on DCE-MRI in spatially co-localized regions of the tumor. Independently, we evaluated clinical applicability of our findings in 19 metastatic RCC patients (39 metastases) treated with first-line anti-angiogenic drugs or checkpoint inhibitors.

Results: DCE-MRI identified tumor features associated with angiogenesis and inflammation, which differed within and across tumors, and likely contribute to the efficacy of anti-angiogenic and immuno-therapies. Our vertically-integrated analyses show that angiogenesis and inflammation frequently co-exist and spatially anti-correlate in the same tumor. Furthermore, MRI contrast enhancement identifies phenotypes with better response to anti-angiogenic therapy among metastatic RCC patients.

Conclusion: These findings have important implications for decision models based on biopsy samples and highlight the potential of more comprehensive imaging-based approaches.
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http://dx.doi.org/10.1158/1078-0432.CCR-21-0706DOI Listing
July 2021

Magnetic Resonance Imaging Detection of Glucose-Stimulated Zinc Secretion in the Enlarged Dog Prostate as a Potential Method for Differentiating Prostate Cancer From Benign Prostatic Hyperplasia.

Invest Radiol 2021 Jul;56(7):450-457

Department of Radiology, University of Texas Southwestern Medical Center, Dallas.

Objectives: In the United States, prostate cancer (PCa) is the most common cancer in men. Multi-parametric magnetic resonance imaging (MRI) is increasingly being relied upon for the diagnosis and characterization of PCa, but differentiating malignancy from benign prostatic hyperplasia (BPH) in the transition zone using MRI can be challenging. The characteristically high levels of zinc in human prostate tissue and a close relationship between malignant proliferation and zinc homeostatic dysregulation create opportunities to visualize PCa with novel contrast media. In mouse models, glucose-stimulated zinc secretion (GSZS) can be preferentially observed in healthy prostate tissue compared with malignant tissue; in vivo, these differences can be captured with MRI by using Gdl1, a gadolinium-based zinc-responsive contrast agent. In this study, we examined whether this technology can be applied in a large animal model by imaging older dogs with clinically diagnosed BPH.

Materials And Methods: Four intact male dogs 6 years or older with enlarged prostates were imaged (T1-weighted turbo spin-echo, TE/TR, 12/400 milliseconds and T2-weighted, TE/TR, 112/5000 milliseconds) using a 3 T scanner before and at multiple time points after intravenous injection of 0.05 mmol/kg GdL1 plus either (a) 2 mL/kg of 50% dextrose in 1 session or (b) 2 mL/kg normal saline in another session. The two sessions were one week apart, and their order was randomly determined for each dog. During postprocessing, regions of interest were generated in prostate tissue and in paraspinal muscles to evaluate the contrast-to-noise ratio (CNR). The ratio of CNR at any postinjection time point compared with baseline CNR was defined as r-CNR. After the second imaging session, the dogs were euthanized, and their prostates were harvested for histopathological examination. Baseline and postintervention plasma and urine samples were analyzed for total zinc by inductively coupled plasma mass spectrometry.

Results: The mean ± SD r-CNR values at 13 minutes postinjection in the dextrose versus saline imaging sessions were 134% ± 10% and 127% ± 7%, respectively (P < 0.01). The histopathologic evaluation of prostate tissues confirmed BPH in all dogs. Interestingly, prostatic intraepithelial neoplasia was detected in 1 animal, and a suspicious mass was found in the same region on T2-weighted scans. The r-CNR of the mass was calculated as 113% ± 4% and 111% ± 6% in the dextrose and saline groups, respectively, with no significant differences between the 2 interventions (P = 0.54), whereas there was a statistically significant difference between the r-CNR of the whole prostate in the dextrose (130% ±11%) and saline (125% ± 9%) interventions (P = 0.03). Inductively coupled plasma mass spectrometry analyses showed a significantly higher urinary zinc in the dextrose versus saline groups, but no differences were found in plasma zinc levels.

Conclusions: T1-weighted MRI of the enlarged canine prostate showed higher r-CNR after injection of GdL1 plus dextrose compared with GdL1 plus saline, consistent with GSZS from BPH tissues. One small region of neoplastic tissue was identified in a single dog on the basis of less GSZS from that region by MRI. These findings suggest a new method for the detection of PCa by MRI that could facilitate the differentiation of BPH from PCa in the transition zone.
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http://dx.doi.org/10.1097/RLI.0000000000000760DOI Listing
July 2021

Regional White Matter Diffusion Changes Associated with the Cumulative Tensile Strain and Strain Rate in Non-concussed Youth Football Players.

J Neurotrauma 2021 May 27. Epub 2021 May 27.

University of Texas Southwestern Medical Center at Dallas, 12334, Radiology, 5323 Harry Hines Blvd, Dallas, Texas, United States, 75390;

The purpose of this study is to assess the relationship between regional white matter diffusion imaging metrics and finite element strain measures in non-concussed youth football players. Pre and postseason diffusion-weighted imaging was performed in 102 youth football subject-seasons, in which no concussions were diagnosed. The diffusion data was normalized to the IXI template. Percent change in fractional anisotropy FA (%ΔFA) images were generated. Using data from the head impact telemetry system, the cumulative maximum principal strain 1 times strain rate (CMPS1xSR), a measure of the cumulative tensile brain strain and strain rate for one season, was generated for each subject. Two linear regression analyses were performed to identify significant positive or inverse relationships between CMPS1xSR and %ΔFA within the international consortium for brain mapping white matter mask. Age, BMI, days between pre and postseason imaging, prior brain injury, attention disorder diagnosis, and imaging protocol were included as covariates. False discovery rate correction was used with corrected alphas of 0.025 and voxel thresholds of zero. Controlling for all covariates, a significant, positive linear relationship between %ΔFA and CMPS1xSR was identified in the bilateral cingulum, fornix, internal capsule, external capsule, corpus callosum, corona radiata, corticospinal tract, cerebral and middle cerebellar peduncle, superior longitudinal fasciculus, and right superior fronto-occipital fasciculus. Post-hoc analyses further demonstrated significant %ΔFA differences between high-strain football subjects and non-collision control athletes, no significant %ΔFA differences between low-strain subjects and non-collision control athletes, and that CMPS1xSR significantly explained more %ΔFA variance than number of head impacts alone. In the absence of clinically diagnosed concussion, youth football players experience regional, dose-dependent white matter FA increases that are significantly associated with CMPS1xSR.
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http://dx.doi.org/10.1089/neu.2020.7580DOI Listing
May 2021

Three-dimensional vectorcardiographic characteristics of breast cancer patients treated with chemotherapy.

J Electrocardiol 2021 May 7;67:23-30. Epub 2021 May 7.

Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China. Electronic address:

Background: Patients receiving chemotherapy for breast cancer (breast cancer) may develop cardiac electrophysiological abnormalities. The aim of this study is to examined possible alterations in cardiac electrophysiological parameters detected by three-dimensional vectorcardiograms (3D-VCGs) in breast cancer patients who received chemotherapy.

Methods: This was a prospective single-center cohort study conducted in Fourth Hospital of Hebei Medical University, China. Patients with breast cancer referred for chemotherapy from May 1, 2019, to October 1, 2019 were invited to participate in the study. 3D-VCGs and echocardiography were recorded at rest four times (baseline, after the first cycle, after third cycles and at the end of the regimen, respectively).

Results: A total of 63 patients were included. Compared with baseline, decreases in 3D maximum T vector magnitude (TVM) (0.29 ± 0.10 vs. 0.25 ± 0.10 mV; p < 0.05) and 3D T/QRS ratio (0.26 ± 0.11 vs. 0.21 ± 0.11; p < 0.05) were observed by the end of chemotherapy regimen, while echocardiographic parameters showed no significant variation before and after chemotherapy (all P > 0.05). Furthermore, after third cycles, maximum TVM were correlated with LVEF except in horizontal plane (3D: r = 0.33, p < 0.01; frontal plane: r = 0.34, p < 0.01; horizontal plane: r = 0.24, p = 0.06; right side plane: r = 0.30, p = 0.02). After completion of chemotherapy, maximum TVM were also positive correlated with LVEF (3D: r = 0.33, P < 0.01; frontal plane: r = 0.32, P = 0.01; horizontal plane: r = 0.27, P = 0.03, right side plane: r = 0.38, P < 0.01).

Conclusions: Along with chemotherapy, maximum TVM and T/QRS is lower in patients with breast cancer. After third cycles and after completion of chemotherapy, there is a positive correlation between maximum TVM and LVEF. 3D-VCGs can be used to detect electrophysiological abnormalities in breast cancer patients receiving chemotherapy.
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http://dx.doi.org/10.1016/j.jelectrocard.2021.04.018DOI Listing
May 2021

Active Reprioritization of the Reading Worklist Using Artificial Intelligence Has a Beneficial Effect on the Turnaround Time for Interpretation of Head CT with Intracranial Hemorrhage.

Radiol Artif Intell 2021 Mar 18;3(2):e200024. Epub 2020 Nov 18.

Departments of Radiology (T.J.O., Y.X., E.S., T.B., Y.S.N., R.M.P.) and Health Systems Information Resources (C.B.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas, 5323 Harry Hines Blvd, Dallas TX 75235.

Purpose: To determine how to optimize the delivery of machine learning techniques in a clinical setting to detect intracranial hemorrhage (ICH) on non-contrast-enhanced CT images to radiologists to improve workflow.

Materials And Methods: In this study, a commercially available machine learning algorithm that flags abnormal noncontrast CT examinations for ICH was implemented in a busy academic neuroradiology practice between September 2017 and March 2019. The algorithm was introduced in three phases: as a "pop-up" widget on ancillary monitors, as a marked examination in reading worklists, and as a marked examination for reprioritization based on the presence of the flag. A statistical approach, which was based on a queuing theory, was implemented to assess the impact of each intervention on queue-adjusted wait and turnaround time compared with historical controls.

Results: Notification with a widget or flagging the examination had no effect on queue-adjusted image wait ( > .99) or turnaround time ( = .6). However, a reduction in queue-adjusted wait time was observed between negative (15.45 minutes; 95% CI: 15.07, 15.38) and positive (12.02 minutes; 95% CI: 11.06, 12.97; < .0001) artificial intelligence-detected ICH examinations with reprioritization. Reduced wait time was present for all order classes but was greatest for examinations ordered as routine for both inpatients and outpatients because of their low priority.

Conclusion: The approach used to present flags from artificial intelligence and machine learning algorithms to the radiologist can reduce image wait time and turnaround times.© RSNA, 2021See also the commentary by O'Connor and Bhalla in this issue.
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http://dx.doi.org/10.1148/ryai.2020200024DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8043365PMC
March 2021

Implementation and Service Impact of a Clinical Radiology Subinternship.

J Am Coll Radiol 2021 Apr 28. Epub 2021 Apr 28.

Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address:

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http://dx.doi.org/10.1016/j.jacr.2021.03.029DOI Listing
April 2021

Single-shot RARE with Dixon: Application to robust abdominal imaging with uniform fat and water separation at 3T.

Magn Reson Med 2021 09 30;86(3):1463-1471. Epub 2021 Apr 30.

Department of Radiology, UT Southwestern Medical Center, Dallas, Texas, USA.

Purpose: To develop a true single shot turbo spin echo (SShTSE) acquisition with Dixon for robust T -weighted abdominal imaging with uniform fat and water separation at 3T.

Methods: The in-phase (IP) and out-of-phase (OP) echoes for Dixon processing were acquired in the same repetition time of a SShTSE using partial echoes. A phase-preserved bi-directional homodyne reconstruction was developed to compensate the partial echo and the partial phase encoding of SShTSE. With IRB approval, the SShTSE-Dixon was compared against standard SShTSE, without and with fat suppression using spectral adiabatic inversion recovery (SPAIR) in 5 healthy volunteers and 5 patients. The SNR and contrast ratio (CR) of spleen to liver were compared among different acquisitions.

Results: The bi-directional homodyne reconstruction successfully minimized ringing artifacts because of partial acquisitions. SShTSE-Dixon achieved uniform fat suppression compared to SShTSE-SPAIR with fat suppression failures of 1/10 versus 10/10 in the axial plane and 0/5 versus 5/5 in the coronal plane, respectively. The SNRs of the liver (12.2 ± 4.9 vs. 11.7 ± 5.2; P = .76) and spleen (25.9 ± 11.6 vs. 23.7 ± 9.7; P = .14) were equivalent between fat-suppressed images (SShTSE-Dixon water-only and SShTSE-SPAIR). The SNRs of liver (14.4 ± 5.7 vs. 13.4 ± 5.0; P = .60) and spleen (26.5 ± 10.1 vs. 25.7 ± 8.5; P = .56) were equivalent between non-fat-suppressed images (SShTSE-Dixon IP and SShTSE). The CRs of spleen to liver were also similar between fat-suppressed images (2.6 ± 0.4 vs. 2.5 ± 0.5; P =.92) and non-fat-suppressed images (2.3 ± 0.6 vs. 2.2 ± 0.4; P =.84).

Conclusion: SShTSE-Dixon generates robust abdominal T -weighted images at 3T with and without uniform fat suppression, along with perfectly co-registered fat-only images in a single acquisition.
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http://dx.doi.org/10.1002/mrm.28816DOI Listing
September 2021

Exogenous microbiota-derived metabolite trimethylamine N-oxide treatment alters social behaviors: Involvement of hippocampal metabolic adaptation.

Neuropharmacology 2021 06 20;191:108563. Epub 2021 Apr 20.

Neuroscience Research Center, Institute of Medical and Health Science of HeBMU, Hebei Medical University, Shijiazhuang, 050017, China; Hebei Key Laboratory of Neurophysiology, Hebei Medicinal University, 050017, China; Department of Biochemistry and Molecular Biology, College of Basic Medicine, Hebei Medicinal University, Shijiazhuang, 050017, China; Research Unit of Digestive Tract Microecosystem Pharmacology and Toxicology. Chinese Academy of Medical Sciences, Shijiazhuang, 050017, China. Electronic address:

Increasing evidence indicates that gut microbiota and its metabolites can influence the brain function and the related behaviors. Trimethylamine N-oxide (TMAO), an indirect metabolite of gut microbiota, has been linked to aging, cognitive impairment, and many brain disorders. However, the potential effects of TMAO on social behaviors remain elusive. The present study investigated the effects of early life systemic TMAO exposure and intra-hippocampal TMAO infusion during adulthood on social behaviors in mice. We also analyzed the effects of intra-hippocampus infusion of TMAO during adulthood on levels of metabolites. The results showed that both systemic TMAO exposure in the post-weaning period and intra-hippocampal TMAO infusion during adulthood decreased social rank and reduced sexual preference in adult mice. Data from LC-MS metabolomics analysis showed that intra-hippocampal TMAO infusion induced a total 207 differential metabolites, which belongs to several metabolic or signaling pathways, especially FoxO signaling pathway and retrograde endocannabinoid signaling pathway. These data suggest that TMAO may affect social behaviors by regulating metabolites in the hippocampus, which may provide a new insight into the role of gut microbiota in regulating social behaviors.
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http://dx.doi.org/10.1016/j.neuropharm.2021.108563DOI Listing
June 2021

Investigating new CT contrast agents: a phantom study exploring quantification and differentiation methods for high-Z elements using dual-energy CT.

Eur Radiol 2021 Apr 15. Epub 2021 Apr 15.

Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9061, USA.

Objectives: To develop a dual-energy CT method for differentiating and quantifying high-Z contrast elements and to evaluate the limitations based on element concentration and atomic number by using an anthropomorphic phantom study.

Methods: Mass spectrometry standards for iodine, barium, gadolinium, ytterbium, tantalum, gold, and bismuth were diluted from 10.0 to 0.3 mg/mL, placed inside 7-mL vials, and scanned with dual-energy CT using an abdominal phantom and cylindrical water-filled insert. This procedure was repeated with all seven high-Z elements at six isoattenuating values from 250 to 8 HU. Quantification accuracy was measured using a linear regression model and residual error analysis with 90% limits of agreement. The limit of detection for each element was evaluated using the limit of blank of water. Pairwise differentiation of isoattenuating vials was evaluated using AUC values and the difference in fit angles between the two elements.

Results: Each high-Z element had a unique concentration vector in a two-dimensional plot of Compton scattering versus photoelectric effect attenuations. Mean quantification values were within ± 0.1 mg/mL of the true values for each element with no proportional bias. Limits of detection ranged from 0.35 to 0.56 mg/mL. Pairwise differentiations were proportional to the isoattenuating HU and the angle between the linear fits with mean AUC values increasing from 0.61 to 0.98 at 8 to 250 HU, respectively.

Conclusion: Dual-energy CT can differentiate and quantify isoattenuating high-Z elements. The high-attenuation characteristics and unique concentration vectors of ytterbium, tantalum, gold, and bismuth are well suited for new dual-energy CT contrast agents especially when simultaneously imaged with iodine, barium, or gadolinium.

Key Points: • Dual-energy CT can accurately quantify high-Z contrast elements and readily differentiate iodine, barium, and gadolinium from ytterbium, tantalum, gold, and bismuth. • The differentiation and quantification capabilities for high-Z contrast elements are largely unaffected by phantom size and transaxial location within the phantom. • Potential benefits of new CT contrast agents based on these high-Z elements include alternatives for patients with iodine sensitivity, high conspicuity at both 120 and 140 kVp, simultaneous imaging of two contrast agents, and reduced injection volume.
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http://dx.doi.org/10.1007/s00330-021-07886-xDOI Listing
April 2021

Tumor-associated macrophages are associated with response to neoadjuvant chemotherapy and poor outcomes in patients with triple-negative breast cancer.

J Cancer 2021 15;12(10):2886-2892. Epub 2021 Mar 15.

Dept. of General Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.

Tumor-associated macrophages (TAMs) play an essential role in tumor progression and metastasis. However, the role of TAMs in neoadjuvant chemotherapy (NAC) is unclear and need to be identified. The main subject of this study was to investigate whether TAMs are related to the chemotherapeutic response with triple-negative breast cancers (TNBC). We retrospectively analyzed pretreatment tissue from patients who received NAC and followed by a mastectomy or breast-conservation for stage II-III TNBC in this study. The association between TAMs and the pathological complete response (pCR) rate of TNBC to NAC was analyzed. In addition, the correlation of the TAMs with recurrence-free survival (RFS) in patients with TNBC was also evaluated. Of the 91 patients, 31 (34.1%) patients experienced pathological complete response (pCR) after completion of NAC. Regarding the chemotheraptic response, patients with low infiltration of CD163 macrophages achieved a significantly higher rate of pCR. Importantly, Kaplan-Meier survival shown that patients with high infiltration of CD163 macrophages and non-pCR had poor OS and RFS. our data showed that TAMs may predict chemotherapeutic response and can be used as a promising prognostic candidate for poor survival in TNBC patients treated with NAC.
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http://dx.doi.org/10.7150/jca.47566DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8040876PMC
March 2021

Dyskinesia-hyperpyrexia syndrome in Parkinson's disease: a systematic review.

Clin Auton Res 2021 Aug 7;31(4):529-542. Epub 2021 Apr 7.

Geriatric Neurological Department of the Second Medical Center, National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army General Hospital, Beijing, China.

Purpose: Dyskinesia-hyperpyrexia syndrome (DHS) is a rare but life-threatening disease. The clinical manifestations of this syndrome overlap substantially with Parkinson hyperpyrexia syndrome and serotonin syndrome and are often confused by clinicians. The purpose of this review was to enable clinicians to recognize this syndrome and thereby reach a correct diagnosis and provide optimal treatments to improve prognosis in clinical practice.

Methods: Using the methodology described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we conducted a literature search of the PubMed, Embase, and MEDLINE databases using keywords in titles and abstracts of published literature. Quality assessment was performed using the modified Newcastle-Ottawa scale.

Results: A total of 11 patients obtained from nine publications were included in this systematic review. All of the cases occurred in patients with advanced Parkinson's disease (PD) of long disease duration. High ambient temperature was the most common trigger of this syndrome. Hyperpyrexia and dyskinesias were present in all cases. The consciousness disturbances of this syndrome included confusion, hallucination, and lethargy or stupor. Autonomic dysfunction (except for hyperpyrexia) is uncommon in DHS, and only two patients presented with tachycardia. The treatment of this syndrome included supportive interventions (including rehydration, anti-pyretic and anti-infection treatments, and maintaining electrolyte balance), dopaminergic drug reduction and sedation. Two patients died due to DHS.

Conclusions: We summarized the triggers, clinical features, and treatments of all reported dyskinesia-hyperpyrexia syndrome cases, proposed guiding diagnostic criteria, and established a flow chart to guide diagnoses to quickly identify these three syndromes in clinical practice.
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http://dx.doi.org/10.1007/s10286-021-00801-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8292264PMC
August 2021

Gleason Grade Group Concordance between Preoperative Targeted Biopsy and Radical Prostatectomy Histopathologic Analysis: A Comparison Between In-Bore MRI-guided and MRI-Transrectal US Fusion Prostate Biopsies.

Radiol Imaging Cancer 2021 03 5;3(2):e200123. Epub 2021 Mar 5.

Departments of Radiology (D.N.C., Y.X., D.Z.R., N.S., N.M.R., A.D.d.L., I.P.), Pathology (Q.C., R.B.S.), and Urology (A.B., C.G.R., B.H., K.G.), University of Texas Southwestern Medical Center, 2201 Inwood Rd, Dallas TX 75390.

Purpose: To determine and compare rates of grade group (GG) discrepancies between different targeted biopsy techniques (in-bore vs fusion) after propensity score weighting using whole-mount radical prostatectomy (RP) histopathologic analysis as the reference standard.

Materials And Methods: This retrospective study evaluated men who underwent targeted (fusion or in-bore) biopsy between April 2017 and January 2019 followed by prostatectomy. The primary endpoint of the study was a change in GG from biopsy to RP at a patient level. For downgrade and upgrade analysis, men with biopsy GG1 (downgrade not possible) and GG5 (upgrade not possible) were excluded, respectively. GG upgrade, downgrade, and concordance rates of each targeting approach were compared using propensity score weighting and logistic regression with inverse probability of treatment weighting. Significance level was set at .05. Index lesion GG on RP specimen served as the reference standard.

Results: A total of 191 men (90 in the in-bore [mean age, 63 years ± 7 (standard deviation)] and 101 in the fusion biopsy group [mean age, 65 years ± 7]) were eligible and included. Fewer GG upgrades were noted in the in-bore biopsy group (14%; 12 of 85) compared with the fusion plus systematic biopsy group (30%; 28 of 93) ( = .012). The incidence of GG downgrade in the in-bore group (25%; 21 of 84) was higher than in the fusion group (17%; 16 of 93); however, the difference was not statistically significant ( = .2). Of the 77 men misclassified by both biopsy techniques, the majority (56%, = 43) had a change in GG of 2 to 3 or 3 to 2.

Conclusion: Superior sampling accuracy with MRI-guided in-bore biopsies offers a lower incidence of GG upgrades compared with MRI-transrectal US fusion biopsies upon RP. Biopsy/Needle Aspiration, MR-Imaging, Oncology, Pathology, Prostate © RSNA, 2021.
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http://dx.doi.org/10.1148/rycan.2021200123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011452PMC
March 2021

Fetal liver and lung volume index of neonatal survival with congenital diaphragmatic hernia.

Pediatr Radiol 2021 Mar 29. Epub 2021 Mar 29.

Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390, USA.

Background: Magnetic resonance imaging (MRI) assesses pulmonary hypoplasia in fetal congenital diaphragmatic hernia (CDH). Neonatal mortality may occur with CDH.

Objective: To quantify MRI parameters associated with neonatal survival in fetuses with isolated CDH.

Materials And Methods: Fetal MRI for assessing CDH included region of interest (ROI) measurements for total lung volume (TLV), herniated liver volume, herniated other organ volume and predicted lung volume. Ratios of observed lung volume and liver up volume to predicted lung volume (observed to predicted TLV, percentage of the thorax occupied by liver) were calculated and compared to neonatal outcomes. Analyses included Wilcoxon rank sum test, multivariate logistic regression and receiver operating characteristic (ROC) curves.

Results: Of 61 studies, the median observed to predicted TLV was 0.25 in survivors and 0.16 in non-survivors (P=0.001) with CDH. The median percentage of the thorax occupied by liver was 0.02 in survivors and 0.22 in non-survivors (P<0.001). The association of observed to predicted TLV and percentage of the thorax occupied by liver with survival for gestational age (GA) >28 weeks was greater compared to GA ≤28 weeks. The ROC analysis demonstrated an area under the curve of 0.96 (95% confidence interval 0.91-1.00) for the combined observed to predicted TLV, percentage of the thorax occupied by liver and GA.

Conclusion: The percentage of the thorax occupied by liver and observed to predicted TLV was predictive of neonatal survival in fetuses with CDH.
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http://dx.doi.org/10.1007/s00247-021-05049-0DOI Listing
March 2021

Intratumoral Metabolic Heterogeneity and Other Quantitative F-FDG PET/CT Parameters for Prognosis Prediction in Esophageal Cancer.

Radiol Imaging Cancer 2021 01 18;3(1):e200022. Epub 2020 Dec 18.

Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8827.

Purpose: To evaluate the impact of intratumoral metabolic heterogeneity (IMH) and other quantitative fluorine 18 (F) fluorodeoxyglucose (FDG) PET/CT parameters for predicting progression-free survival (PFS) and overall survival (OS) in patients with esophageal cancer.

Materials And Methods: In this retrospective study, an automated gradient-based segmentation method was used to assess the maximum standardized uptake value, mean standardized uptake value, metabolic tumor volume (MTV), and IMH index of the primary tumor in patients with biopsy-proven adenocarcinoma or squamous cell carcinoma of the esophagus with an initial staging F-FDG PET/CT. Data were collected between July 2006 and February 2016. OS and PFS were calculated using multivariable Cox proportional hazards regression with the adjustment (as covariates) of age, sex, weight, stage, tumor type, tumor grade, and treatment. All PET parameters were standardized before analysis. Log-rank tests were performed, and corresponding Kaplan-Meier survival plots were generated.

Results: A total of 71 patients (mean age, 64 years ± 10 [standard deviation], 62:9 men:women) were included. Median follow-up time was 28.2 months (range, 4-38 months), and median survival was 16.1 months (range, 0.1-60.3 months). Higher MTV was associated with reduced PFS for every standard deviation increase (hazard ratio [HR], 0.193; 95% CI: 0.052, 0.711; = .01). Higher IMH was associated with reduced PFS for every standard deviation decrease in the area under the curve (HR, 10.78; 95% CI: 1.31, 88.96; = .03).

Conclusion: PFS for patients with esophageal cancer was associated with MTV and with IMH. Esophagus, Neoplasms-Primary, PET/CT, Tumor Response © RSNA, 2020.
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http://dx.doi.org/10.1148/rycan.2020200022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983774PMC
January 2021

Clinico-pathological features and mutational spectrum of 16 nemaline myopathy patients from a Chinese neuromuscular center.

Acta Neurol Belg 2021 Mar 19. Epub 2021 Mar 19.

Department of Neurology, the First Hospital of Shanxi Medical University, 85 Jiefang South Road, Taiyuan, 030001, China.

Nemaline myopathy (NM) is a congenital myopathy of great heterogeneity, characterized by the presence of rods in the cytoplasm of muscle fibers. The samples of 16 nemaline myopathy patients diagnosed by characteristically pathological features went through whole exon sequencing. Clinico-pathological and genetic features of the cases were systematically analyzed. According to the classification of nemaline myopathy by ENMC, 8 cases are typical congenital subtype, 6 cases are childhood/juvenile onset subtype and 2 case are adult onset subtype. In histological findings, characteristic purple-colored rods are discovered under modified gömöri trichrome staining (MGT). Electron microscopy revealed the presence of high electron-dense nemaline bodies around the submucosa and the nucleus nine patients (9/16 56.3%) were detected pathogenic causative mutations, among whom mutations in the NEB gene were the most frequent (6 patients, 66.7%). KBTBD13 gene mutation was discovered in two patients and ACTA1 gene mutation was discovered in 1 patient. Nemaline myopathy is a congenital myopathy with highly clinico-pathological and genetic heterogeneity. NEB gene mutation is the most common mutation, in which splicing change c.21522 +3A > G is hotspot mutation in Chinese NM patients.
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http://dx.doi.org/10.1007/s13760-020-01542-9DOI Listing
March 2021

18F-fluciclovine PET/CT detection of biochemical recurrent prostate cancer in patients with PSA levels <2.00 ng/mL.

Nucl Med Commun 2021 Aug;42(8):907-913

UT Southwestern: The University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Objective: To establish the detection rate of prostate cancer recurrence following definitive therapy by 18F-fluciclovine PET/computed tomography (CT) in patients with biochemical recurrence (BCR) and prostate-specific antigen (PSA) levels less than 2.00 ng/mL.

Methods: In this retrospective study, 78 patients with a PSA level of less than 2.00 ng/mL were selected from the 211 patients who underwent at least one 18F-fluciclovine PET/CT scan at our institution for the detection of biochemical recurrent prostate cancer between April 2017 and December 2018. Inherent differences in the characteristics of patients with and without a positive scan were investigated for possible associations using multivariable analysis.

Results: One or more positive sites of recurrence were identified in 44 out of 78 patients (56.4%). Patients with a Gleason score between 8 and 10 were more likely to have a positive scan compared to patients with Gleason scores of 6-7 [adjusted odds ratio: 3.53, 95% confidence interval (1.13-10.99), P = 0.03]. No other significant association was found between PSA, T classification, and detection rate.

Conclusion: 18F-fluciclovine PET/CT demonstrated a detection rate of 56.4% among patients with a PSA below 2.0 ng/mL. The results of this study support the use of 18F-fluciclovine PET/CT for the detection of recurrent prostate cancer at lower PSA levels, even at PSA levels less than 0.5 ng/mL.
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http://dx.doi.org/10.1097/MNM.0000000000001412DOI Listing
August 2021

Mapping default mode connectivity alterations following a single season of subconcussive impact exposure in youth football.

Hum Brain Mapp 2021 Jun 18;42(8):2529-2545. Epub 2021 Mar 18.

Advanced Neuroscience Imaging Research (ANSIR) Laboratory, University of Texas Southwestern Medical Center, Dallas, Texas, USA.

Repetitive head impact (RHI) exposure in collision sports may contribute to adverse neurological outcomes in former players. In contrast to a concussion, or mild traumatic brain injury, "subconcussive" RHIs represent a more frequent and asymptomatic form of exposure. The neural network-level signatures characterizing subconcussive RHIs in youth collision-sport cohorts such as American Football are not known. Here, we used resting-state functional MRI to examine default mode network (DMN) functional connectivity (FC) following a single football season in youth players (n = 50, ages 8-14) without concussion. Football players demonstrated reduced FC across widespread DMN regions compared with non-collision sport controls at postseason but not preseason. In a subsample from the original cohort (n = 17), players revealed a negative change in FC between preseason and postseason and a positive and compensatory change in FC during the offseason across the majority of DMN regions. Lastly, significant FC changes, including between preseason and postseason and between in- and off-season, were specific to players at the upper end of the head impact frequency distribution. These findings represent initial evidence of network-level FC abnormalities following repetitive, non-concussive RHIs in youth football. Furthermore, the number of subconcussive RHIs proved to be a key factor influencing DMN FC.
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http://dx.doi.org/10.1002/hbm.25384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8090779PMC
June 2021

Transvaginal Color Mapping Ultrasound in the First Trimester Predicts Placenta Accreta Spectrum: A Retrospective Cohort Study.

J Ultrasound Med 2021 Mar 16. Epub 2021 Mar 16.

Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Texas Southwestern Medical Center, Parkland Health and Hospital System, Dallas, TX, USA.

Objectives: Ultrasound (US) prediction of placenta accreta spectrum (PAS) in the first trimester may be aided by postprocessing mechanisms employing color pixel quantification near the bladder-uterine serosal interface. Our objective was to create a postprocessing algorithm of color images to identify findings associated with PAS and compare quantification to sonologist impression in prospectively obtained cine US images.

Methods: Transverse transvaginal (TV) US color cines obtained in the first trimester as part of a prospective study were reviewed. Investigators blinded to clinical outcomes reviewed anonymized cines that were archived and labeled the bladder-uterine serosal interface. Color pixels within 2 cm of the defined bladder-uterine serosal interface were ascertained using a Python-based plugin in the Horos open-source DICOM viewer. A sonologist classified the findings as suspicious for invasion, indeterminate, or normal. Statistical analysis was performed using Wilcoxon rank-sum test, Cochran-Armitage trend test, and calculation of receiver-operating characteristic (ROC) curves.

Results: Fifty-four studies met inclusion criteria. Of those, six (11%) required hysterectomy with pathologic confirmation of PAS. Women requiring hysterectomy had a significantly higher color Doppler pixel area than those not requiring hysterectomy (P = .0205). A significant trend was identified in the sonologist impression of invasion (P = .0003). ROC's comparing sonologist impression to Doppler color imaging areas were comparable (P = .054).

Conclusions: Color Doppler mapping in the first trimester showed an increase in color pixel area near the bladder-uterine serosal interface in women requiring cesarean hysterectomy with histologically confirmed PAS at time of delivery, compared to women without hysterectomy or pathologic evidence of PAS.
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http://dx.doi.org/10.1002/jum.15674DOI Listing
March 2021

Demographic, signs and symptoms, imaging characteristics of 2126 patients with COVID-19 pneumonia in the whole quarantine of Wuhan, China.

Clin Imaging 2021 Sep 23;77:169-174. Epub 2021 Feb 23.

Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Jie-Fang-Da-Dao 1095, Wuhan 430030, China. Electronic address:

Objective: The accurate knowledge of demographic, signs and symptoms, imaging characteristics of coronavirus disease 2019 (COVID-19) is essential for the accurate management of these patients. However, the claims between the previous papers are not always consistent and may even contradict each other, for example, some claims the virus infects more men than women in Wuhan. In this large-scale cohort study, we aimed to update the demographic, signs and symptoms, imaging characteristics of patients with COVID-19 in the whole quarantine of Wuhan, China.

Methods: A cohort of 2126 patients with a diagnosis of COVID-19 pneumonia (confirmed by real-time reverse transcriptase-polymerase chain reaction, RT-PCR) who were admitted to one hospital in Wuhan were retrospectively enrolled. Data were collected between January 13, 2020, and April 8, 2020, the end of Wuhan quarantine. Demographic, signs and symptoms, imaging characteristics were analyzed. CT imaging characteristics associated with respiratory failure or death were identified.

Results: Of the 2126 patients with COVID-19, 1051 (49.44%) were men and 1075 (50.56%) were women, 1933 (90.92%) have fever and 1328 (62.46%) have dry cough. The mean age was 57.43 years of age (range 1-95). The CT imaging findings were bilateral pneumonia (1883[88.57%]), unilateral pneumonia (243[11.43%]), ground-glass opacity (GGO) or consolidation (1175[55.27%]), pleural effusion (69[3.25%]). Patients with respiratory failure or death were more likely to have pleural effusion on CT than patients without respiratory failure or death (p < 0.05).

Conclusion: Men and women have been infected by SARS-CoV-2 in roughly equal numbers. Fever and cough are the most prevalent symptoms at disease onset in patients. Other prevalent symptoms include fatigue, and sputum production. COVID-19 patients with bilateral pneumonia and pleural effusion are more likely to develop respiratory failure or death.
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http://dx.doi.org/10.1016/j.clinimag.2021.02.034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901270PMC
September 2021

Awareness and prevalence of e-cigarette use among Chinese adults: policy implications.

Tob Control 2021 Feb 19. Epub 2021 Feb 19.

Chinese Center for Disease Control and Prevention, Beijing, Beijing, China.

Objective: To assess the awareness and prevalence of electronic cigarettes (e-cigarettes) and associated factors among Chinese adults (15 years and older).

Method: This study examined data from Global Adults Tobacco Survey China Project, which was nationally representative and used stratified multiphase cluster randomised sampling design. Data were collected in 2018 through a household survey with in-person interviews using tablet computers. Complex sampling weighted analysis method was used.

Results: 48.5% of Chinese adults had heard of e-cigarettes. The proportions of Chinese adults who had ever used, had used in the last 12 months, and currently used e-cigarettes were 5.0%, 2.2% and 0.9%, respectively; people in the 15-24 years group showed the highest rates of ever use, last 12-month use and current use at 7.6%, 4.4%, and 1.5%, respectively. Among males, higher e-cigarette use was associated with 15-24 years age group, college/university or above education, and daily use of combustible cigarettes. Among all e-cigarette users, 90.6% also used combustible cigarettes. The most common reason for e-cigarette use was smoking cessation (46.2%) while among ever smokers, 9.5% of ever e-cigarette users had quit smoking and 21.8% of never e-cigarette users had quit smoking (adjusted OR 0.454, 95% CI 0.290 to 0.712).

Conclusion: Prevalence of e-cigarettes among Chinese adults had increased since 2015, especially among young people aged 15-24. The high level of dual use and lower quit rate among e-cigarette users indicated e-cigarettes had not shown cessation utility at the population level in China. Regulation of e-cigarettes is needed to protect youth and minimise health risks.
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http://dx.doi.org/10.1136/tobaccocontrol-2020-056114DOI Listing
February 2021

ACR BI-RADS Category 3 Lesions in Women Younger Than 30: Follow-up Outcomes and Factors Associated With Biopsy.

J Ultrasound Med 2021 Feb 18. Epub 2021 Feb 18.

Diagnostic Radiology, The UT Southwestern Medical Center, Dallas, Texas, USA.

Objective: Investigate imaging follow-up patterns and assessment of malignancy rate of BI-RADS 3 lesions in women younger than 30 years.

Methods: We retrospectively reviewed consecutive studies between January 1, 2013 and January 1, 2015 with BI-RADS 3 assessment in women <30 years. Lesion size, follow-up rate, and biopsy rate were recorded. Completion of 24-month imaging follow-up or biopsy determined the endpoint. Statistical analysis of follow-up rates and biopsy timing was performed.

Results: Of 2525 BI-RADS 3 lesions, 278 were identified in 215 women <30 years. Fifty-two (24%) women underwent a biopsy which was more frequently done at patient request than for lesion growth [33 (63.4%) versus 19 (36.5%), P <.01]. The odds of having biopsy upfront was significantly higher in lesions >2 cm in diameter (OR: 4.4 [95% CI 2.1-9.4], P <.01). The malignancy rate in our cohort was 0% (95% CI 0-1.7%). Of the 188 women expected for follow-up imaging, 58 (30%) were lost to follow-up, while 103 (55%) had 6-month follow-up, 74 (39%) 12-month follow-up, and 56 (30%) 24-month follow-up.

Conclusions: BI-RADS 3 lesions identified in our cohort had high biopsy rates and low compliance with no cancers. Our findings suggest that probable fibroadenomas in young women may only warrant abbreviated short-term follow-up at 6-months.
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http://dx.doi.org/10.1002/jum.15660DOI Listing
February 2021

Variability in utilization and techniques of pelvic floor imaging: findings of the SAR pelvic floor dysfunction disease-focused panel.

Abdom Radiol (NY) 2021 04 13;46(4):1294-1301. Epub 2021 Feb 13.

University of Texas Southwestern Medical Center, Dallas, USA.

Pelvic floor disorders are common and can negatively impact quality of life. Imaging of patients with pelvic floor disorders has been extremely heterogeneous between institutions due in part to variations in clinical expectations, technical considerations, and radiologist experience. In order to assess variations in utilization and technique of pelvic floor imaging across practices, the society of abdominal radiology (SAR) disease-focused panel on pelvic floor dysfunction developed and administered an online survey to radiologists including the SAR membership. Results of the survey were compared with published recommendations for pelvic floor imaging to identify areas in need of further standardization. MRI was the most commonly reported imaging technique for pelvic floor imaging followed by fluoroscopic defecography. Ultrasound was only used by a small minority of responding radiologists. The survey responses demonstrated variability in imaging utilization, patient referral patterns, imaging protocols, patient education, and interpretation and reporting of pelvic floor imaging examinations. This survey highlighted inconsistencies in technique between institutions as well as potential gaps in knowledge that should be addressed to standardize evaluation of patients with pelvic floor dysfunction.
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http://dx.doi.org/10.1007/s00261-021-02957-5DOI Listing
April 2021

Fidelity of Electronic Documentation for Reactions Prompting Premedication to Iodinated Contrast Media.

J Am Coll Radiol 2021 Jul 8;18(7):982-989. Epub 2021 Feb 8.

Associate Chair of Operations, Service Chief of Adult Radiology, Departments of Radiology and Urology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.

Purpose: The aims of this study were to assess the fidelity of electronic health record documentation prompting premedication to iodinated contrast media and to determine the appropriateness of administered premedication on the basis of that documentation.

Methods: In this retrospective quality assurance cohort study, medication adverse events recorded in electronic health records between January 1, 2018, and August 31, 2019, to "iodine," "iodine-containing products," and "iodinated contrast media" were identified (N = 4,309); entries missing documentation (n = 1,651) and breakthrough reactions (n = 22) were excluded. Reaction description, severity, and free-text comments were used to categorize each entry as concordant (documentation matches recorded severity per the ACR Manual on Contrast Media version 10.3), discordant (description-severity mismatch, agent unrelated to iodinated contrast media, not a hypersensitivity reaction), or unclear. A subset of patients undergoing premedication was identified, and premedication was categorized as appropriate, inappropriate, or unsure on the basis of the index reaction using the aforementioned framework. Descriptive statistics were calculated.

Results: There were 2,636 adverse event entries in 2,441 patients: 59.9% (1,578 of 2,636) were classified as concordant, 30.2% (797 of 2,636) as discordant (n = 377 not a hypersensitivity reaction, n = 317 description-severity mismatch, and n = 103 unrelated agent), and 9.9% (n = 261) as unclear documentation. For the premedicated subset, concordance classification was feasible for 202 unique patients premedicated 335 times. Premedication was appropriate in 72% (240 of 335) and inappropriate in 22% (73 of 335); 17% of premedication events (56 of 335) were inappropriately administered for a prior physiologic reaction.

Conclusions: Premedication prompts in the electronic health record are often erroneous because of inaccurate coding, incomplete data, and reaction misclassification. These errors result in inappropriate premedication for a substantial minority of patients.
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http://dx.doi.org/10.1016/j.jacr.2021.01.005DOI Listing
July 2021

Short Term Radiographic and Patient Outcomes of a Biplanar Plating System for Triplanar Hallux Valgus Correction.

J Foot Ankle Surg 2021 May-Jun;60(3):461-465. Epub 2020 Aug 15.

Assistant Professor, Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:

Hallux valgus is a complex deformity with a variety of techniques described for correction. A biplanar plating system for triplanar correction system has been developed to address both the translation and rotational component of the hallux valgus deformity and allow an accelerated weightbearing protocol. The purpose of this study was to determine the correction and complications using radiographic parameters and patient reported outcomes. We sought to determine prognostic factors for successful correction, including age, gender, and preoperative deformity. From the medical records, we collected preoperative data. Patient-reported outcomes were obtained using AOFAS Hallux Metatarsophalangeal-Interphalangeal score, FAAM, and SF-12 scores preoperatively and postoperatively. Imaging was reviewed at preoperative and postoperative visits to determine hallux valgus angle, intermetatarsal angle, and tibial sesamoid position. Fifty-seven procedures, in 55 patients, were performed. There were 7 complications and mean follow-up time was 45.7 weeks (+ 28.3 weeks). Age over 62.5 years were associated with an increased risk of complications (p = .018). Males had an increased rate of complications (71%) compared with females. Radiographic parameters were significantly improved from preoperative values at alltime points (p < .05). Only the AOFAS Hallux Metatarsophalangeal-Interphalangeal score was statistically significant at 3, 6 and 12 months. We sought to determine the effectiveness of biplanar plating and triplanar correction procedure with early weightbearing. Over a 12 month follow-up period, our results showed significant improvement in deformity and maintained correction. AOFAS Hallux Metatarsophalangeal-Interphalangeal scores significantly improved from the preoperative to the postoperative state. Our results show a nonunion rate of 5.2%, which is comparable to prior studies.
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http://dx.doi.org/10.1053/j.jfas.2020.06.026DOI Listing
June 2021

Value of Intra-Perinodular Textural Transition Features from MRI in Distinguishing Between Benign and Malignant Testicular Lesions.

Cancer Manag Res 2021 28;13:839-847. Epub 2021 Jan 28.

Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People's Republic of China.

Purpose: To compare the performance of histogram analysis and intra-perinodular textural transition (Ipris) for distinguishing between benign and malignant testicular lesions.

Patients And Methods: This retrospective study included 76 patients with 80 pathologically confirmed testicular lesions (55 malignant, 25 benign). All patients underwent preoperative T2-weighted imaging (T2WI) on a 3.0T MR scanner. All testicular lesions were manually segmented on axial T2WI, and histogram and Ipris features were extracted. Thirty enrolled patients were randomly selected to estimate the robustness of the features. We used intraclass correlation coefficients (ICCs) to evaluate intra- and interobserver agreement of features, independent -test or Mann-Whitney -test to compare features between benign and malignant lesions, and receiver operating characteristic curve analysis to evaluate the diagnostic performance of features.

Results: Eighteen histogram features and forty-eight Ipris features were extracted from T2WI of each lesion. Most (60/66) histogram and Ipris features had good robustness (ICC of both intra- and interobserver variabilities >0.6). Three histogram and nine Ipris features were significantly different between the benign and malignant groups. The area under the curve values for Energy, TotalEnergy, and Ipris_shell1_id_std were 0.807, 0.808, and 0.708, respectively, which were relatively higher than those of other features.

Conclusion: Ipris features may be useful for identifying benign and malignant testicular tumors but have no significant advantage over conventional histogram features.
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http://dx.doi.org/10.2147/CMAR.S288378DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7850382PMC
January 2021