Terry Desser

All Publications

• Top down and bottom up: A review of strategies for wellness programs in academic radiology. Clinical imaging Yoon, L., Desser, T., Jokerst, C., Snyder, E., Kennedy, T., Korngold, E., Azour, L. 2024; 109: 110131

  Abstract

  Formal physician-wellness programs have come into vogue in professional organizations in recent years. Wellness programs in academic centers vary from institution to institution but foundational to all is their aim to reduce burnout and increase professional fulfillment. As radiologists in charge of wellness program implementation in different academic institutions, we describe existing academic radiology wellness programs with two detailed examples. Physician well-being programs need to be both leadership-driven (i.e., "top down") and receptive to feedback ("bottom up").

  View details for DOI 10.1016/j.clinimag.2024.110131

  View details for PubMedID 38490079

• In Vivo Ultrasound Molecular Imaging in the Evaluation of Complex Ovarian Masses: A Practical Guide to Correlation with Ex Vivo Immunohistochemistry. Advanced biology Antil, N., Wang, H., Kaffas, A. E., Desser, T. S., Folkins, A., Longacre, T., Berek, J., Lutz, A. M. 2023: e2300091

  Abstract

  Ovarian cancer is the fifth leading cause of cancer-related deaths in women and the most lethal gynecologic cancer. It is curable when discovered at an early stage, but usually remains asymptomatic until advanced stages. It is crucial to diagnose the disease before it metastasizes to distant organs for optimal patient management. Conventional transvaginal ultrasound imaging offers limited sensitivity and specificity in the ovarian cancer detection. With molecularly targeted ligands addressing targets, such as kinase insert domain receptor (KDR), attached to contrast microbubbles, ultrasound molecular imaging (USMI) can be used to detect, characterize and monitor ovarian cancer at a molecular level. In this article, the authors propose a standardized protocol is proposed for the accurate correlation between in- vivo transvaginal KDR-targeted USMI and ex vivo histology and immunohistochemistry in clinical translational studies. The detailed procedures of in vivo USMI and ex vivo immunohistochemistry are described for four molecular markers, CD31 and KDR with a focus on how to enable the accurate correlation between in vivo imaging findings and ex vivo expression of the molecular markers, even if not the entire tumor could can be imaged by USMI, which is not an uncommon scenario in clinical translational studies. This work aims to enhance the workflow and the accuracy of characterization of ovarian masses on transvaginal USMI using histology and immunohistochemistry as reference standards, which involves sonographers, radiologists, surgeons, and pathologists in a highly collaborative research effort of USMI in cancer.

  View details for DOI 10.1002/adbi.202300091

  View details for PubMedID 37403275

• Practical Tips and a Template for Developing Your Curriculum Vitae. Academic radiology Hecht, E. M., Leyendecker, J. R., Spieler, B. M., Chaturvedi, A., Fennessy, F. M., Gadde, J. A., Horowitz, J. M., Robbins, J. B., Shah, G. V., Desser, T. S., Lewis, P. J. 2023

  Abstract

  The Alliance of Leaders in Academic Affairs in Radiology (ALAAR) advocates for a Universal Curriculum Vitae for all medical institutions and to that end, we have developed a template that can be downloaded on the AUR website (ALAAR CV template) that includes all of the elements required by many academic institutions. Members of ALAAR represent multiple academic institutions and have spent many hours reviewing and providing input on radiologists' curricula vitae. The purpose of this review is to help academic radiologists accurately maintain and optimize their CVs with minimal effort and to clarify common questions that arise at many different institutions in the process of constructing a CV.

  View details for DOI 10.1016/j.acra.2023.04.018

  View details for PubMedID 37208259

• Defining the Roles and Responsibilities for the Vice Chair for Academic Affairs/Faculty Development in Radiology. Academic radiology Hecht, E. M., Robbins, J. B., Desser, T. S., Grist, T. M., Min, R. J., Catanzano, T. M., Slanetz, P. J. 2023

  Abstract

  To inform the development of a job description for Vice-Chairs for academic affairs (VCAA), members of the Alliance of Leaders in Academic Affairs in Radiology (ALAAR) were surveyed to better understand their current job responsibilities and how they would ideally allocate their professional time.Based on a survey of 33 university-affiliated radiology departments and discussion among ALAAR members, the authors developed a detailed job description for the VCAA. The 21-question survey was composed and validated by experts in the field. It was distributed to all members of ALAAR via email with an electronic link and was open for 5 months. Results of the survey were tabulated, and a job description was crafted to represent the foundational roles of academic affairs leaders in radiology.The response rate for institutions represented in ALAAR was 73% (33/45). All participants reported that they practiced in a university-affiliated institution. Faculty size varied from ≤49 (30.3%, 10/33), 50-99 faculty (24.2%, 8/33), and ≥100 faculty members (45.5%, 15/33). Only 24% of survey respondents had a detailed job description at the time of hire. More than 40% attested to significant oversight over faculty development programs (45%), mentorship programs (42%, and promotions (45%). Respondents ideally want increased oversight (defined as >10%) over exit interviews, faculty awards, promotions, onboarding, recruitment and hiring, and wellness programming.The aspirational mission of the VCAA is to oversee components of sequential stages in the professional lifecycle of faculty members but a common job description for this role is lacking.

  View details for DOI 10.1016/j.acra.2023.03.015

  View details for PubMedID 37059613

• Toward Reduction in False-Positive Thyroid Nodule Biopsies with a Deep Learning-based Risk Stratification System Using US Cine-Clip Images. Radiology. Artificial intelligence Yamashita, R., Kapoor, T., Alam, M. N., Galimzianova, A., Syed, S. A., Ugur Akdogan, M., Alkim, E., Wentland, A. L., Madhuripan, N., Goff, D., Barbee, V., Sheybani, N. D., Sagreiya, H., Rubin, D. L., Desser, T. S. 2022; 4 (3): e210174

  Abstract

  To develop a deep learning-based risk stratification system for thyroid nodules using US cine images.In this retrospective study, 192 biopsy-confirmed thyroid nodules (175 benign, 17 malignant) in 167 unique patients (mean age, 56 years ± 16 [SD], 137 women) undergoing cine US between April 2017 and May 2018 with American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS)-structured radiology reports were evaluated. A deep learning-based system that exploits the cine images obtained during three-dimensional volumetric thyroid scans and outputs malignancy risk was developed and compared, using fivefold cross-validation, against a two-dimensional (2D) deep learning-based model (Static-2DCNN), a radiomics-based model using cine images (Cine-Radiomics), and the ACR TI-RADS level, with histopathologic diagnosis as ground truth. The system was used to revise the ACR TI-RADS recommendation, and its diagnostic performance was compared against the original ACR TI-RADS.The system achieved higher average area under the receiver operating characteristic curve (AUC, 0.88) than Static-2DCNN (0.72, P = .03) and tended toward higher average AUC than Cine-Radiomics (0.78, P = .16) and ACR TI-RADS level (0.80, P = .21). The system downgraded recommendations for 92 benign and two malignant nodules and upgraded none. The revised recommendation achieved higher specificity (139 of 175, 79.4%) than the original ACR TI-RADS (47 of 175, 26.9%; P < .001), with no difference in sensitivity (12 of 17, 71% and 14 of 17, 82%, respectively; P = .63).The risk stratification system using US cine images had higher diagnostic performance than prior models and improved specificity of ACR TI-RADS when used to revise ACR TI-RADS recommendation.Keywords: Neural Networks, US, Abdomen/GI, Head/Neck, Thyroid, Computer Applications-3D, Oncology, Diagnosis, Supervised Learning, Transfer Learning, Convolutional Neural Network (CNN) Supplemental material is available for this article. © RSNA, 2022.

  View details for DOI 10.1148/ryai.210174

  View details for PubMedID 35652118

  View details for PubMedCentralID PMC9152684

• Automated Identification and Measurement Extraction of Pancreatic Cystic Lesions from Free-Text Radiology Reports Using Natural Language Processing. Radiology. Artificial intelligence Yamashita, R., Bird, K., Cheung, P. Y., Decker, J. H., Flory, M. N., Goff, D., Morimoto, L. N., Shon, A., Wentland, A. L., Rubin, D. L., Desser, T. S. 2022; 4 (2): e210092

  Abstract

  Purpose: To automatically identify a cohort of patients with pancreatic cystic lesions (PCLs) and extract PCL measurements from historical CT and MRI reports using natural language processing (NLP) and a question answering system.Materials and Methods: Institutional review board approval was obtained for this retrospective Health Insurance Portability and Accountability Act-compliant study, and the requirement to obtain informed consent was waived. A cohort of free-text CT and MRI reports generated between January 1991 and July 2019 that covered the pancreatic region were identified. A PCL identification model was developed by modifying a rule-based information extraction model; measurement extraction was performed using a state-of-the-art question answering system. The system's performance was evaluated against radiologists' annotations.Results: For this study, 430426 free-text radiology reports from 199783 unique patients were identified. The NLP model for identifying PCL was applied to 1000 test samples. The interobserver agreement between the model and two radiologists was almost perfect (Fleiss kappa = 0.951), and the false-positive rate and true-positive rate were 3.0% and 98.2%, respectively, against consensus of radiologists' annotations as ground truths. The overall accuracy and Lin concordance correlation coefficient for measurement extraction were 0.958 and 0.874, respectively, against radiologists' annotations as ground truths.Conclusion: An NLP-based system was developed that identifies patients with PCLs and extracts measurements from a large single-institution archive of free-text radiology reports. This approach may prove valuable to study the natural history and potential risks of PCLs and can be applied to many other use cases.Keywords: Informatics, Abdomen/GI, Pancreas, Cysts, Computer Applications-General (Informatics), Named Entity Recognition Supplemental material is available for this article. © RSNA, 2022See also commentary by Horii in this issue.

  View details for DOI 10.1148/ryai.210092

  View details for PubMedID 35391762

• Transfer language space with similar domain adaptation: a case study with hepatocellular carcinoma. Journal of biomedical semantics Tariq, A., Kallas, O., Balthazar, P., Lee, S. J., Desser, T., Rubin, D., Gichoya, J. W., Banerjee, I. 2022; 13 (1): 8

  Abstract

  BACKGROUND: Transfer learning is a common practice in image classification with deep learning where the available data is often limited for training a complex model with millions of parameters. However, transferring language models requires special attention since cross-domain vocabularies (e.g. between two different modalities MR and US) do not always overlap as the pixel intensity range overlaps mostly for images.METHOD: We present a concept of similar domain adaptation where we transfer inter-institutional language models (context-dependent and context-independent) between two different modalities (ultrasound and MRI) to capture liver abnormalities.RESULTS: We use MR and US screening exam reports for hepatocellular carcinoma as the use-case and apply the transfer language space strategy to automatically label imaging exams with and without structured template with >0.9 average f1-score.CONCLUSION: We conclude that transfer learning along with fine-tuning the discriminative model is often more effective for performing shared targeted tasks than the training for a language space from scratch.

  View details for DOI 10.1186/s13326-022-00262-8

  View details for PubMedID 35197110

• Factors Influential in the Selection of Radiology Residents in the Post-Step 1 World: A Discrete Choice Experiment. Journal of the American College of Radiology : JACR Maxfield, C. M., Montano-Campos, J. F., Chapman, T., Desser, T. S., Ho, C. P., Hull, N. C., Kelly, H. R., Kennedy, T. A., Koontz, N. A., Knippa, E. E., McLoud, T. C., Milburn, J., Mills, M. K., Morgan, D. E., Morgan, R., Peterson, R. B., Salastekar, N., Thorpe, M. P., Zarour, J. G., Reed, S. D., Grimm, L. J. 2021

  Abstract

  OBJECTIVES: Reporting of United States Medical Licensing Examination Step 1 results will transition from a numerical score to a pass-or-fail result. We sought an objective analysis to determine changes in the relative importance of resident application attributes when numerical Step 1 results are replaced.METHODS: A discrete choice experiment was designed to model radiology resident selection and determine the relative weights of various application factors, when paired with a numerical or pass-or-fail Step 1 result. Faculty involved in resident selection at 14 US radiology programs chose between hypothetical pairs of applicant profiles between August and November 2020. A conditional logistic regression model assessed the relative weights of the attributes and odds ratios (ORs) were calculated.RESULTS: There were 212 participants. When a numerical Step 1 score was provided, the most influential attributes were medical school (OR: 2.35, 95% confidence interval [CI]: 2.07-2.67), Black or Hispanic race or ethnicity (OR: 2.04, 95% CI: 1.79-2.38), and Step 1 score (OR: 1.8, 95% CI: 1.69-1.95). When Step 1 was reported as pass, the applicant's medical school grew in influence (OR: 2.78, 95% CI: 2.42-3.18), and there was a significant increase in influence of Step 2 scores (OR: 1.31, 95% CI: 1.23-1.40 versus OR 1.57, 95% CI: 1.46-1.69). There was little change in the relative influence of race or ethnicity, gender, class rank, or clerkship honors.DISCUSSION: When Step 1 reporting transitions to pass or fail, medical school prestige gains outsized influence and Step 2 scores partly fill the gap left by Step 1 examination as a single metric of decisive importance in application decisions.

  View details for DOI 10.1016/j.jacr.2021.07.005

  View details for PubMedID 34332914

• Ultrasound Liver Imaging Reporting and Data System (US LI-RADS) Visualization Score: a reliability analysis on inter-reader agreement. Abdominal radiology (New York) Tiyarattanachai, T., Bird, K. N., Lo, E. C., Mariano, A. T., Ho, A. A., Ferguson, C. W., Chima, R. S., Desser, T. S., Morimoto, L. N., Kamaya, A. 2021

  Abstract

  BACKGROUND & AIM: The American College of Radiology Ultrasound Liver Imaging Reporting and Data System (ACR US LI-RADS) Visualization Score conveys the expected level of sensitivity of screening and surveillance ultrasound exams in patients at risk for hepatocellular carcinoma (HCC). We sought to determine inter-reader agreement of the Visualization Score which is currently unknown.METHODS: Consecutive 6998 ultrasound HCC screening and surveillance studies in 3115 patients from 2017 to 2020 were retrospectively retrieved. Of these, 6154 (87.9%) studies were Visualization A (No or minimal limitations), 709 (10.1%) were Visualization B (Moderate limitations), and 135 (1.9%) were Visualization C (Severe limitations). Randomly sampled 90 studies, with 30 studies in each Visualization category, were included for analysis. Nine radiologists (3 senior attendings, 3 junior attendings and 3 body imaging fellows) blinded to the original categorization independently reviewed each study and assigned a Visualization Score. Intraclass correlation coefficient (ICC) was used to quantify inter-reader agreement.RESULTS: ICC among all 9 radiologists was 0.70 (95% CI 0.63-0.77). ICCs among senior attendings, junior attendings and body imaging fellows were 0.68 (CI 0.58-0.76), 0.72 (CI 0.62-0.80) and 0.76 (CI 0.68-0.83), respectively. Subgroup analysis by liver parenchyma was further performed. ICC was highest in the patient group with normal liver parenchyma (0.69, CI 0.56-0.81), followed by steatosis (0.66, CI 0.54-0.79) and cirrhosis (0.58, CI 0.43-0.73), respectively.CONCLUSIONS: US LI-RADS Visualization Score is a reliable tool with good inter-reader agreement that can be used to indicate the expected level of sensitivity of a screening and surveillance ultrasound examination for detecting focal liver observations.

  View details for DOI 10.1007/s00261-021-03067-y

  View details for PubMedID 34228197

• Can the use of deception be justified in medical education research? A point/counterpoint and case study. Academic radiology Maxfield, C. M., Thorpe, M. P., Desser, T. S., Heitkamp, D., Hull, N. C., Koontz, N. A., Welch, T. J., Grimm, L. J. 2021

  Abstract

  Deception is a common feature of behavioral research design, although not commonly employed in the medical literature. It can promote scientific validity but is ethically controversial because it compromises subject autonomy and incurs additional costs. In this Point/Counterpoint monograph, we review the nature of deception in research and present arguments for and against its ethical use as a research methodology in behavioral studies. We describe the necessary guidelines, safeguards, and oversight, when deceptive methodology is considered, and report our experiences and lessons learned from conducting a multi-institutional audit study that relied upon deception of academic radiology faculty.

  View details for DOI 10.1016/j.acra.2021.05.008

  View details for PubMedID 34172348

• Inclusion of Thyroid Nodule Location in ACR TI-RADS Scoring: Impact on System Performance. AJR. American journal of roentgenology Jasim, S. n., Teefey, S. A., Baranski, T. J., Coble, D. W., Langer, J. E., Reading, C. C., Beland, M. D., Desser, T. S., Szabunio, M. M., Middleton, W. D. 2021

  Abstract

  Emerging data suggest thyroid nodule location influences malignancy risk. We explore the impact of including location in ACR TI-RADS scoring. Four of five revised scoring algorithms that add one or two points to higher risk locations lowered accuracy due to lower specificity. However, an algorithm that adds one point to isthmus nodules did not differ significantly from ACR TI-RADS in accuracy, diagnosing one additional isthmus cancer for each 10.3 additional benign nodules recommended for biopsy.

  View details for DOI 10.2214/AJR.20.24224

  View details for PubMedID 33470836

• Review of Learning Tools for Effective Radiology Education During the COVID-19 Era. Academic radiology Chen, D., Ayoob, A., Desser, T., Khurana, A. 2021

  Abstract

  Coronavirus disease 2019 (COVID-19) has significantly disrupted medical education around the world and created the risk of students missing vital education and experience previously held within actively engaging in-person activities by switching to online leaning and teaching activities. To retain educational yield, active learning strategies, such as microlearning and visual learning tools are increasingly utilized in the new digital format. This article will introduce the challenges of a digital learning environment, review the efficacy of applying microlearning and visual learning strategies, and demonstrate tools that can reinforce radiology education in this constantly evolving digital era such as innovative tablet apps and tools. This will be key in preserving and augmenting essential medical teaching in the currently trying socially and physically distant times of COVID-19 as well as in similar future scenarios.

  View details for DOI 10.1016/j.acra.2021.10.006

  View details for PubMedID 34799258

• Imaging Assessment of Pancreatic Cancer Resectability after Neoadjuvant Therapy: AJR Expert Panel Narrative Review. AJR. American journal of roentgenology Soloff, E., Al-Hawary, M., Desser, T. S., Fishman, E. K., Minter, R. M., Zins, M. 2021

  Abstract

  Despite important innovations in the treatment of pancreatic ductal adenocarcinoma (PDAC), PDAC remains a disease with a poor prognosis and high mortality. A key area for potential improvement in the management of PDAC, aside from earlier detection in patients with treatable disease, is improved ability of imaging techniques to differentiate treatment response after neoadjuvant therapy (NAT) from worsening disease. It is well established that current imaging techniques cannot reliably make this distinction. This narrative review provides an update on the imaging assessment of pancreatic cancer resectability after NAT. Current definitions of borderline resectable PDAC, as well as implications for determining likely patient benefit from NAT, are described. Challenges relevant to radiologists deriving from PDAC pathologic evaluation and from surgical decision making are discussed. Specific limitations of imaging in differentiating response after NAT from stable or worsening disease, including issues relating to protocol optimization, tumor size assessment, vascular assessment, and liver metastasis detection, are explored. Roles of MRI and of PET and/or hybrid imaging are considered. Finally, a short PDAC reporting template is provided for use after NAT. The highlighted methods seek to improve radiologists' assessment of PDAC treatment response after NAT.

  View details for DOI 10.2214/AJR.21.26931

  View details for PubMedID 34851713

• Looking Ahead: Succession Planning for Education Leadership Roles. Journal of the American College of Radiology : JACR Deitte, L. A., Mian, A. Z., Mullins, M. E., Desser, T. S. 2021

  View details for DOI 10.1016/j.jacr.2021.08.015

  View details for PubMedID 34592144

• Effect of Decreasing the ACR TI-RADS Point Assignment for Punctate Echogenic Foci When They Occur in Mixed Solid and Cystic Thyroid Nodules. AJR. American journal of roentgenology Teefey, S. A., Middleton, W. D., Reading, C. C., Langer, J. E., Beland, M. D., Szabunio, M. M., Desser, T. S. 2020: 1–7

  Abstract

  OBJECTIVE. Using the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS), this study sought to determine whether decreasing the point assignment for punctate echogenic foci in mixed solid and cystic nodules would reduce the number of benign mixed solid and cystic nodules that were biopsied and would not substantially increase the number of missed mixed carcinomas MATERIALS AND METHODS. A multiinstitutional database of 3422 pathologically proven thyroid nodules was evaluated to identify all mixed solid and cystic nodules with punctate echogenic foci. We determined the numbers of mixed benign and malignant nodules that would receive ACR TI-RADS recommendations of fine-needle aspiration, follow-up, and no further evaluation if the points assigned to punctate echogenic foci were changed from 3 points to 1 or 2 points. RESULTS. A total of 287 mixed nodules were adequately characterized for evaluation. When the number of points assigned to punctate echogenic foci was changed from 3 points to 1 point, the point categories changed for 198 mixed nodules. Seven carcinomas would not undergo biopsy, but six of those seven would receive follow-up, and 44 benign nodules would not undergo biopsy. When 2 points were assigned to punctate echogenic foci, the point categories changed for 66 mixed nodules. Three carcinomas would not undergo biopsy, but all three of these would receive follow-up, and eight benign nodules would not undergo biopsy. CONCLUSION. Consideration should be given to decreasing the number of points assigned to punctate echogenic foci in mixed solid and cystic thyroid nodules, given the substantial decrease in the number of benign nodules requiring biopsy and the recommendation of follow-up for any carcinoma 1 cm or larger that did not undergo biopsy.

  View details for DOI 10.2214/AJR.20.22793

  View details for PubMedID 33295817

• Awareness of implicit bias mitigates discrimination in radiology resident selection. Medical education Maxfield, C. M., Thorpe, M. P., Desser, T. S., Heitkamp, D., Hull, N. C., Johnson, K. S., Koontz, N. A., Mlady, G. W., Welch, T. J., Grimm, L. J. 2020

  Abstract

  PURPOSE: Implicit bias is common and is thought to drive discriminatory behavior. Having previously demonstrated discrimination against specific applicant demographics by academic radiology faculty in a simulated resident selection process, the authors sought to better understand the relationship between implicit bias and discrimination, as well as the potential and mechanisms for their mitigation.METHOD: Fifty-one faculty at three academic radiology departments, who had participated in a 2017 audit study in which they were shown to treat applicants differently based on race/ethnicity and physical appearance, were invited to complete testing for implicit racial and weight bias using the Implicit Association Test in 2019. Respondents were also surveyed regarding awareness of their own personal racial and weight biases, as well as any prior participation in formal diversity training. Comparisons were made between implicit bias scores and applicant ratings, as well as between diversity training and self-awareness of bias.RESULTS: Thirty-one of 51 faculty (61%) completed and submitted results of race and weight Implicit Association Tests. Seventy-four percent (23/31) reported implicit anti-obese bias, concordant with discrimination demonstrated in the resident selection simulation, in which obese applicants were rated 0.40 standard deviations lower than non-obese applicants (p < 0.001). Seventy-one percent (22/31) reported implicit anti-black bias, discordant with application ratings, which were 0.47 standard deviations higher for black than for white applicants (p < 0.001). Eighty-four percent (26/31) of participants reported feeling self-aware of potential racial bias at the time of application review, significantly higher than the 23% (7/31) reporting self-awareness of potential anti-obese bias (p < 0.001). Participation in formal diversity training was not associated with implicit anti-black or anti-fat bias, nor with self-reported awareness of potential racial or weight-based bias (all p > 0.2).CONCLUSIONS: These findings suggest that implicit bias, as measured by the Implicit Association Test, does not inevitably lead to discrimination, and that personal awareness of implicit biases may allow their mitigation.

  View details for DOI 10.1111/medu.14146

  View details for PubMedID 32119145

• Quantitative Framework for Risk Stratification of Thyroid Nodules With Ultrasound: A Step Toward Automated Triage of Thyroid Cancer. AJR. American journal of roentgenology Galimzianova, A. n., Siebert, S. M., Kamaya, A. n., Rubin, D. L., Desser, T. S. 2020: 1–8

  Abstract

  OBJECTIVE. The purpose of this study was to explore whether a quantitative framework can be used to sonographically differentiate benign and malignant thyroid nodules at a level comparable to that of experts. MATERIALS AND METHODS. A dataset of ultrasound images of 92 biopsy-confirmed nodules was collected retrospectively. The nodules were delineated and annotated by two expert radiologists using the standardized Thyroid Imaging Reporting and Data System lexicon of the American College of Radiology. In the framework studied, quantitative features of echogenicity, texture, edge sharpness, and margin curvature properties of thyroid nodules were analyzed in a regularized logistic regression model to predict malignancy of a nodule. The framework was validated by leave-one-out cross-validation technique, and ROC AUC, sensitivity, and specificity were used to compare with those obtained with six expert annotation-based classifiers. RESULTS. The AUC of the proposed method was 0.828 (95% CI, 0.715-0.942), which was greater than or comparable to that of the expert classifiers, for which the AUC values ranged from 0.299 to 0.829 (p = 0.99). Use of the proposed framework could have avoided biopsy of 20 of 46 benign nodules in a curative strategy (at sensitivity of 1, statistically significantly higher than three expert classifiers) or helped identify 10 of 46 malignancies in a conservative strategy (at specificity of 1, statistically significantly higher than five expert classifiers). CONCLUSION. When the proposed quantitative framework was used, thyroid nodule malignancy was predicted at the level of expert classifiers. Such a framework may ultimately prove useful as the basis for a fully automated system of thyroid nodule triage.

  View details for DOI 10.2214/AJR.19.21350

  View details for PubMedID 31967504

• Analysis of Malignant Thyroid Nodules That Do Not Meet ACR TI-RADS for Fine-Needle Aspiration. AJR. American journal of roentgenology Middleton, W. D., Teefey, S. A., Tessler, F. N., Hoang, J. K., Reading, C. C., Langer, J. E., Beland, M. D., Szabunio, M. M., Desser, T. S. 2020: 1–8

  Abstract

  OBJECTIVE. Compared with other guidelines, the American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) has decreased the number of nodules for which fine-needle aspiration is recommended. The purpose of this study was to evaluate the characteristics of malignant nodules that would not be biopsied when the ACR TI-RADS recommendations are followed. MATERIALS AND METHODS. We retrospectively reviewed a total of 3422 thyroid nodules for which a definitive cytologic diagnosis, a definitive histologic diagnosis, or both diagnoses as well as diagnostic ultrasound (US) examinations were available. All nodules were categorized using the ACR TI-RADS, and they were divided into three groups according to the recommendation received: fine-needle aspiration (group 1), follow-up US examination (group 2), or no further evaluation (group 3). RESULTS. Of the 3422 nodules, 352 were malignant. Of these, 240 nodules were assigned to group 1, whereas 72 were assigned to group 2 and 40 were included in group 3. Sixteen of the 40 malignant nodules in group 3 were 1 cm or larger, and, on the basis of analysis of the sonographic features described in the ACR TI-RADS, these nodules were classified as having one of five ACR TI-RADS risk levels (TR1-TR5), with one nodule classified as a TR1 nodule, eight as TR2 nodules, and seven as TR3 nodules. If the current recommendation of no follow-up for TR2 nodules was changed to follow-up for nodules 2.5 cm or larger, seven additional malignant nodules and 316 additional benign nodules would receive a recommendation for follow-up. If the current size threshold (1.5 cm) used to recommend US follow-up for TR3 nodules was decreased to 1.0 cm, seven additional malignant nodules and 118 additional benign nodules would receive a recommendation for follow-up. CONCLUSION. With use of the ACR TI-RADS, most malignant nodules that would not be biopsied would undergo US follow-up, would be smaller than 1 cm, or would both undergo US follow-up and be smaller than 1 cm. Adjusting size thresholds to decrease the number of missed malignant nodules that are 1 cm or larger would result in a substantial increase in the number of benign nodules undergoing follow-up.

  View details for DOI 10.2214/AJR.20.23123

  View details for PubMedID 32603228

• Acquired Esophagobronchial Fistula in a Patient with Hodgkin's Lymphoma ISRAEL MEDICAL ASSOCIATION JOURNAL Decker, J., Desser, T., Gayer, G. 2019; 21 (9): 634–35

  View details for Web of Science ID 000489674500017

• Acquired Esophagobronchial Fistula in a Patient with Hodgkin's Lymphoma. The Israel Medical Association journal : IMAJ Decker, J. H., Desser, T., Gayer, G. 2019; 21 (9): 634–35

  View details for PubMedID 31542915

• Ultrasound Assessment of Acute Kidney Injury ULTRASOUND QUARTERLY Kelahan, L. C., Desser, T. S., Troxell, M. L., Kamaya, A. 2019; 35 (2): 173–80

  View details for DOI 10.1097/RUQ.0000000000000389

  View details for Web of Science ID 000474131600014

• Bias in Radiology Resident Selection: Do We Discriminate Against the Obese and Unattractive? Academic medicine : journal of the Association of American Medical Colleges Maxfield, C. M., Thorpe, M. P., Desser, T. S., Heitkamp, D. E., Hull, N. C., Johnson, K. S., Koontz, N. A., Mlady, G. W., Welch, T. J., Grimm, L. J. 2019

  Abstract

  To evaluate for appearance-based discrimination in the selection of radiology residents.A deception study simulating the resident selection process to examine the impact of attractiveness and obesity on resident selection. Seventy-four core faculty from five academic radiology departments reviewed mock residency applications in September and October 2017. Applications included demographic information and photograph, representing a prespecified distribution of facial attractiveness and obesity, combined with randomized academic and supporting variables. Reviewers independently scored applications for interview desirability. Reviewer scores and application variables were compared using linear mixed fixed and random effects models.Reviewers evaluated 5,447 applications (mean: 74 applications per reviewer). United States Medical Licensing Examination Step 1 scores were the strongest predictor of reviewer rating (B = 0.35 [standard error (SE) = 0.029]). Applicant facial attractiveness strongly predicted rating (attractive versus unattractive, B = 0.30 [SE = 0.056]; neutral versus unattractive, B = 0.13 [SE = 0.028]). Less influential but still significant predictors included race/ethnicity (B = 0.25 [SE = 0.059]), preclinical class rank (B = 0.25 [SE = 0.040]), clinical clerkship grades (B = 0.23 [SE = 0.034]), Alpha Omega Alpha membership (B = 0.21 [SE = 0.032]), and obesity (versus not obese) (B = -0.14 [SE = 0.024]).Findings provide preliminary evidence of discrimination against facially unattractive and obese applicants in radiology resident selection. Obesity and attractiveness were as influential in applicant selection for interview as traditional medical school performance metrics. Selection committees should invoke strategies to detect and manage appearance-based bias.

  View details for DOI 10.1097/ACM.0000000000002813

  View details for PubMedID 31149924

• Bladder cancer and its mimics: a sonographic pictorial review with CT/MR and histologic correlation. Abdominal radiology (New York) Wentland, A. L., Desser, T. S., Troxell, M. L., Kamaya, A. n. 2019

  Abstract

  Bladder cancer is the most common cancer of the urinary system and often presents with hematuria. Despite its relatively high incidence, bladder cancer is often under-recognized sonographically. Moreover, even when bladder abnormalities are identified, numerous other entities may mimic the appearance of bladder cancer. Given the incidence and prevalence of bladder cancer, it is important to recognize its variable appearance sonographically and distinguish it from its common mimics. We review the sonographic appearance of bladder cancer and its mimics, providing correlative CT/MR imaging as well as pathology. We stress the importance and advantage of ultrasound as a dynamic imaging modality, with the ability to optimize distinguishing bladder cancer from similar-appearing entities.

  View details for DOI 10.1007/s00261-019-02276-w

  View details for PubMedID 31676920

• Bayonet sign in dysphagia lusoria ABDOMINAL RADIOLOGY Tse, J. R., Desser, T. S. 2018; 43 (12): 3527–29

  View details for DOI 10.1007/s00261-018-1650-9

  View details for Web of Science ID 000448788000048

• Bayonet sign in dysphagia lusoria. Abdominal radiology (New York) Tse, J. R., Desser, T. S. 2018

  View details for PubMedID 29796846

• Comparison of Performance Characteristics of American College of Radiology TI-RADS, Korean Society of Thyroid Radiology TIRADS, and American Thyroid Association Guidelines AMERICAN JOURNAL OF ROENTGENOLOGY Middleton, W. D., Teefey, S. A., Reading, C. C., Langer, J. E., Beland, M. D., Szabunio, M. M., Desser, T. S. 2018; 210 (5): 1148–54

  Abstract

  The American College of Radiology (ACR) Thyroid Imaging Reporting and Data System (TI-RADS) provides guidelines to practitioners who interpret sonographic examinations of thyroid nodules. The purpose of this study is to compare the ACR TI-RADS system with two other well-established guidelines.The ACR TI-RADS, the Korean Society of Thyroid Radiology (KSThR) Thyroid Imaging Reporting and Data System (TIRADS), and the American Thyroid Association guidelines were compared using 3422 thyroid nodules for which pathologic findings were available. The composition, echogenicity, margins, echogenic foci, and size of the nodules were assessed to determine whether a recommendation would be made for fine-needle aspiration or follow-up sonography when each system was used. The biopsy yield of malignant findings, the yield of follow-up, and the percentage of malignant and benign nodules that would be biopsied were determined for all nodules and for nodules 1 cm or larger.The percentage of nodules that could not be classified was 0%, 3.9%, and 13.9% for the ACR TI-RADS, KSThR TIRADS, and ATA guidelines, respectively. The biopsy yield of malignancy was 14.2%, 10.2%, and 10.0% for nodules assessed by the ACR TI-RADS, KSThR TIRADS, and ATA guidelines, respectively. The percentage of malignant nodules that were biopsied was 68.2%, 78.7%, and 75.9% for the ACR TI-RADS, the KSThR TIRADS, and the ATA guidelines, respectively, whereas the percentage of malignant nodules that would be either biopsied or followed was 89.2% for the ACR TI-RADS. The percentage of benign nodules that would be biopsied was 47.1%, 79.7%, and 78.1% for the ACR TI-RADS, the KSThR TIRADS, and the ATA guidelines, respectively. The percentage of benign nodules that would be either biopsied or followed was 65.2% for the ACR TI-RADS.The ACR TI-RADS performs well when compared with other well-established guidelines.

  View details for PubMedID 29629797

• Diagnostic Performance of Margin Features in Thyroid Nodules in Prediction of Malignancy. AJR. American journal of roentgenology Siebert, S. M., Gomez, A. J., Liang, T. n., Tahvildari, A. M., Desser, T. S., Jeffrey, R. B., Kamaya, A. n. 2018: 1–6

  Abstract

  The purpose of this study was to evaluate thyroid nodule margins for specific morphologic features and determine the diagnostic performance of these features in differentiating papillary carcinoma from benign thyroid nodules.Nodules measuring 1-3 cm in largest diameter that had been evaluated with high-resolution ultrasound (12-18 MHz) and ultrasound-guided biopsy with definitive pathologic diagnosis were analyzed. Three blinded board-certified readers evaluated high-resolution images of each nodule for jagged edges, lobulated borders, and curved borders along their margins. Reader interpretations were correlated with the pathologic diagnosis to determine the diagnostic performance of each feature. A board-certified pathologist analyzed 10 randomly selected nodules with jagged edges by slide review to evaluate for structural correlation with the imaging finding.The diagnostic performance of jagged edges in papillary carcinoma of the thyroid was 67.4% sensitive and 78.3% specific (odds ratio, 7.44; p < 0.001) for malignancy. Jagged edges correlated with infiltrative variant expansion at slide review. Lobulated borders had sensitivity of 76.1% and specificity of 60.9% for papillary carcinoma (odds ratio, 4.95; p = 0.001) for malignancy. Curved borders were not a significant predictor of papillary carcinoma.Jagged edges and lobulated borders of thyroid nodule margins are statistically significant predictors of papillary carcinoma of the thyroid. Jagged edges correlate with infiltrative-type expansion and may be useful predictors of more aggressive papillary carcinomas.

  View details for PubMedID 29446670

• Ultrasound Assessment of Acute Kidney Injury. Ultrasound quarterly Kelahan, L. C., Desser, T. S., Troxell, M. L., Kamaya, A. n. 2018

  Abstract

  Ultrasound assessment of the kidneys in patients with renal impairment has been described in various ways in the critical care, nephrology, and radiology literature, resulting in a somewhat heterogeneous picture of the gray-scale and Doppler ultrasound manifestation of acute kidney injury (AKI). Given that ultrasound assessment can potentially identify reversible causes of AKI or identify underlying chronic kidney disease, it is important for radiologists to be aware of the common etiologies of AKI and the spectrum of ultrasound findings. We review the definition and etiologies of renal injury and introduce the ultrasound SERVeillance framework-assessment of renal size, echogenicity, renal hilum, and vascularity-for the imaging assessment of AKI.

  View details for PubMedID 30300324

• A Scalable Machine Learning Approach for Inferring Probabilistic US-LI-RADS Categorization. AMIA ... Annual Symposium proceedings. AMIA Symposium Banerjee, I., Choi, H. H., Desser, T., Rubin, D. L. 2018; 2018: 215–24

  Abstract

  We propose a scalable computerized approach for large-scale inference of Liver Imaging Reporting and Data System (LI-RADS) final assessment categories in narrative ultrasound (US) reports. Although our model was trained on reports created using a LI-RADS template, it was also able to infer LI-RADS scoring for unstructured reports that were created before the LI-RADS guidelines were established. No human-labelled data was required in any step of this study; for training, LI-RADS scores were automatically extracted from those reports that contained structured LI-RADS scores, and it translated the derived knowledge to reasoning on unstructured radiology reports. By providing automated LI-RADS categorization, our approach may enable standardizing screening recommendations and treatment planning of patients at risk for hepatocellular carcinoma, and it may facilitate AI-based healthcare research with US images by offering large scale text mining and data gathering opportunities from standard hospital clinical data repositories.

  View details for PubMedID 30815059

• Molecular and Clinical Approach to Intra-abdominal Adverse Effects of Targeted Cancer Therapies RADIOGRAPHICS Chang, S. T., Menias, C. O., Lubner, M. G., Mellnick, V. M., Hara, A. K., Desser, T. S. 2017; 37 (5): 1461–82

  Abstract

  Targeted cancer therapies encompass an exponentially growing number of agents that involve a myriad of molecular pathways. To excel within this rapidly changing field of clinical oncology, radiologists must eschew traditional organ system-based approaches of cataloging adverse effects in favor of a conceptual framework that incorporates molecular mechanisms and associated clinical outcomes. Understanding molecular mechanisms that underlie imaging manifestations of adverse effects and known associations with treatment response allows radiologists to more effectively recognize adverse effects and differentiate them from tumor progression. Radiologists can therefore more effectively guide oncologists in the management of adverse effects and treatment decisions regarding continuation or cessation of drug therapy. Adverse effects from targeted cancer therapies can be classified into four categories: (a) category 1, on-target adverse effects associated with treatment response; (b) category 2, on-target adverse effects without associated treatment response; (c) category 3, off-target adverse effects; and (d) category 4, tumor necrosis-related adverse effects. This review focuses on adverse effects primarily within the abdomen and pelvis classified according to established or hypothesized molecular mechanisms and illustrated with images of classic examples and several potential emerging toxic effects. ©RSNA, 2017.

  View details for PubMedID 28753381

• Multiinstitutional Analysis of Thyroid Nodule Risk Stratification Using the American College of Radiology Thyroid Imaging Reporting and Data System AMERICAN JOURNAL OF ROENTGENOLOGY Middleton, W. D., Teefey, S. A., Reading, C. C., Langer, J. E., Beland, M. D., Szabunio, M. M., Desser, T. S. 2017; 208 (6): 1324–34

  Abstract

  Guidelines for managing thyroid nodules are highly dependent on risk stratification based on sonographic findings. The purpose of this study is to evaluate the risk stratification system used by the American College of Radiology Thyroid Imaging Reporting and Data System (TIRADS).Patients with thyroid nodules who underwent sonography and fine-needle aspiration were enrolled in a multiinstitutional study. The sonographic nodule features evaluated in the study were composition, echogenicity, margins, and echogenic foci. Images were reviewed by two radiologists who were blinded to the results of cytologic analysis. Nodules were assigned points for each feature, and the points were totaled to determine the final TIRADS level (TR1-TR5). The risk of cancer associated with each point total and final TIRADS level was determined.A total of 3422 nodules, 352 of which were malignant, were studied. The risk of malignancy was closely associated with the composition, echogenicity, margins, and echogenic foci of the nodules (p < 0.0001, in all cases). An increased aggregate risk of nodule malignancy was noted as the TIRADS point level increased from 0 to 10 (p < 0.0001) and as the final TIRADS level increased from TR1 to TR5 (p < 0.0001). Of the 3422 nodules, 2948 (86.1%) had risk levels that were within 1% of the TIRADS risk thresholds. Of the 474 nodules that were more than 1% outside these thresholds, 88.0% (417/474) had a risk level that was below the TIRADS threshold.The aggregate risk of malignancy for nodules associated with each individual TIRADS point level (0-10) and each final TIRADS level (TR1-TR5) falls within the TIRADS risk stratification thresholds. A total of 85% of all nodules were within 1% of the specified TIRADS risk thresholds.

  View details for PubMedID 28402167

• ACR Thyroid Imaging, Reporting and Data System (TI-RADS): White Paper of the ACR TI-RADS Committee JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Tessler, F. N., Middleton, W. D., Grant, E. G., Hoang, J. K., Berland, L. L., Teefey, S. A., Cronan, J. J., Beland, M. D., Desser, T. S., Frates, M. C., Hammers, L. W., Hamper, U. M., Langer, J. E., Reading, C. C., Scoutt, L. M., Stavros, A. T. 2017; 14 (5): 587-595

  Abstract

  Thyroid nodules are a frequent finding on neck sonography. Most nodules are benign; therefore, many nodules are biopsied to identify the small number that are malignant or require surgery for a definitive diagnosis. Since 2009, many professional societies and investigators have proposed ultrasound-based risk stratification systems to identify nodules that warrant biopsy or sonographic follow-up. Because some of these systems were founded on the BI-RADS(®) classification that is widely used in breast imaging, their authors chose to apply the acronym TI-RADS, for Thyroid Imaging, Reporting and Data System. In 2012, the ACR convened committees to (1) provide recommendations for reporting incidental thyroid nodules, (2) develop a set of standard terms (lexicon) for ultrasound reporting, and (3) propose a TI-RADS on the basis of the lexicon. The committees published the results of the first two efforts in 2015. In this article, the authors present the ACR TI-RADS Committee's recommendations, which provide guidance regarding management of thyroid nodules on the basis of their ultrasound appearance. The authors also describe the committee's future directions.

  View details for DOI 10.1016/j.jacr.2017.01.046

  View details for PubMedID 28372962

• Doppler Ultrasound in Liver Cirrhosis: Correlation of Hepatic Artery and Portal Vein Measurements With Model for End-Stage Liver Disease Score JOURNAL OF ULTRASOUND IN MEDICINE Park, H. S., Desser, T. S., Jeffrey, R. B., Kamaya, A. 2017; 36 (4): 725-730

  Abstract

  To determine whether hepatic arterial and portal venous Doppler ultrasound measurements of the liver in cirrhotic patients correlate with patients' Model for End-Stage Liver Disease (MELD) scores, splenomegaly, or ascites.Sonographic images and reports were reviewed of 264 patients with hepatic cirrhosis who underwent abdominal ultrasound with Doppler in this internal review board-approved retrospective study. MELD scores were recorded at the time of ultrasound. On gray-scale ultrasound, spleen length was measured and the presence of ascites was noted. Hepatic arterial velocity (HAv) with angle correction, hepatic arterial resistive index, and portal vein velocity with angle correction were measured on Doppler ultrasound. Correlation of hepatic arterial and portal venous Doppler values with MELD score, presence of splenomegaly, and presence of ascites was tested using linear or binary logistic regression analysis. Diagnostic performance of Doppler parameters for high-risk MELD was assessed.The HAv statistically significantly correlated with the MELD score (P = .0001), spleen size (P =.027), and presence of ascites (P =.0001), whereas the hepatic arterial resistive index and portal vein velocity did not correlate with these factors. For MELD scores greater than 19, an HAv greater than 120 cm/s showed accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 74, 42, 90, 67, and 76%, respectively. With an HAv greater than 160 cm/s, the odds ratio for MELD scores greater than 19 was 42.1.We found a statistically significant correlation with elevated HAv and increasing MELD scores, splenomegaly, and presence of ascites in patients with cirrhotic liver disease; this may be a useful imaging biomarker in the evaluation of patients with cirrhosis.

  View details for DOI 10.7863/ultra.16.03107

  View details for Web of Science ID 000397505800006

• Toward Automated Pre-Biopsy Thyroid Cancer Risk Estimation in Ultrasound. AMIA ... Annual Symposium proceedings. AMIA Symposium Galimzianova, A. n., Siebert, S. M., Kamaya, A. n., Desser, T. S., Rubin, D. L. 2017; 2017: 734–41

  Abstract

  We propose a computational framework for automated cancer risk estimation of thyroid nodules visualized in ultrasound (US) images. Our framework estimates the probability of nodule malignancy using random forests on a rich set of computational features. An expert radiologist annotated thyroid nodules in 93 biopsy-confirmed patients using semantic image descriptors derived from standardized lexicon. On our dataset, the AUC of the proposed method was 0.70, which was comparable to five baseline expert annotation-based classifiers with AUC values from 0.72 to 0.81. Moreover, the use of the framework for decision making on nodule biopsy could have spared five out of 46 benign nodule biopsies at no cost to the health of patients with malignancies. Our results confirm the feasibility of computer-aided tools for noninvasive malignancy risk estimation in patients with thyroid nodules that could help to decrease the number of unnecessary biopsies and surgeries.

  View details for PubMedID 29854139

• Indolent thyroid cancer: knowns and unknowns. Cancers of the head & neck Hahn, L. D., Kunder, C. A., Chen, M. M., Orloff, L. A., Desser, T. S. 2017; 2: 1

  Abstract

  Thyroid cancer incidence is rapidly increasing due to increased detection and diagnosis of indolent thyroid cancer, i.e. cancer that is likely to be clinically insignificant. Clinical, radiologic, and pathologic features predicting indolent behavior of thyroid cancer are still largely unknown and unstudied. Existing clinicopathologic staging systems are useful for providing prognosis in the context of treated thyroid cancer but are not designed for and are inadequate for predicting indolent behavior. Ultrasound studies have primarily focused on discrimination between malignant and benign nodules; some studies show promising data on using sonographic features for predicting indolence but are still in their early stages. Similarly, molecular studies are being developed to better characterize thyroid cancer and improve the yield of fine needle aspiration biopsy, but definite markers of indolent thyroid cancer have yet to be identified. Nonetheless, active surveillance has been introduced as an alternative to surgery in the case of indolent thyroid microcarcinoma, and protocols for safe surveillance are in development. As increased detection of thyroid cancer is all but inevitable, increased research on predicting indolent behavior is needed to avoid an epidemic of overtreatment.

  View details for PubMedID 31093348

  View details for PubMedCentralID PMC6460732

• Doppler Ultrasound in Liver Cirrhosis: Correlation of Hepatic Artery and Portal Vein Measurements With Model for End-Stage Liver Disease Score. Journal of ultrasound in medicine Park, H. S., Desser, T. S., Jeffrey, R. B., Kamaya, A. 2016

  Abstract

  To determine whether hepatic arterial and portal venous Doppler ultrasound measurements of the liver in cirrhotic patients correlate with patients' Model for End-Stage Liver Disease (MELD) scores, splenomegaly, or ascites.Sonographic images and reports were reviewed of 264 patients with hepatic cirrhosis who underwent abdominal ultrasound with Doppler in this internal review board-approved retrospective study. MELD scores were recorded at the time of ultrasound. On gray-scale ultrasound, spleen length was measured and the presence of ascites was noted. Hepatic arterial velocity (HAv) with angle correction, hepatic arterial resistive index, and portal vein velocity with angle correction were measured on Doppler ultrasound. Correlation of hepatic arterial and portal venous Doppler values with MELD score, presence of splenomegaly, and presence of ascites was tested using linear or binary logistic regression analysis. Diagnostic performance of Doppler parameters for high-risk MELD was assessed.The HAv statistically significantly correlated with the MELD score (P = .0001), spleen size (P =.027), and presence of ascites (P =.0001), whereas the hepatic arterial resistive index and portal vein velocity did not correlate with these factors. For MELD scores greater than 19, an HAv greater than 120 cm/s showed accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of 74, 42, 90, 67, and 76%, respectively. With an HAv greater than 160 cm/s, the odds ratio for MELD scores greater than 19 was 42.1.We found a statistically significant correlation with elevated HAv and increasing MELD scores, splenomegaly, and presence of ascites in patients with cirrhotic liver disease; this may be a useful imaging biomarker in the evaluation of patients with cirrhosis.

  View details for DOI 10.7863/ultra.16.03107

  View details for PubMedID 28026900

• Sonographic Evaluation for Endometrial Polyps: The Interrupted Mucosa Sign. Journal of ultrasound in medicine Kamaya, A., Yu, P. C., Lloyd, C. R., Chen, B. H., Desser, T. S., Maturen, K. E. 2016; 35 (11): 2381-2387

  Abstract

  To evaluate the interrupted mucosa sign for identification of endometrial polyps, using pathologic confirmation as the reference standard, compared to other accepted sonographic findings.We reviewed 195 patients referred for pelvic sonographic evaluations for suspected endometrial polyps in this retrospective Institutional Review Board-approved study. Of these, 82 had tissue sampling of the endometrium and constituted the final study group. Patient data, including age, menopausal status, last menstrual period, and final pathologic diagnosis, were recorded. Sonograms were reviewed by 2 blinded board-certified radiologists for endometrial features, including thickness, echogenicity, vascularity, presence of a mass, and the interrupted mucosa sign. Descriptive statistics and multivariate logistic regression analysis were performed.The mean age of the patients was 44.99 (SD, 9.88) years, 79.1% of whom were premenopausal. Pathologic diagnosis confirmed polyps in 58 (70.73%). A single feeding vessel was visualized in 36 patients with polyps (62.07%), whereas the interrupted mucosa sign was visualized in 34 (58.62%). The presence of a feeding vessel, the interrupted mucosa sign, or both detected 48 (82.76%) of the polyps. In the multivariate analysis, only the interrupted mucosa sign was a statistically significant predictor of pathologic diagnosis of a polyp (P = .035), with an odds ratio of 3.83 (95% confidence interval, 1.10-13.29). Other sonographic findings were not independent predictors of a polyp: mass (P = .35), single feeding vessel (P = .31), endometrial thickness (P = .88), and endometrial echogenicity (P = .45). The sensitivity, specificity, and positive predictive value of the interrupted mucosa sign were 59%, 75%, and 85%, respectively.The interrupted mucosa sign is a promising sonographic sign for identification of endometrial polyps, with greater predictive power than previously described signs. It has the potential to improve the diagnostic performance of sonography, especially when used in combination with other described signs.

  View details for PubMedID 27629758

• Sonographic-Pathologic Correlation for Punctate Echogenic Reflectors in Papillary Thyroid Carcinoma: What Are They? Journal of ultrasound in medicine Tahvildari, A. M., Pan, L., Kong, C. S., Desser, T. 2016; 35 (8): 1645-1652

  Abstract

  It is commonly held that punctate nonshadowing echogenic foci on sonography, often termed microcalcifications, represent psammoma bodies. We aimed to determine the validity of this supposition by correlating the presence of punctate echogenic foci on sonography with their presence at histopathologic examination.We examined 51 nodules (surgically proven papillary thyroid carcinoma) by sonography and histopathologic examination. On the latter, nodules were examined for evidence of psammomatous calcifications, dystrophic calcifications, and colloid. Two subspecialty-trained radiologists with 2 and 25 years of experience in sonography, respectively, reviewed the sonograms for the presence and distribution of punctate echogenic foci.All nodules contained colloid at histologic examination. Twenty of the papillary carcinomas lacked any calcification at pathologic examination. In the remaining 31 nodules with calcifications, 13 had psammomatous calcifications only; 6 had both coarse and psammomatous calcifications; and 12 had only coarse calcifications. The presence of punctate echogenic foci on sonography was 74% sensitive, was 46% to 53% specific, and had a positive predictive value of only 45% to 48% for the presence of psammomatous calcifications. The computed 2-tailed P value indicated that the punctate echogenic foci-to-psammoma body correlation was not statistically significant.The sonographic signature commonly referred to as "microcalcifications" may represent a variety of entities, including psammomatous calcifications, dystrophic calcifications, and eosinophilic colloid; for this reason, "punctate echogenic foci" would be a more accurate term.

  View details for DOI 10.7863/ultra.15.09048

  View details for PubMedID 27302897

• Secondary sclerosing cholangitis in a critically ill patient. Quantitative imaging in medicine and surgery Weiss, K. E., Willmann, J. K., Jeffrey, R. B., Desser, T. S. 2016; 6 (2): 224-228

  Abstract

  Critically ill patients are commonly imaged for liver dysfunction. An often fatal condition, secondary sclerosing cholangitis, is an important and likely under-recognized hepatic condition in these patients. In presenting this case report, we hope to raise awareness of this condition amongst radiologists as well as other physicians caring for the critically ill.

  View details for DOI 10.21037/qims.2016.04.04

  View details for PubMedID 27190777

• Duplex Doppler Ultrasound of the Hepatic Artery: A Window to Diagnosis of Diffuse Liver Pathology. Ultrasound quarterly Go, S., Kamaya, A., Jeffrey, B., Desser, T. S. 2016; 32 (1): 58-66

  Abstract

  The use of Doppler sonography for evaluation of the liver is well established, and evaluation of the portal and hepatic veins in native livers, as well as the hepatic artery in transplant livers, is a standard part of the examination. Less well known, however, is that assessment hepatic of artery blood flow velocities and waveforms can permit inferences to be made about liver and system pathophysiology even in native livers. This review will illustrate that hepatic parenchymal abnormalities, as well as primary vascular abnormalities both upstream and downstream of the proper hepatic artery, can be inferred from careful interrogation of its Doppler signature during routine abdominal sonography.

  View details for DOI 10.1097/RUQ.0000000000000166

  View details for PubMedID 26938035

• Sonographic Detection of Extracapsular Extension in Papillary Thyroid Cancer. Journal of ultrasound in medicine Kamaya, A., Tahvildari, A. M., Patel, B. N., Willmann, J. K., Jeffrey, R. B., Desser, T. S. 2015; 34 (12): 2225-2230

  Abstract

  To identify and evaluate sonographic features suggestive of extracapsular extension in papillary thyroid cancer.Three board-certified radiologists blinded to the final pathologic tumor stage reviewed sonograms of pathologically proven cases of papillary thyroid cancer for the presence of extracapsular extension. The radiologists evaluated the following features: capsular abutment, bulging of the normal thyroid contour, loss of the echogenic capsule, and vascularity extending beyond the capsule.A total of 129 cases of pathologically proven thyroid cancer were identified. Of these, 51 were excluded because of lack of preoperative sonography, and 16 were excluded because of pathologic findings showing anaplastic carcinoma, follicular carcinoma, or microcarcinoma (<10 mm). The final analysis group consisted of 62 patients with papillary thyroid carcinoma, 16 of whom had pathologically proven extracapsular extension. The presence of capsular abutment had 100% sensitivity for detection of extracapsular extension. Conversely, lack of capsular abutment had a 100% negative predictive value (NPV) for excluding extracapsular extension. Contour bulging had 88% sensitivity for detection of extracapsular extension and when absent had an 87% NPV. Loss of the echogenic capsule was the best predictor of the presence of extracapsular extension, with an odds ratio of 10.23 (P= .034). This sonographic finding had 75% sensitivity, 65% specificity, and an 88% NPV. Vascularity beyond the capsule had 89% specificity but sensitivity of only 25%.Sonographic features of capsular abutment, contour bulging, and loss of the echogenic thyroid capsule have excellent predictive value for excluding or detecting extracapsular extension and may help in biopsy selection, surgical planning, and treatment of patients with papillary thyroid cancer.

  View details for DOI 10.7863/ultra.15.02006

  View details for PubMedID 26518279

• Thyroid Ultrasound Reporting Lexicon: White Paper of the ACR Thyroid Imaging, Reporting and Data System (TIRADS) Committee JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Grant, E. G., Tessler, F. N., Hoang, J. K., Langer, J. E., Beland, M. D., Berland, L. L., Cronan, J. J., Desser, T. S., Frates, M. C., Hamper, U. M., Middleton, W. D., Reading, C. C., Scoutt, L. M., Stavros, A., Teefey, S. A. 2015; 12 (12): 1272–79

  Abstract

  Ultrasound is the most commonly used imaging technique for the evaluation of thyroid nodules. Sonographic findings are often not specific, and definitive diagnosis is usually made through fine-needle aspiration biopsy or even surgery. In reviewing the literature, terms used to describe nodules are often poorly defined and inconsistently applied. Several authors have recently described a standardized risk stratification system called the Thyroid Imaging, Reporting and Data System (TIRADS), modeled on the BI-RADS system for breast imaging. However, most of these TIRADS classifications have come from individual institutions, and none has been widely adopted in the United States. Under the auspices of the ACR, a committee was organized to develop TIRADS. The eventual goal is to provide practitioners with evidence-based recommendations for the management of thyroid nodules on the basis of a set of well-defined sonographic features or terms that can be applied to every lesion. Terms were chosen on the basis of demonstration of consistency with regard to performance in the diagnosis of thyroid cancer or, conversely, classifying a nodule as benign and avoiding follow-up. The initial portion of this project was aimed at standardizing the diagnostic approach to thyroid nodules with regard to terminology through the development of a lexicon. This white paper describes the consensus process and the resultant lexicon.

  View details for PubMedID 26419308

• Variable color Doppler sonographic appearances of retained products of conception: radiologic-pathologic correlation. Abdominal imaging Kamaya, A., Krishnarao, P. M., Folkins, A. K., Jeffrey, R. B., Desser, T. S., Maturen, K. E. 2015; 40 (7): 2683-2689

  Abstract

  Retained products of conception (RPOC) displays variable vascularity, ranging from avascular to markedly vascular on color Doppler sonography. We hypothesize that variability in sonographic vascularity may be due to histopathologic variation in the placental tissue.After institutional review board approval, sonographic images and pathologic specimens were retrospectively reviewed in 26 patients with pathologically proven RPOC. Ultrasound (US) images were scored 0-3 for the degree of vascularity by two radiologists blinded to the diagnosis. Corresponding pathologic specimens were evaluated for vascularization of chorionic villi, degree of inflammation, morphology of maternal arteries, chorionic villous preservation, and percentage of clot, membranes, chorionic villi, and decidua/myometrium. Statistical analysis, including multiple linear regression, was performed.RPOC with histologically avascular chorionic villi or those with markedly reduced vascularization had significantly lower US vascularity scores (p = 0.030) than those with chorionic villi showing normal or decreased vascularization. Sonographically avascular RPOC had a significantly lower percentage villi (p = 0.028) and higher percentage of decidua (p = 0.004) than specimens where US showed any Doppler vascularity. Histologic vascularity of villi (p = 0.049) and non-observation of maternal arteries (p = 0.001) were significant predictors of US vascularity scores in multivariate linear regression analysis, while inflammation of villi (p = 0.053) was a marginally significant predictor.Histologic vascularity of villi appears to contribute to the observed variation in sonographic vascularity. This finding may underlie known differences in clinical outcomes between sonographic vascularity groups.

  View details for DOI 10.1007/s00261-015-0424-x

  View details for PubMedID 25862548

• Applicant to Residency Program Translation Guide JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY Grimm, L. J., Desser, T. S., Bailey, J. E., Maxfield, C. M. 2015; 12 (6): 622–23

  View details for PubMedID 25620237

• Atypia of undetermined significance and follicular lesions of undetermined significance: sonographic assessment for prediction of the final diagnosis. Journal of ultrasound in medicine Kamaya, A., Lewis, G. H., Liu, Y., Akatsu, H., Kong, C., Desser, T. S. 2015; 34 (5): 767-774

  Abstract

  To determine whether radiologic assessment of thyroid nodules can potentially help guide clinical management after a cytologic diagnosis of atypia of undetermined significance or a follicular lesion of undetermined significance.We identified 41 patients with 41 thyroid nodules initially diagnosed as atypia or follicular lesions of undetermined significance on fine-needle aspiration that were subsequently definitively diagnosed by either surgical resection or repeated fine-needle aspiration. All sonograms of nodules were reviewed by 2 blinded board-certifiedradiologists. Lesions were assessed in 3 ways: (1) Mayo pattern classification as benign, indeterminate, or worrisome for malignancy (Ultrasound Q 2005; 21:157-165); (2) thyroid imaging reporting and data system scores (scale of 1-5) based on 2 different previously published scoring criteria (Park et al [Thyroid 2009; 19:1257-1264] and Kwak et al [Radiology 2011; 260:892-899]); and (3) binary classification as benign or malignant.Of the 41 nodules, 25 had benign histologic findings, and 16 were malignant. Mayo pattern classification was 100% accurate for the benign score. Lesions with a Mayo score of indeterminate were malignant in 21% of cases (6 of 28) and benign in 79% (22 of 28). Lesions with a Mayo score of malignant were malignant in 91% of cases (10 of 11) and benign in 9% (1 of 11). Thyroid imaging reporting and data system scores had area under the receiver operating characteristic curve values of 0.827 for Park scores and 0.822 for Kwak scores. Radiologist binary classification of thyroid nodules showed 88% overall accuracy.Radiologist assessment of thyroid nodules in cases of atypia of undetermined significance or follicular lesions of undetermined significance is highly predictive of the final diagnosis and can help guide management of thyroid nodules of these pathologic types.

  View details for DOI 10.7863/ultra.34.5.767

  View details for PubMedID 25911708

• Classification of Hypervascular Liver Lesions Based on Hepatic Artery and Portal Vein Blood Supply Coefficients Calculated from Triphasic CT Scans JOURNAL OF DIGITAL IMAGING Boas, F. E., Kamaya, A., Do, B., Desser, T. S., Beaulieu, C. F., Vasanawala, S. S., Hwang, G. L., Sze, D. Y. 2015; 28 (2): 213-223

  Abstract

  Perfusion CT of the liver typically involves scanning the liver at least 20 times, resulting in a large radiation dose. We developed and validated a simplified model of tumor blood supply that can be applied to standard triphasic scans and evaluated whether this can be used to distinguish benign and malignant liver lesions. Triphasic CTs of 46 malignant and 32 benign liver lesions were analyzed. For each phase, regions of interest were drawn in the arterially enhancing portion of each lesion, as well as the background liver, aorta, and portal vein. Hepatic artery and portal vein blood supply coefficients for each lesion were then calculated by expressing the enhancement curve of the lesion as a linear combination of the enhancement curves of the aorta and portal vein. Hepatocellular carcinoma (HCC) and hypervascular metastases, on average, both had increased hepatic artery coefficients compared to the background liver. Compared to HCC, benign lesions, on average, had either a greater hepatic artery coefficient (hemangioma) or a greater portal vein coefficient (focal nodular hyperplasia or transient hepatic attenuation difference). Hypervascularity with washout is a key diagnostic criterion for HCC, but it had a sensitivity of 72 % and specificity of 81 % for diagnosing malignancy in our diverse set of liver lesions. The sensitivity for malignancy was increased to 89 % by including enhancing lesions that were hypodense on all phases. The specificity for malignancy was increased to 97 % (p = 0.039) by also examining hepatic artery and portal vein blood supply coefficients, while maintaining a sensitivity of 76 %.

  View details for DOI 10.1007/s10278-014-9725-9

  View details for Web of Science ID 000351242500012

  View details for PubMedID 25183580

• JOURNAL CLUB: The Alvarado Score as a Method for Reducing the Number of CT Studies When Appendiceal Ultrasound Fails to Visualize the Appendix in Adults. AJR. American journal of roentgenology Jones, R. P., Jeffrey, R. B., Shah, B. R., Desser, T. S., Rosenberg, J., Olcott, E. W. 2015; 204 (3): 519-526

  Abstract

  OBJECTIVE. The purpose of this article is to evaluate the hypothesis that Alvarado scores of 3 or lower identify adult patients who are unlikely to benefit from CT after appendiceal ultrasound fails to show the appendix and is otherwise normal. MATERIALS AND METHODS. We identified 119 consecutive adults for whom the appendix was not seen on otherwise normal appendiceal sonography performed as the first imaging study for suspected appendicitis, who subsequently underwent CT within 48 hours, and whose data permitted retrospective calculation of admission Alvarado scores. Specific benefits of CT were defined as diagnoses of appendicitis or significant alternative findings, and specific benefits were compared between patients with Alvarado scores of 3 or less and 4 or higher. Significant alternative findings on CT were findings other than appendicitis that were treated with medical or surgical therapy during the admission or that were to be addressed during follow-up care. Diagnostic reference standards were discharge diagnoses, pathologic examinations, and clinical follow-up. RESULTS. No patients (0.0%, 0/49) with Alvarado scores 3 or lower had appendicitis, compared with 17.1% (12/70) of patients with Alvarado scores 4 or higher (p = 0.001), and CT showed neither appendicitis nor significant alternative findings in 85.7% (42/49) versus 58.6% (41/70) of these patients, respectively (p = 0.002). The rates of perforated appendicitis, as well as significant alternative CT findings, did not differ significantly. CONCLUSION. Adults with Alvarado scores 3 or lower who have nonvisualized appendixes and otherwise normal appendiceal sonography are at very low risk for appendicitis or significant alternative findings and therefore are not likely to benefit from CT.

  View details for DOI 10.2214/AJR.14.12864

  View details for PubMedID 25714280

• The Alvarado Score as a Method for Reducing the Number of CT Studies When Appendiceal Ultrasound Fails to Visualize the Appendix in Adults AMERICAN JOURNAL OF ROENTGENOLOGY Jones, R. P., Jeffrey, R. B., Shah, B. R., Desser, T. S., Rosenberg, J., Olcott, E. W. 2015; 204 (3): 519-526

  Abstract

  OBJECTIVE. The purpose of this article is to evaluate the hypothesis that Alvarado scores of 3 or lower identify adult patients who are unlikely to benefit from CT after appendiceal ultrasound fails to show the appendix and is otherwise normal. MATERIALS AND METHODS. We identified 119 consecutive adults for whom the appendix was not seen on otherwise normal appendiceal sonography performed as the first imaging study for suspected appendicitis, who subsequently underwent CT within 48 hours, and whose data permitted retrospective calculation of admission Alvarado scores. Specific benefits of CT were defined as diagnoses of appendicitis or significant alternative findings, and specific benefits were compared between patients with Alvarado scores of 3 or less and 4 or higher. Significant alternative findings on CT were findings other than appendicitis that were treated with medical or surgical therapy during the admission or that were to be addressed during follow-up care. Diagnostic reference standards were discharge diagnoses, pathologic examinations, and clinical follow-up. RESULTS. No patients (0.0%, 0/49) with Alvarado scores 3 or lower had appendicitis, compared with 17.1% (12/70) of patients with Alvarado scores 4 or higher (p = 0.001), and CT showed neither appendicitis nor significant alternative findings in 85.7% (42/49) versus 58.6% (41/70) of these patients, respectively (p = 0.002). The rates of perforated appendicitis, as well as significant alternative CT findings, did not differ significantly. CONCLUSION. Adults with Alvarado scores 3 or lower who have nonvisualized appendixes and otherwise normal appendiceal sonography are at very low risk for appendicitis or significant alternative findings and therefore are not likely to benefit from CT.

  View details for DOI 10.2214/AJR.14.12864

  View details for Web of Science ID 000351598800030

• Atypical thyroid cancers on sonography. Ultrasound quarterly Klang, K., Kamaya, A., Tahvildari, A. M., Jeffrey, R. B., Desser, T. S. 2015; 31 (1): 69-74

  Abstract

  The management of thyroid nodules is a common clinical problem. Thyroid nodules are present in up to 50% of the adult population. However, thyroid malignancy is rare, occurring in only 5% to 15% of nodules. Although certain specific patterns on imaging are almost always indicative of benignity, there is considerable overlap between the sonographic appearances of benign and malignant nodules. Radiologists should be wary of applying pattern recognition approaches too liberally as some malignant nodules may exhibit sonographic features more commonly associated with benign nodules such as cystic change, comet-tail artifact, smooth margins, echogenic echotexture, hypoechoic halos, or peripheral calcifications. This article illustrates atypical imaging appearances of thyroid malignancies and reviews recent literature in an attempt to clarify nuances in the diagnosis of malignancy in benign-appearing nodules.

  View details for DOI 10.1097/RUQ.0000000000000079

  View details for PubMedID 25706368

• Metastatic Melanoma in the Chest and Abdomen: The Great Radiologic Imitator SEMINARS IN ULTRASOUND CT AND MRI Chang, S. T., Desser, T. S., Gayer, G., Menias, C. O. 2014; 35 (3): 272-289

  Abstract

  Metastatic melanoma causes an unpredictable variety of manifestations in the chest and abdomen that may be indistinguishable from other diseases by imaging alone. Melanoma metastases commonly involve the lymph nodes, lungs, liver, and small bowel, but virtually any organ can be affected. Newer modalities, such as contrast-enhanced ultrasound and whole-body magnetic resonance imaging, may provide more sensitive detection of metastatic melanoma for diagnosis, staging, and surveillance. An understanding of the predominantly hematogenous nature of metastatic spread by melanoma as well as a high index of suspicion in any patient with a history of melanoma may allow for more precise and confident diagnosis.

  View details for DOI 10.1053/j.sult.2014.02.001

  View details for PubMedID 24929267

• Predictors of an academic career on radiology residency applications. Academic radiology Grimm, L. J., Shapiro, L. M., Singhapricha, T., Mazurowski, M. A., Desser, T. S., Maxfield, C. M. 2014; 21 (5): 685-690

  Abstract

  To evaluate radiology residency applications to determine if any variables are predictive of a future academic radiology career.Application materials from 336 radiology residency graduates between 1993 and 2010 from the Department of Radiology, Duke University and between 1990 and 2010 from the Department of Radiology, Stanford University were retrospectively reviewed. The institutional review boards approved this Health Insurance Portability and Accountability Act-compliant study with a waiver of informed consent. Biographical (gender, age at application, advanced degrees, prior career), undergraduate school (school, degree, research experience, publications), and medical school (school, research experience, manuscript publications, Alpha Omega Alpha membership, clerkship grades, United States Medical Licensing Examination Step 1 and 2 scores, personal statement and letter of recommendation reference to academics, couples match status) data were recorded. Listing in the Association of American Medical Colleges Faculty Online Directory and postgraduation publications were used to determine academic status.There were 72 (21%) radiologists in an academic career and 264 (79%) in a nonacademic career. Variables associated with an academic career were elite undergraduate school (P = .003), undergraduate school publications (P = .018), additional advanced degrees (P = .027), elite medical school (P = .006), a research year in medical school (P < .001), and medical school publications (P < .001). A multivariate cross-validation analysis showed that these variables are jointly predictive of an academic career (P < .001).Undergraduate and medical school rankings and publications, as well as a medical school research year and an additional advanced degree, are associated with an academic career. Radiology residency selection committees should consider these factors in the context of the residency application if they wish to recruit future academic radiologists.

  View details for DOI 10.1016/j.acra.2013.10.019

  View details for PubMedID 24629444

• A randomized controlled trial on 2 simulation-based training methods in radiology: effects on radiologic technology student skill in assessing image quality. Simulation in healthcare Ahlqvist, J. B., Nilsson, T. A., Hedman, L. R., Desser, T. S., Dev, P., Johansson, M., Youngblood, P. L., Cheng, R. P., Gold, G. E. 2013; 8 (6): 382-387

  Abstract

  A simulator for virtual radiographic examinations was developed. In the virtual environment, the user can perform and analyze radiographic examinations of patient models without the use of ionizing radiation. We investigated if this simulation technique could improve education of radiology technology students. We compared student performance in the assessment of radiographic image quality after training with a conventional manikin or with the virtual radiography simulator.A randomized controlled experimental study involving 31 first-year radiology technology students was performed. It was organized in 4 phases as follows: (I) randomization to control or experimental group based on the results of an anatomy examination; (II) proficiency testing before training; (III) intervention (control group, exposure and analysis of radiographic images of the cervical spine of a manikin; experimental group, exposure and analysis of the cervical spine images in the virtual radiography simulator); and (IV) proficiency testing after training.The experimental group showed significantly higher scores after training compared with those before training (P < 0.01). A linear mixed-effect analysis revealed a significant difference between the control and experimental groups regarding proficiency change (P = 0.01).Virtual radiographic simulation is an effective tool for learning image quality assessment. Simulation can therefore be a valuable adjunct to traditional educational methods and reduce exposure to x-rays and tutoring time.

  View details for DOI 10.1097/SIH.0b013e3182a60a48

  View details for PubMedID 24096919

• The elusive parathyroid adenoma: techniques for detection. Ultrasound quarterly Devcic, Z., Jeffrey, R. B., Kamaya, A., Desser, T. S. 2013; 29 (3): 179-187

  Abstract

  The success of minimally invasive surgery for hyperparathyroidism depends on accurate preoperative localization of the hyperfunctioning adenoma with imaging. Ultrasound is an excellent initial modality because it has a high positive predictive value, sensitivity, and specificity, while being inexpensive and noninvasive without use of ionizing radiation. Determining the exact location and number of adenomas is essential, because these factors guide the surgical approach. The goal of this review article was to discuss specific sonographic techniques that can be applied to find even the elusive adenoma, which include (1) compression scanning, (2) color Doppler, (3) scanning regions where ectopic glands may be located, and (4) evaluating intrathyroidal adenomas.

  View details for DOI 10.1097/RUQ.0b013e3182a1ba6f

  View details for PubMedID 23975046

• New technologies in clinical ultrasound. Seminars in roentgenology Kamaya, A., Machtaler, S., Safari Sanjani, S., Nikoozadeh, A., Graham Sommer, F., Pierre Khuri-Yakub, B. T., Willmann, J. K., Desser, T. S. 2013; 48 (3): 214-223

  View details for DOI 10.1053/j.ro.2013.03.009

  View details for PubMedID 23796372

• New Technologies in Clinical Ultrasound SEMINARS IN ROENTGENOLOGY Kamaya, A., Machtaler, S., Sanjani, S. S., Nikoozadeh, A., Sommer, F. G., Khuri-Yakub, B. T., Willmann, J. K., Desser, T. S. 2013; 48 (3): 214-223

  View details for DOI 10.1053/j.ro.2013.03.009

  View details for Web of Science ID 000321602300005

• Pitfalls in sonographic evaluation of thyroid abnormalities. Seminars in ultrasound, CT, and MR Patel, B. N., Kamaya, A., Desser, T. S. 2013; 34 (3): 226-235

  Abstract

  Ultrasound of the thyroid has become increasingly common, with evaluation of thyroid nodules representing the main indication for its use. While detection of thyroid nodules with modern high-resolution sonographic equipment is generally not a challenge, pitfalls may occur by which normal structures or pathology in neighboring organs are mistaken for thyroid nodules. Numerous reports in the literature describe various sonographic features of nodules in an attempt to stratify lesions into benign or malignant categories. While neither nodule size nor number is reliable, echogenicity, microcalcifcation, shape, and composition have been reported to be helpful in classifying thyroid nodules. No single feature should be used in isolation, and consensus guidelines have been established as to when fine-needle aspiration is indicated. Pitfalls remain in the evaluation of thyroid nodules demonstrating atypical features, such as cystic papillary carcinomas. Focal presentation of typically diffuse processes, such as Graves' disease and Hashimoto thyroiditis, may mimic malignant nodules, but carcinomas occur in these settings as well as in a background of normal thyroid parenchyma. Finally, because ultrasound is commonly used for surveillance of patients with thyroid carcinoma after thyroidectomy, sonographers should be familiar with the ultrasound appearance of disease recurrence and its mimics.

  View details for DOI 10.1053/j.sult.2012.11.001

  View details for PubMedID 23768889

• Physiologic, histologic, and imaging features of retained products of conception. Radiographics Sellmyer, M. A., Desser, T. S., Maturen, K. E., Jeffrey, R. B., Kamaya, A. 2013; 33 (3): 781-796

  Abstract

  Retained products of conception (RPOC) are a common and treatable complication after delivery or termination of pregnancy. The pathologic diagnosis of RPOC is made based on the presence of chorionic villi, which indicates persistent placental or trophoblastic tissue. In the setting of postpartum hemorrhage, however, distinguishing RPOC from bleeding related to normal postpartum lochia or uterine atony can be clinically challenging. Ultrasonographic (US) evaluation can be particularly helpful in these patients, and a thickened endometrial echo complex (EEC) or a discrete mass in the uterine cavity is a helpful gray-scale US finding that suggests RPOC. However, gray-scale US findings alone are inadequate for accurate diagnosis. Detection of vascularity in a thickened EEC or an endometrial mass at color or power Doppler US increases the positive predictive value for the diagnosis of RPOC. Computed tomography or magnetic resonance imaging may be helpful when US findings are equivocal and typically demonstrates an enhancing intracavitary mass in patients with RPOC. Diagnostic pitfalls are rare but may include highly vascular RPOC, which can be mistaken for a uterine arteriovenous malformation; true arteriovenous malformations of the uterus; invasive moles; blood clot; and subinvolution of the placental implantation site. © RSNA, 2013.

  View details for DOI 10.1148/rg.333125177

  View details for PubMedID 23674774

• Sonographic Evaluation of Cervical Lymph Nodes in Papillary Thyroid Cancer ULTRASOUND QUARTERLY Shin, L. K., Olcott, E. W., Jeffrey, R. B., Desser, T. S. 2013; 29 (1): 25-32

  Abstract

  Sonography is the modality of choice for imaging cervical lymph nodes in patients with papillary thyroid cancer, both before surgery and for postoperative surveillance. Sonography is also an invaluable tool to guide fine-needle aspiration of abnormal nodes. Microcalcifications, cystic changes, abnormal morphology, and disordered vascularity are features of metastatic nodal involvement with papillary thyroid carcinoma and should be sought during surveillance scans as well as in targeting for fine-needle aspiration.

  View details for DOI 10.1097/RUQ.0b013e31827c7a9e

  View details for PubMedID 23358214

• Segmental testicular infarction: report of seven new cases and literature review EMERGENCY RADIOLOGY Saxon, P., Badler, R. L., Desser, T. S., Tublin, M. E., Katz, D. S. 2012; 19 (3): 217–23

  Abstract

  Segmental testicular infarction is a relatively rare acute or subacute condition which is infrequently thought of in the differential diagnosis for testicular pain. However, missing or misdiagnosing this entity on clinical evaluation and/or imaging has significant implications for patients as they may undergo unnecessary surgery for suspected testicular torsion or tumor. Knowledge and recognition of the features of segmental testicular infarction on ultrasound and MRI will aid in the diagnosis of this disease early in the patient's course. The common imaging features of segmental testicular infarction and the clinical literature are reviewed, with an emphasis on ultrasound, utilizing seven recent cases from three institutions.

  View details for DOI 10.1007/s10140-011-0999-7

  View details for Web of Science ID 000217348400006

  View details for PubMedID 22252203

• Imaging Manifestations of Abdominal Fat Necrosis and Its Mimics RADIOGRAPHICS Kamaya, A., Federle, M. P., Desser, T. S. 2011; 31 (7): 2021-2034

  Abstract

  Intraabdominal fat is a metabolically active tissue that may undergo necrosis through a number of mechanisms. Fat necrosis is a common finding at abdominal cross-sectional imaging, and it may cause abdominal pain, mimic findings of acute abdomen, or be asymptomatic and accompany other pathophysiologic processes. Common processes that are present in fat necrosis include torsion of an epiploic appendage, infarction of the greater omentum, and fat necrosis related to trauma or pancreatitis. In addition, other pathologic processes that involve fat may be visualized at computed tomography, including focal lipohypertrophy, pathologic fat paucity (lipodystrophies), and malignancies such as liposarcoma, which may mimic benign causes of fat stranding. Because fat necrosis and malignant processes such as liposarcoma and peritoneal carcinomatosis may mimic one another, knowledge of a patient's clinical history and prior imaging studies is essential for accurate diagnosis.

  View details for DOI 10.1148/rg.317115046

  View details for PubMedID 22084185

• Spontaneous Suburothelial Hemorrhage in Coagulopathic Patients: CT Diagnosis AMERICAN JOURNAL OF ROENTGENOLOGY Gayer, G., Desser, T. S., Hertz, M., Osadchy, A., Daniel, B. L., Zissin, R. 2011; 197 (5): W887-W890

  Abstract

  The objective of our study was to identify and describe the spectrum of CT findings in patients with coagulopathy-induced suburothelial hemorrhage involving the renal collecting system.CT findings of suburothelial hemorrhage are often subtle and are best appreciated on unenhanced CT scans because of the high density of the hemorrhage. After contrast injection, uniformly thickened soft tissue enveloping the collecting system is suggestive of this condition. Clinical information regarding the presence of coagulopathy is essential for the radiologist to entertain this relatively rare diagnosis.

  View details for DOI 10.2214/AJR.11.6474

  View details for Web of Science ID 000296512800013

  View details for PubMedID 22021537

• SINGLE-FRACTION STEREOTACTIC BODY RADIATION THERAPY AND SEQUENTIAL GEMCITABINE FOR THE TREATMENT OF LOCALLY ADVANCED PANCREATIC CANCER INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Schellenberg, D., Kim, J., Ciristman-Skieller, C., Chun, C. L., Columbo, L. A., Ford, J. M., Fisher, G. A., Kunz, P. L., Van Dam, J., Quon, A., Desser, T. S., Norton, J., Hsu, A., Maxim, P. G., Xing, L., Goodman, K. A., Chang, D. T., Koong, A. C. 2011; 81 (1): 181-188

  Abstract

  This Phase II trial evaluated the toxicity, local control, and overall survival in patients treated with sequential gemcitabine and linear accelerator-based single-fraction stereotactic body radiotherapy (SBRT).Twenty patients with locally advanced, nonmetastatic pancreatic adenocarcinoma were enrolled on this prospective single-institution, institutional review board-approved study. Gemcitabine was administered on Days 1, 8, and 15, and SBRT on Day 29. Gemcitabine was restarted on Day 43 and continued for 3-5 cycles. SBRT of 25 Gy in a single fraction was delivered to the internal target volume with a 2- 3-mm margin using a nine-field intensity-modulated radiotherapy technique. Respiratory gating was used to account for breathing motion. Follow-up evaluations occurred at 4-6 weeks, 10-12 weeks, and every 3 months after SBRT.All patients completed SBRT and a median of five cycles of chemotherapy. Follow-up for the 2 remaining alive patients was 25.1 and 36.4 months. No acute Grade 3 or greater nonhematologic toxicity was observed. Late Grade 3 or greater toxicities occurred in 1 patient (5%) and consisted of a duodenal perforation (G4). Three patients (15%) developed ulcers (G2) that were medically managed. Overall, median survival was 11.8 months, with 1-year survival of 50% and 2-year survival of 20%. Using serial computed tomography, the freedom from local progression was 94% at 1 year.Linear accelerator-delivered SBRT with sequential gemcitabine resulted in excellent local control of locally advanced pancreatic cancer. Future studies will address strategies for reducing long-term duodenal toxicity associated with SBRT.

  View details for DOI 10.1016/j.ijrobp.2010.05.006

  View details for Web of Science ID 000294093300025

  View details for PubMedID 21549517

• A Bayesian Network for Differentiating Benign From Malignant Thyroid Nodules Using Sonographic and Demographic Features AMERICAN JOURNAL OF ROENTGENOLOGY Liu, Y. I., Kamaya, A., Desser, T. S., Rubin, D. L. 2011; 196 (5): W598-W605

  Abstract

  The objective of our study was to create a Bayesian network (BN) that incorporates a multitude of imaging features and patient demographic characteristics to guide radiologists in assessing the likelihood of malignancy in suspicious-appearing thyroid nodules.We built a BN to combine multiple indicators of the malignant potential of thyroid nodules including both imaging and demographic factors. The imaging features and conditional probabilities relating those features to diagnoses were compiled from an extensive literature review. To evaluate our network, we randomly selected 54 benign and 45 malignant nodules from 93 adult patients who underwent ultrasound-guided biopsy. The final diagnosis in each case was pathologically established. We compared the performance of our network with that of two radiologists who independently evaluated each case on a 5-point scale of suspicion for malignancy. Probability estimates of malignancy from the BN and radiologists were compared using receiver operating characteristic (ROC) analysis.The network performed comparably to the two expert radiologists. Using each radiologist's assessment of the imaging features as input to the network, the differences between the area under the ROC curve (A(z)) for the BN and for the radiologists were -0.03 (BN vs radiologist 1, 0.85 vs 0.88) and -0.01 (BN vs radiologist 2, 0.76 vs 0.77).We created a BN that incorporates a range of sonographic and demographic features and provides a probability about whether a thyroid nodule is benign or malignant. The BN distinguished between benign and malignant thyroid nodules as well as the expert radiologists did.

  View details for DOI 10.2214/AJR.09.4037

  View details for PubMedID 21512051

• Renewing Focus on Resident Education: Increased Responsibility and Ownership in Interventional Radiology Rotations Improves the Educational Experience JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Kothary, N., Ghatan, C. E., Hwang, G. L., Kuo, W. T., Louie, J. D., Sze, D. Y., Hovsepian, D. M., Desser, T. S., Hofmann, L. V. 2010; 21 (11): 1697-1702

  Abstract

  To enhance the educational experience among residents rotating through interventional radiology (IR) by encouraging ownership and responsibility.In May 2006, the authors implemented changes in resident education in IR that included increased clinical responsibilities, structured didactics, and greater hands-on experience, including call. Residents were assigned as first assistants, ownership of cases was encouraged, and assignment to a week on the consult service was instituted to help residents better understand all aspects of IR practice. Additional faculty recruitment and program expansion ensured the same high level of training for the fellowship program. Evaluations were reviewed every year (July 1, 2007-June 30, 2009) for hands-on training, daily teaching, didactic conferences, and overall effectiveness of the clinical service. A graduated scale of 1-5 was used.In 2009, 3 years after the curricular changes were made, the quality of hands-on training, daily case reviews and consults, didactics, and overall education had markedly improved with 89%, 71%, 65%, and 82% of the residents rating these respective aspects of the training as "above expectations" (4 on a scale of 5) or "superior" (5 on a scale of 5) compared with 77%, 23%, 20%, and 60% in 2005-2006. Three years after the changes, the impact of these changes on recruitment patterns also showed improvement, with 28.6% of the class of 2010 pursuing a fellowship in IR.Increasing resident ownership, responsibility, and hands-on experience improves resident education in IR, which, in turn, promotes interest in the field.

  View details for DOI 10.1016/j.jvir.2010.07.009

  View details for PubMedID 20884234

• Hashimoto Thyroiditis: Part 1, Sonographic Analysis of the Nodular Form of Hashimoto Thyroiditis AMERICAN JOURNAL OF ROENTGENOLOGY Anderson, L., Middleton, W. D., Teefey, S. A., Reading, C. C., Langer, J. E., Desser, T., Szabunio, M. M., Hildebolt, C. F., Mandel, S. J., Cronan, J. J. 2010; 195 (1): 208–15

  Abstract

  The purpose of this article is to analyze the sonographic appearance of nodular Hashimoto thyroiditis.As part of an ongoing multiinstitutional study, patients who underwent ultrasound examination and fine-needle aspiration of one or more thyroid nodules were analyzed for multiple predetermined sonographic features. Patients completed a questionnaire, including information about thyroid function and thyroid medication. Patients (n = 61) with fine-needle aspiration cytologic results consistent with nodular Hashimoto thyroiditis (n = 64) were included in the study.The mean (+/- SD) diameter of nodular Hashimoto thyroiditis was 15 +/- 7.33 mm. Nodular Hashimoto thyroiditis occurred as a solitary nodule in 36% (23/64) of cases and in the setting of five or more nodules in 23% (15/64) of cases. Fifty-five percent (35/64) of the cases of nodular Hashimoto thyroiditis occurred within a sonographic background of diffuse Hashimoto thyroiditis, and 45% (29/64) of cases occurred within normal thyroid parenchyma. The sonographic appearance was extremely variable. It was most commonly solid (69% [42/61] of cases) and hypoechoic (47% [27/58] of cases). Twenty percent (13/64) of nodules had calcifications (seven with nonspecific bright reflectors, four with macrocalcifications, and three eggshell), and 5% (3/64) of nodules had colloid. Twenty-seven percent (17/64) of nodules had a hypoechoic halo. The margins were well defined in 60% (36/60) and ill defined in 40% (24/60) of nodules. On Doppler analysis, 35% (22/62) of nodules were hypervascular, 42% (26/62) were isovascular or hypovascular, and 23% (14/62) were avascular.The sonographic features and vascularity of nodular Hashimoto thyroiditis were extremely variable.

  View details for DOI 10.2214/AJR.09.2459

  View details for Web of Science ID 000278998200029

  View details for PubMedID 20566818

• Hashimoto Thyroiditis: Part 2, Sonographic Analysis of Benign and Malignant Nodules in Patients With Diffuse Hashimoto Thyroiditis AMERICAN JOURNAL OF ROENTGENOLOGY Anderson, L., Middleton, W. D., Teefey, S. A., Reading, C. C., Langer, J. E., Desser, T., Szabunio, M. M., Mandel, S. J., Hildebolt, C. F., Cronan, J. J. 2010; 195 (1): 216–22

  Abstract

  The purpose of this article is to compare sonographic features of benign and malignant nodules in patients with diffuse Hashimoto thyroiditis.As part of an ongoing multiinstitutional study, patients who underwent ultrasound and fine-needle aspiration of one or more thyroid nodules were analyzed for a variety of predetermined sonographic features. Patients with a sonographic appearance consistent with diffuse Hashimoto thyroiditis and with coexisting nodules that could be confirmed to be benign or malignant by fine-needle aspiration or surgical pathologic analysis were included in the study.Among nodules within diffuse Hashimoto thyroiditis, 84% (69/82) were benign (35 nodular Hashimoto thyroiditis, 32 nodular hyperplasia, and two follicular adenoma), and 16% (13/82) were malignant (12 papillary carcinoma and one lymphoma). Malignant nodules were more likely to be solid and hypoechoic (62% vs 19%). All types of calcifications were more prevalent among malignant nodules, including microcalcifications (39% vs 0%), nonspecific tiny bright reflectors (39% vs 6%), macrocalcifications (15% vs 3%), and eggshell (15% vs 2%). Benign nodules were more likely to be hyperechoic (46% vs 9%), to have a halo (39% vs 15%), and to lack calcifications (88% vs 23%). Benign nodules more often had ill-defined margins (36% vs 8%).Sonographic features of benign and malignant nodules within diffuse Hashimoto thyroiditis are generally similar to the features typical of benign and malignant nodules in the general population. If calcifications of any type are added to the list of malignant sonographic features, the decision to biopsy a nodule in patients with diffuse Hashimoto thyroiditis can be based on recommendations that have been published previously.

  View details for DOI 10.2214/AJR.09.3680

  View details for Web of Science ID 000278998200030

  View details for PubMedID 20566819

• Learning a Bayesian Classifier for Thyroid Nodule Evaluation 110th Annual Meeting of the American-Roentgen-Ray-Society Liu, Y., Kamaya, A., Desser, T., Rubin, D. AMER ROENTGEN RAY SOC. 2010

  View details for Web of Science ID 000276931000177

• A Systemic Search for Patterns for Thyroid Nodule Evaluation Using a Bayesian Classifier 110th Annual Meeting of the American-Roentgen-Ray-Society Liu, Y., Kamaya, A., Desser, T., Rubin, D. AMER ROENTGEN RAY SOC. 2010

  View details for Web of Science ID 000276931000178

• Pearls and Pitfalls in Hepatic Ultrasonography ULTRASOUND QUARTERLY Shin, D. S., Jeffrey, R. B., Desser, T. S. 2010; 26 (1): 17-25

  Abstract

  Ultrasonography is often the initial imaging study in patients who present with right upper quadrant abdominal complaints. However, due to its intrinsic technical limitations, ultrasonography generally has a lower sensitivity than contrast-enhanced computed tomography or magnetic resonance imaging in detecting hepatic lesions. In this review, we describe several subtle sonographic signs that suggest the presence of an otherwise inconspicuous focal liver lesion, including disease in the pleural space or the lung parenchyma, refractive edge shadows, distorted or absent venous landmarks, abnormal Doppler patterns, and venous thrombosis. When encountered, these features should trigger careful evaluation of the adjacent areas for abnormalities and may warrant further studies with computed tomography, magnetic resonance imaging, or positron emission tomography. We also summarize common sonographic findings of diffuse liver diseases, including fatty infiltration and cirrhosis.

  View details for PubMedID 20216191

• The dangling diaphragm sign: sensitivity and comparison with existing CT signs of blunt traumatic diaphragmatic rupture. Emergency radiology Desser, T. S., Edwards, B., Hunt, S., Rosenberg, J., Purtill, M. A., Jeffrey, R. B. 2010; 17 (1): 37-44

  Abstract

  The objectives of our study were to describe a new CT sign of diaphragmatic injury, the "dangling diaphragm" sign, and assess its comparative utility relative to other signs in the diagnosis of diaphragmatic injury resulting from blunt trauma. CT scans of 16 blunt trauma patients (12 men and four women, mean age 36.6 years old) with surgically proven diaphragmatic injury and 32 blunt trauma patients (24 men and eight women; mean age 37.4 years old) without evidence of diaphragmatic injury at surgery were blindly reviewed by three board certified radiologists specializing in body imaging. Studies were evaluated for the presence of established signs of diaphragmatic injury, as well as the dangling diaphragm sign, in which the free edge of the torn hemidiaphragm curls inward from its normal course parallel to the body wall. The sensitivity and specificity of each sign were determined, as were the correlation between the signs and the interobserver agreement in evaluation of these findings. The radiologists' overall impression as to whether rupture was present was also recorded. In select cases, coronal and/or sagittal reformatted images were available, and they were reviewed following evaluation of the original axial images. Any change in interpretation due to these images was noted. The sensitivity of the radiologists' overall impression for detection of diaphragmatic injury was 77%, with 98% specificity. Individual signs of diaphragmatic injury had sensitivities ranging from 44% to 69%, with specificities of 98% to 100%. The dangling diaphragm sign had a sensitivity of 54% and a specificity of 98%, similar to the other signs. Multiple signs were present in most cases of diaphragmatic injury, and coronal and sagittal reformatted images had little impact. Diaphragmatic injury remains a challenging radiographic diagnosis. The dangling diaphragm is a conspicuous sign of diaphragmatic injury, and awareness of it may increase detection of diaphragmatic injury on CT studies.

  View details for DOI 10.1007/s10140-009-0819-5

  View details for PubMedID 19449046

• Understanding Transient Hepatic Attenuation Differences SEMINARS IN ULTRASOUND CT AND MRI Desser, T. S. 2009; 30 (5): 408-417

  Abstract

  Transient hepatic attenuation differences (THADs) are the imaging manifestation of regional variations in the balance between hepatic arterial, portal venous, and third inflow sources of hepatic blood flow. THADs are typically wedge-shaped hypervascular regions visible on the hepatic arterial phase, and fade to isodense on venous and delayed phases. They are commonly seen in the setting of locally diminished portal venous inflow. Familiarity with the characteristic appearance and the physiology of THADs should permit discrimination of these fascinating pseudolesions from true space occupying masses.

  View details for DOI 10.1053/j.sult.2009.07.003

  View details for PubMedID 19842565

• Hypervascular Liver Lesions SEMINARS IN ULTRASOUND CT AND MRI Kamaya, A., Maturen, K. E., Tye, G. A., Liu, Y. I., Parti, N. N., Desser, T. S. 2009; 30 (5): 387-407

  Abstract

  Hypervascular hepatocellular lesions include both benign and malignant etiologies. In the benign category, focal nodular hyperplasia and adenoma are typically hypervascular. In addition, some regenerative nodules in cirrhosis may be hypervascular. Malignant hypervascular primary hepatocellular lesions include hepatocellular carcinoma, fibrolamellar carcinoma, and peripheral cholangiocarcinoma. Vascular liver lesions often appear hypervascular because they tend to follow the enhancement of the blood pool; these include hemangiomas, arteriovenous malformations, angiosarcomas, and peliosis. While most gastrointestinal malignancies that metastasize to the liver will appear hypovascular on arterial and portal-venous phase imaging, certain cancers such as metastatic neuroendocrine tumors (including pancreatic neuroendocrine tumors, carcinoid, and gastrointestinal stromal tumors) tend to produce hypervascular metastases due to the greater recruitment of arterial blood supply. Finally, rare hepatic lesions such as glomus tumor and inflammatory pseudotumor may have a hypervascular appearance.

  View details for DOI 10.1053/j.sult.2009.06.001

  View details for PubMedID 19842564

• Imaging and Diagnosis of Postpartum Complications Sonography and Other Imaging Modalities ULTRASOUND QUARTERLY Kamaya, A., Ro, K., Benedetti, N. J., Chang, P. L., Desser, T. S. 2009; 25 (3): 151-162

  Abstract

  Postpartum complications can be broadly divided into 4 categories: postpartum hemorrhage, obstetrical trauma, thromboembolic complications, and puerperal infections. Postpartum hemorrhage is most commonly caused by uterine atony, abnormal placentation, or genital tract trauma. Secondary causes of hemorrhage include retained products of conception and, rarely, subinvolution of the placental implantation site. Uterine dehiscence or rupture may be occult on ultrasound examination and may be better visualized on sagittal computed tomography or magnetic resonance imaging. Obstetric trauma during prolonged vaginal or cesarean delivery may lead to fistula formation, ureteral injury, or bowel injury. Later potential complications of cesarean delivery include cesarean delivery scar ectopic, endometrial implants in the cesarean scar, and placenta accreta. Thromboembolic complications can include pulmonary embolism and deep vein thrombosis as well as ovarian vein thrombosis, the latter of which can be difficult to clinically differentiate from appendicitis in the postpartum female.

  View details for PubMedID 19730078

• A Controlled Vocabulary to Represent Sonographic Features of the Thyroid and its Application in a Bayesian Network to Predict Thyroid Nodule Malignancy 109th Annual Meeting of the American-Roentgen-Ray-Society Liu, Y., Kamaya, A., Desser, T., Rubin, D. AMER ROENTGEN RAY SOC. 2009

  View details for Web of Science ID 000265387200024

• Stereotactic Radiotherapy for Unresectable Adenocarcinoma of the Pancreas CANCER Chang, D. T., Schellenberg, D., Shen, J., Kim, J., Goodman, K. A., Fisher, G. A., Ford, J. M., Desser, T., Quon, A., Koong, A. C. 2009; 115 (3): 665-672

  Abstract

  The authors report on the local control and toxicity of stereotactic body radiotherapy (SBRT) for patients with unresectable pancreatic adenocarcinoma.Seventy-seven patients with unresectable adenocarcinoma of the pancreas received 25 gray (Gy) in 1 fraction. Forty-five patients (58%) had locally advanced disease, 11 patients (14%) had medically inoperable disease, 15 patients (19%) had metastatic disease, and 6 patients (8%) had locally recurrent disease. Nine patients (12%) had received prior chemoradiotherapy. Sixteen patients (21%) received between 45 to 54 Gy of fractionated radiotherapy and SBRT. Various gemcitabine-based chemotherapy regimens were received by 74 patients (96%), but 3 patients (4%) did not receive chemotherapy until they had distant failure.The median follow-up was 6 months (range, 3-31 months) and, among surviving patients, it was 12 months (range, 3-31 months). The overall rates of freedom from local progression (FFLP) at 6 months and 12 months were 91% and 84%, respectively. The 6- and 12-month isolated local recurrence rates were 5% and 5%, respectively. There was no difference in the 12-month FFLP rate based on tumor location (head/uncinate, 91% vs body/tail, 86%; P = .52). The progression-free survival (PFS) rates at 6 months and 12 months were 26% and 9%, respectively. The PFS rate at 6 months was superior for patients who had nonmetastatic disease versus patients who had metastatic disease (28% vs 15%; P = .05). The overall survival (OS) rates at 6 months and 12 months from SBRT were 56% and 21%, respectively. Four patients (5%) experienced grade > or = 2 acute toxicity. Three patients (4%) experienced grade 2 late toxicity, and 7 patients (9%) experienced grade > or = 3 late toxicity. At 6 months and 12 months, the rates of grade > or = 2 late toxicity were 11% and 25%, respectively.SBRT for pancreatic adenocarcinoma was effective for local control with associated risk of toxicity and should be used with rigorous attention to quality assurance. Efforts to reduce complications are warranted. Distant metastases account for the vast majority of disease-related mortality.

  View details for DOI 10.1002/cncr.24059

  View details for PubMedID 19117351

• A Controlled Vocabulary to Represent Sonographic Features of the Thyroid and its application in a Bayesian Network to Predict Thyroid Nodule Malignancy. Summit on translational bioinformatics Liu, Y. I., Kamaya, A., Desser, T. S., Rubin, D. L. 2009; 2009: 68-72

  Abstract

  It is challenging to distinguish benign from malignant thyroid nodules on high resolution ultrasound. Many ultrasound features have been studied individually as predictors for thyroid malignancy, none with a high degree of accuracy, and there is no consistent vocabulary used to describe the features. Our hypothesis is that a standard vocabulary will advance accuracy. We performed a systemic literature review and identified all the sonographic features that have been well studied in thyroid cancers. We built a controlled vocabulary for describing sonographic features and to enable us to unify data in the literature on the predictive power of each feature. We used this terminology to build a Bayesian network to predict thyroid malignancy. Our Bayesian network performed similar to or slightly better than experienced radiologists. Controlled terminology for describing thyroid radiology findings could be useful to characterize thyroid nodules and could enable decision support applications.

  View details for PubMedID 21347173

• Imaging of hepatic infections. Ultrasound quarterly Benedetti, N. J., Desser, T. S., Jeffrey, R. B. 2008; 24 (4): 267-278

  Abstract

  Hepatic infections include pyogenic and amebic abscesses and fungal and parasitic diseases. Entry of the infectious organisms into the liver can occur by hematogenous spread via the portal vein or hepatic artery, ascension of the infection from the biliary tract, or from trauma. Worldwide, liver abscess is most often caused by Entamoeba histolytica, but in the developed world, pyogenic liver abscess is more common. Fungal infection is most often seen in immunosuppressed chemotherapy patients, whereas parasitic infections are seen in patients with recent travel to endemic areas of Asia, Africa, and South America. Imaging, and in particular ultrasound, plays a crucial role in following patients from treatment to resolution of disease.We review the ultrasound and computed tomographic findings and the clinical features that are characteristic of hepatic pyogenic abscess, amebic abscess, fungal infection, and parasitic infection.

  View details for DOI 10.1097/RUQ.0b013e31818e5981

  View details for PubMedID 19060716

• Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS Schellenberg, D., Goodman, K. A., Lee, F., Chang, S., Kuo, T., Ford, J. M., Fisher, G. A., Quon, A., Desser, T. S., Norton, J., Greco, R., Yang, G. P., Koong, A. C. 2008; 72 (3): 678-686

  Abstract

  Fractionated radiotherapy and chemotherapy for locally advanced pancreatic cancer achieves only modest local control. This prospective trial evaluated the efficacy of a single fraction of 25 Gy stereotactic body radiotherapy (SBRT) delivered between Cycle 1 and 2 of gemcitabine chemotherapy.A total of 16 patients with locally advanced, nonmetastatic, pancreatic adenocarcinoma received gemcitabine with SBRT delivered 2 weeks after completion of the first cycle. Gemcitabine was resumed 2 weeks after SBRT and was continued until progression or dose-limiting toxicity. The gross tumor volume, with a 2-3-mm margin, was treated in a single 25-Gy fraction by Cyberknife. Patients were evaluated at 4-6 weeks, 10-12 weeks, and every 3 months after SBRT.All 16 patients completed SBRT. A median of four cycles (range one to nine) of chemotherapy was delivered. Three patients (19%) developed local disease progression at 14, 16, and 21 months after SBRT. The median survival was 11.4 months, with 50% of patients alive at 1 year. Patients with normal carbohydrate antigen (CA)19-9 levels either at diagnosis or after Cyberknife SBRT had longer survival (p <0.01). Acute gastrointestinal toxicity was mild, with 2 cases of Grade 2 (13%) and 1 of Grade 3 (6%) toxicity. Late gastrointestinal toxicity was more common, with five ulcers (Grade 2), one duodenal stenosis (Grade 3), and one duodenal perforation (Grade 4). A trend toward increased duodenal volumes radiated was observed in those experiencing late effects (p = 0.13).SBRT with gemcitabine resulted in comparable survival to conventional chemoradiotherapy and good local control. However, the rate of duodenal ulcer development was significant.

  View details for DOI 10.1016/j.ijrobp.2008.01.051

  View details for PubMedID 18395362

• Multidetector Row Computed Tomography of Small Bowel Obstruction SEMINARS IN ULTRASOUND CT AND MRI Desser, T. S., Gross, M. 2008; 29 (5): 308-321

  Abstract

  Small bowel obstruction (SBO) is a common clinical problem, and clinical signs and symptoms often do not provide sufficient information for diagnosis or to guide management. During the past two decades, computed tomography has become a mainstay in the evaluation of patients with known or suspected small bowel obstruction. Computed tomography scans should be performed and interpreted with attention to establishing the diagnosis of small bowel obstruction, locating the transition point indicating the site of obstruction, and determining the cause of the obstruction. Complications that suggest the need for urgent surgical intervention, such as closed loop obstruction with superimposed ischemia and/or volvulus, should be sought in every case. Current generation multidetector row computed tomography scanners, with their isotropic resolution, now permit high-quality reformatted images to be obtained in multiple planes and facilitate identification of the transition point and other findings in SBO. Radiologists should be familiar with the myriad features of uncomplicated and complicated small bowel obstruction, which are reviewed in this article.

  View details for DOI 10.1053/j.sult.2008.06.004

  View details for PubMedID 18853838

• Emergency Gynecologic Imaging SEMINARS IN ULTRASOUND CT AND MRI Kamaya, A., Shin, L., Chen, B., Desser, T. S. 2008; 29 (5): 353-368

  Abstract

  Acute pelvic pain in the female patient can have myriad presentations and, depending on the diagnosis, profound consequences. In the pregnant patient with pelvic pain or bleeding, an ectopic pregnancy must be first excluded. Ultrasound is important in determining the size and location of the ectopic pregnancy, and presence of bleeding, which in turn helps guide treatment decisions. Subchorionic or subplacental bleeds in an intrauterine pregnancy may also present with vaginal bleeding with consequences dependent on gestational age and size of bleed. In the postpartum female suspected to have retained products of conception, sonographic findings may vary from a thickened endometrial stripe to an echogenic mass with associated marked vascularity, often mimicking an arterial-venous malformation. In the nonpregnant patient, early diagnosis and treatment of ovarian torsion can preserve ovarian function. Other causes of peritoneal irritation may also cause acute pelvic pain including a ruptured hemorrhagic cyst or ruptured endometrioma. When pelvic inflammatory disease is suspected, imaging is used to evaluate for serious associated complications including the presence of a tuboovarian abscess or peritonitis. While leiomyomas of the uterus are largely asymptomatic, a leiomyoma that undergoes necrosis, torsion or prolapse through the cervix may be associated with acute severe pain or bleeding. The imaging features of these and other important clinical entities in the female pelvis will be presented.

  View details for DOI 10.1053/j.sult.2008.06.006

  View details for PubMedID 18853841

• Ultrasound of thyroid nodules NEUROIMAGING CLINICS OF NORTH AMERICA Desser, T. S., Kamaya, A. 2008; 18 (3): 463-478

  Abstract

  Thyroid nodules can be detected in 4% to 8% of the adult population by palpation, but in 40% to 50% of the population by ultrasound. The overwhelming majority of these represent benign hyperplastic nodules or adenomas. Approximately 5% of nodules are malignant, with papillary carcinoma representing approximately 75% to 80% of primary thyroid malignancies. Although many sonographic features have been studied as a means of distinguishing benign from malignant nodules, ultrasound-guided fine-needle aspiration with cytologic evaluation remains a mainstay in the management of palpable and incidentally detected nodules. This article reviews the current techniques for sonographic evaluation of the thyroid and the imaging features of the various types of thyroid nodules.

  View details for DOI 10.1016/j.nic.2008.03.005

  View details for PubMedID 18656028

• A data warehouse for integrating radiologic and pathologic data. Journal of the American College of Radiology Rubin, D. L., Desser, T. S. 2008; 5 (3): 210-217

  Abstract

  Much of the information needed for radiology teaching and research is not in the picture archiving and communication system but distributed in hospital information systems throughout the medical enterprise. Our objective is to describe the design, methodology, and implementation of a data warehouse to integrate and make accessible the types of medical data pertinent to radiology research and teaching, and to encourage implementation of similar approaches throughout the radiologic community.We identified desiderata of radiology data warehouses and designed and implemented a prototype system (RadBank) to meet these needs. RadBank was built with open-source software tools on a Linux platform with a relational database. We created a text report parsing module that recognizes the structure of radiology reports and makes individual sections available for indexing and search. A database schema was designed to link radiology and pathology reports and to enable users to retrieve cases using flexible queries.Our system contains more than 2 million radiology and pathology reports, and allows full text search by patient history, findings, and diagnosis by radiology and pathology. RadBank has helped radiologists at our institution find teaching cases and identify research cohorts.Data warehouses can provide radiologists access to important clinical information contained in radiology and pathology reports, and supplement the image information in picture archiving and communication system workstations. We believe that data warehouses similar to our system can be implemented in other radiology departments within a reasonable budget to make their vast radiologic-pathologic case material accessible for education and research.

  View details for DOI 10.1016/j.jacr.2007.09.004

  View details for PubMedID 18312970

• A Bayesian classifier for differentiating benign versus malignant thyroid nodules using sonographic features. AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium Liu, Y. I., Kamaya, A., Desser, T. S., Rubin, D. L. 2008: 419-423

  Abstract

  Thyroid nodules are a common, yet challenging clinical problem. The vast majority of these nodules are benign; however, deciding which nodule should undergo biopsy is difficult because the imaging appearance of benign and malignant thyroid nodules overlap. High resolution ultrasound is the primary imaging modality for evaluating thyroid nodules. Many sonographic features have been studied individually as predictors for thyroid malignancy. There has been little work to create predictive models that combine multiple predictors, both imaging features and demographic factors. We have created a Bayesian classifier to predict whether a thyroid nodule is benign or malignant using sonographic and demographic findings. Our classifier performed similar to or slightly better than experienced radiologists when evaluated using 41 thyroid nodules with known pathologic diagnosis. This classifier could be helpful in providing practitioners an objective basis for deciding whether to biopsy suspicious thyroid nodules.

  View details for PubMedID 18999209

• Stereotactic body radiotherapy for unresectable adenocarcinoma of the pancreas 50th Annual Meeting of the American-Society-for-Therapeutic-Radiology-and-Oncology (ASTRO) Chang, D. T., Schellenberg, D., Shen, J., Kim, J., Goodman, K., Fisher, G., Ford, J., Desser, T., Quon, A., Koong, A. ELSEVIER SCIENCE INC. 2008: S249–S249

  View details for Web of Science ID 000258805301032

• Simulation-based training: the next revolution in radiology education? Journal of the American College of Radiology Desser, T. S. 2007; 4 (11): 816-824

  Abstract

  Simulation-based training methods have been widely adopted in hazardous professions such as aviation, nuclear power, and the military. Their use in medicine has been accelerating lately, fueled by the public's concerns over medical errors as well as new Accreditation Council for Graduate Medical Education requirements for outcome-based and proficiency-based assessment methods. This article reviews the rationale for simulator-based training, types of simulators, their historical development and validity testing, and some results to date in laparoscopic surgery and endoscopic procedures. A number of companies have developed endovascular simulators for interventional radiologic procedures; although they cannot as yet replicate the experience of performing cases in real patients, they promise to play an increasingly important role in procedural training in the future.

  View details for PubMedID 17964504

• Small cystic lesions of the pancreas: clinical significance and findings at follow-up ABDOMINAL IMAGING Kirkpatrick, I. D., Desser, T. S., Nino-Murcia, M., Jeffrey, R. B. 2007; 32 (1): 119-125

  Abstract

  Our purpose was to correlate the imaging findings of small cystic pancreatic lesions to the incidence of growth on follow-up imaging and their pathologic diagnoses.CT images for 159 patients with cystic pancreatic lesions were retrospectively evaluated and lesions were assessed for size, number, connection to the main pancreatic duct (MPD), MPD dilatation, and any presence of loculation, wall irregularity, thick septations, or solid components. A total of 86 patients had follow-up imaging with time periods of less than 6 months (n = 21), 6-12 months (n = 22), 1-2 years (n = 14), and greater than 2 years (n = 29). Lesion histology was available in 20 patients.Lesions with pathologic correlation proved to be: side branch intraductal papillary mucinous neoplasm or tumor (IPMT) (n = 5), combined type IPMT (n = 4), nonmucinous cyst (n = 4), chronic pancreatitis (n = 2), and reactive atypia with nonmucinous fluid (n = 1), combined type IMPT with foci of adenocarcinoma (n = 1), mucinous adenocarcinoma (n = 2), and nonmucinous adenocarcinoma (n = 1). Lesions with solid components were significantly more likely to grow and be malignant (P < 0.05). The presence of MPD dilatation was more common in patients with combined type IPMTs or malignancies. No other factors were predictive of malignancy.Solid components are predictive of malignancy, and MPD dilatation should prompt consideration of surgery. Other cystic lesions can be followed.

  View details for DOI 10.1007/s00261-006-9080-5

  View details for Web of Science ID 000246405800020

  View details for PubMedID 16944031

• Multiple lesions of the spleen: Differential diagnosis of cystic and solid lesions SEMINARS IN ULTRASOUND CT AND MRI Kamaya, A., Weinstein, S., Desser, T. S. 2006; 27 (5): 389-403

  Abstract

  Lesions in the spleen may be encountered in a variety of clinical settings ranging from asymptomatic patients to patients who are critically ill. Etiologies for multifocal splenic lesions include infectious and inflammatory processes, primary vascular and lymphoid neoplasms, metastatic disease, vascular processes, and systemic diseases. There is often overlap in the imaging appearance alone, so the clinical setting is very helpful in differential diagnosis. In the immunocompromised patient, multiple small splenic lesions usually represent disseminated fungal disease and microabscesses. The spleen is a relatively rare site for metastatic disease; patients with metastatic lesions in the spleen usually have disease in other sites as well. Breast, lung, ovary, melanoma, and colon cancer are common primary tumors that metastasize to the spleen. Vascular neoplasms of the spleen represent the majority of the nonhematologic/nonlymphoid neoplasms and commonly produce multifocal lesions. Splenic infarcts may be seen with localized processes such as portal hypertension or pancreatitis, or may arise from an embolic source. Radiologists should be aware of the spectrum of processes that may involve the spleen and the clinical context in which they occur.

  View details for DOI 10.1053/j.sult.2006.06.004

  View details for PubMedID 17048454

• Value of delayed imaging in MDCT of the abdomen and pelvis AMERICAN JOURNAL OF ROENTGENOLOGY Vasanawala, S. S., Desser, T. 2006; 187 (1): 154-163

  Abstract

  Our objective was to illustrate the benefits of obtaining delayed CT images.There are several clinical scenarios in which delayed CT images may improve diagnostic specificity.

  View details for DOI 10.2214/AJR.05.0148

  View details for PubMedID 16794170

• Software tools for interactive instruction in radiologic anatomy. Academic radiology Alvarez, A., Gold, G. E., Tobin, B., Desser, T. S. 2006; 13 (4): 512-517

  Abstract

  To promote active learning in an introductory Radiologic Anatomy course through the use of computer-based exercises.DICOM datasets from our hospital PACS system were transferred to a networked cluster of desktop computers in a medical school classroom. Medical students in the Radiologic Anatomy course were divided into four small groups and assigned to work on a clinical case for 45 minutes. The groups used iPACS viewer software, a free DICOM viewer, to view images and annotate anatomic structures. The classroom instructor monitored and displayed each group's work sequentially on the master screen by running SynchronEyes, a software tool for controlling PC desktops remotely.Students were able to execute the assigned tasks using the iPACS software with minimal oversight or instruction. Course instructors displayed each group's work on the main display screen of the classroom as the students presented the rationale for their decisions. The interactive component of the course received high ratings from the students and overall course ratings were higher than in prior years when the course was given solely in lecture format.DICOM viewing software is an excellent tool for enabling students to learn radiologic anatomy from real-life clinical datasets. Interactive exercises performed in groups can be powerful tools for stimulating students to learn radiologic anatomy.

  View details for PubMedID 16554232

• Software tools for interactive instruction in radiologic anatomy ACADEMIC RADIOLOGY Alvarez, A., Gold, G. E., Tobin, B., Desser, T. S. 2006; 13 (4): 510-515

  Abstract

  To promote active learning in an introductory Radiologic Anatomy course through the use of computer-based exercises.DICOM datasets from our hospital PACS system were transferred to a networked cluster of desktop computers in a medical school classroom. Medical students in the Radiologic Anatomy course were divided into four small groups and assigned to work on a clinical case for 45 minutes. The groups used iPACS viewer software, a free DICOM viewer, to view images and annotate anatomic structures. The classroom instructor monitored and displayed each group's work sequentially on the master screen by running SynchronEyes, a software tool for controlling PC desktops remotely.Students were able to execute the assigned tasks using the iPACS software with minimal oversight or instruction. Course instructors displayed each group's work on the main display screen of the classroom as the students presented the rationale for their decisions. The interactive component of the course received high ratings from the students and overall course ratings were higher than in prior years when the course was given solely in lecture format.DICOM viewing software is an excellent tool for enabling students to learn radiologic anatomy from real-life clinical datasets. Interactive exercises performed in groups can be powerful tools for stimulating students to learn radiologic anatomy.

  View details for DOI 10.1016/j.acra.2005.10.005

  View details for Web of Science ID 000236530900015

• Coverage of emergency after-hours ultrasound cases: Survey of practices at US teaching hospitals ACADEMIC RADIOLOGY Desser, T. S., Rubin, D. L., Schraedley-Desmond, P. 2006; 13 (2): 249-253

  Abstract

  Diagnostic ultrasound examinations may be performed after-hours by physicians if technologists are not available or cases are complex. Our experience suggested there is wide variability in how ultrasound coverage is provided after-hours, which motivated us to conduct a formal survey of teaching programs around the country.Four hundred five members of the Association of Program Directors in Radiology were contacted by e-mail and sent a link to a five-part questionnaire posted on the Web. Respondents were asked whether ultrasound cases after-hours are performed in their institutions by radiology residents, technologists on the premises after-hours, technologists on-call, or some combination. Data on the type of program, number of beds in the primary hospital, number of residents in the program, and geographic location of the program were recorded. Responses were automatically written to a data file stored on a Web server and the imported into an Excel spreadsheet for data analysis. A chi(2) analysis was performed to assess associations among the variables and statistical significance.A total of 79 programs responded to the survey. Of those, 32% provided coverage with ultrasound technologists on call, 24% by ultrasound technologists on the premises, 13% provided combination coverage, and 10% provided coverage solely with residents on call. There was no association among number of residents in the program, location of the program, or type of program (university, community, or affiliated) and type of coverage provided.There is wide variability in methods for providing coverage of after-hours ultrasound cases. However, on-site or on-call coverage of emergency cases by technologists did not appear to depend significantly on program location, program type, or program size.

  View details for DOI 10.1016/j.acra.2005.09.091

  View details for PubMedID 16428062

• Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer SURGICAL ONCOLOGY-OXFORD Long, E. E., Van Dam, J., Weinstein, S., Jeffrey, B., Desser, T., Norton, J. A. 2005; 14 (2): 105-113

  Abstract

  Pancreas cancer is the fourth leading cancer killer in adults. Cure of pancreas cancer is dependent on the complete surgical removal of localized tumor. A complete surgical resection is dependent on accurate preoperative and intra-operative imaging of tumor and its relationship to vital structures. Imaging of pancreatic tumors preoperatively and intra-operatively is achieved by pancreatic protocol computed tomography (CT), endoscopic ultrasound (EUS), laparoscopic ultrasound (LUS), and intra-operative ultrasound (IOUS). Multi-detector CT with three-dimensional (3-D) reconstruction of images is the most useful preoperative modality to assess resectability. It has a sensitivity and specificity of 90 and 99%, respectively. It is not observer dependent. The images predict operative findings. EUS and LUS have sensitivities of 77 and 78%, respectively. They both have a very high specificity. Further, EUS has the ability to biopsy tumor and obtain a definitive tissue diagnosis. IOUS is a very sensitive (93%) method to assess tumor resectability during surgery. It adds little time and no morbidity to the operation. It greatly facilitates the intra-operative decision-making. In reality, each of these methods adds some information to help in determining the extent of tumor and the surgeon's ability to remove it. We rely on pancreatic protocol CT with 3-D reconstruction and either EUS or IOUS depending on the tumor location and operability of the tumor and patient. With these modern imaging modalities, it is now possible to avoid major operations that only determine an inoperable tumor. With proper preoperative selection, surgery is able to remove tumor in the majority of patients.

  View details for DOI 10.1016/j.suronc.2005.07.001

  View details for PubMedID 16125619

• Accommodation of requests for emergency US and CT: Applications of queueing theory to scheduling of urgent studies RADIOLOGY Vasanawala, S. S., Desser, T. S. 2005; 235 (1): 244-249

  Abstract

  The purpose of this study was to determine whether queueing theory would allow prediction of optimal number of schedule slots to be reserved for urgent computed tomography (CT) and ultrasonography (US). Institutional review board approval was obtained; informed consent was exempted. Emergency studies were modeled as a Poisson process; slots were reserved such that rate of rescheduling of routine studies to accommodate emergencies was predicted to be below a certain level. Model was tested with 3 years of emergency US and CT requests. US and CT requests showed Poisson distribution. US rescheduling was near that predicted. CT rescheduling exceeded that predicted, which reflected increasing CT use. By using more recent CT data for prediction, a more concordant rescheduling rate resulted.

  View details for DOI 10.1148/radiol.2351040289

  View details for PubMedID 15716391

• Automatic detection and classification of hypodense hepatic lesions on contrast-enhanced venous-phase CT MEDICAL PHYSICS Bilello, M., Gokturk, S. B., Desser, T., Napel, S., Jeffrey, R. B., Beaulieu, C. F. 2004; 31 (9): 2584-2593

  Abstract

  The objective of this work was to develop and validate algorithms for detection and classification of hypodense hepatic lesions, specifically cysts, hemangiomas, and metastases from CT scans in the portal venous phase of enhancement. Fifty-six CT sections from 51 patients were used as representative of common hypodense liver lesions, including 22 simple cysts, 11 hemangiomas, 22 metastases, and 1 image containing both a cyst and a hemangioma. The detection algorithm uses intensity-based histogram methods to find central lesions, followed by liver contour refinement to identify peripheral lesions. The classification algorithm operates on the focal lesions identified during detection, and includes shape-based segmentation, edge pixel weighting, and lesion texture filtering. Support vector machines are then used to perform a pair-wise lesion classification. For the detection algorithm, 80% lesion sensitivity was achieved at approximately 0.3 false positives (FP) per slice for central lesions, and 0.5 FP per slice for peripheral lesions, giving a total of 0.8 FP per section. For 90% sensitivity, the total number of FP rises to about 2.2 per section. The pair-wise classification yielded good discrimination between cysts and metastases (at 95% sensitivity for detection of metastases, only about 5% of cysts are incorrectly classified as metastases), perfect discrimination between hemangiomas and cysts, and was least accurate in discriminating between hemangiomas and metastases (at 90% sensitivity for detection of hemangiomas, about 28% of metastases were incorrectly classified as hemangiomas). Initial implementations of our algorithms are promising for automating liver lesion detection and classification.

  View details for DOI 10.1118/1.1782674

  View details for PubMedID 15487741

• MDCT of intraluminal "windsock" duodenal diverticulum with surgical correlation and multiplanar reconstruction AMERICAN JOURNAL OF ROENTGENOLOGY Johnston, P., Desser, T. S., Bastidas, J. A., Linda, L., Harvin, H. 2004; 183 (1): 249-250

  View details for PubMedID 15208153

• Value of curved planar reformations in MDCT of abdominal pathology AMERICAN JOURNAL OF ROENTGENOLOGY Desser, T. S., Sommer, F. G., Jeffrey, R. B. 2004; 182 (6): 1477-1484

  View details for PubMedID 15149993

• Increased through-transmission in abdominal tuberculous lymphadenitis JOURNAL OF ULTRASOUND IN MEDICINE Ghazinoor, S., Desser, T., Jeffrey, R. B. 2004; 23 (6): 837-841

  Abstract

  To describe 2 cases of abdominal tuberculosis in which sonographic evaluation of mesenteric lymphadenopathy showed increased through-transmission suggestive of caseating necrosis.Two patients with abdominal pain and other symptoms (including fever, diarrhea, and weight loss) underwent abdominal sonography with a 6-MHz curved array transducer. One patient also underwent sonographically guided fine-needle aspiration of multiple lymph nodes, and the other underwent computed tomography, colonoscopy, and colon biopsy.In both patients, sonography showed multiple rounded hypoechoic lesions with increased ultrasound through-transmission suggestive of necrotic lymphadenopathy. No color flow was shown. In 1 case, the posterior acoustic enhancement was accentuated in the harmonic imaging mode. In the other case, the lesions shown on sonography corresponded to computed tomographic findings of low-density lymph nodes. Results of fine-needle aspiration and colon biopsy were positive for tuberculosis.Posterior acoustic enhancement in abdominal lymphadenopathy can suggest the diagnosis of tuberculous lymphadenitis. Detection of this finding is facilitated by scanning in the harmonic mode. Necrotic nodes will lack color flow and can be distinguished from lymphadenopathy of other causes. Sonography can also be used for fine-needle aspiration of necrotic nodes to yield a definitive diagnosis.

  View details for Web of Science ID 000221973600013

  View details for PubMedID 15244308

• Common and uncommon sonographic features of papillary thyroid carcinoma JOURNAL OF ULTRASOUND IN MEDICINE Chan, B. K., Desser, T. S., McDougall, I. R., Weigel, R. J., Jeffrey, R. B. 2003; 22 (10): 1083-1090

  Abstract

  To determine the relative frequency of various sonographic findings in papillary carcinoma of the thyroid.We retrospectively analyzed the sonographic features in 55 patients with proven papillary carcinoma of the thyroid. Sonographic features analyzed were echo texture, cystic change, margin, contour, presence of a peripheral halo, vascularity, and calcification pattern. Features were classified as common (> or = 35% of cases) or uncommon (< 10% of cases). Combinations of features were also analyzed.Common sonographic features of papillary carcinoma included hypoechoic texture (86%), microcalcifications (42%) or no calcifications (47%), well-defined margins (47%), and intrinsic hypervascularity (69%). Uncommon features included hyperechoic or mixed echo texture, cystic elements, irregular margins, hypovascularity, and coarse or peripheral calcifications. Of the 29 lesions that had calcifications, 20 (69%) had microcalcifications; 5 (17%) had coarse calcifications; and 1 had peripheral calcifications. In total, 54% of cases had at least 1 uncommon feature, and 11% had 2 or more uncommon features. Cystic carcinomas were rare and accounted for only 6% of lesions; all had hypervascular solid components. No carcinomas in our series were completely avascular.There is a broad spectrum of sonographic findings in papillary carcinoma of the thyroid. Half of the lesions in this series had at least 1 uncommon sonographic feature.

  View details for PubMedID 14606565

• Imaging and intervention in the hepatic veins AMERICAN JOURNAL OF ROENTGENOLOGY Desser, T. S., Sze, D. Y., Jeffrey, R. B. 2003; 180 (6): 1583-1591

  View details for PubMedID 12760925

• Preoperative CT diagnosis of primary fallopian tube carcinoma in a patient with a history of total abdominal hysterectomy JOURNAL OF COMPUTER ASSISTED TOMOGRAPHY Santana, P., Desser, T. S., Teng, N. 2003; 27 (3): 361-363

  Abstract

  Fallopian tube carcinoma is an unusual gynecologic malignancy that is rarely diagnosed preoperatively. We report a case of fallopian tube carcinoma occurring in a patient who had undergone a hysterectomy many years previously, in whom findings on computed tomography and ultrasound were highly suggestive of the diagnosis.

  View details for PubMedID 12794600

• Sonographic diagnosis of traumatic gallbladder rupture JOURNAL OF ULTRASOUND IN MEDICINE Kao, E. Y., Desser, T. S., Jeffrey, R. B. 2002; 21 (11): 1295-1297

  Abstract

  Gallbladder injuries after blunt abdominal trauma are rare and often follow a vague and insidious clinical course. Consequently, gallbladder injuries commonly go undiagnosed until exploratory laparotomy. Early diagnosis is essential, because trauma to the gallbladder is typically treated surgically, and delay in treatment can result in considerable mortality and morbidity. With sonography emerging as a first-line modality for evaluation of intra-abdominal trauma, sonographers may wish to become more familiar with the appearance of gallbladder injury on sonography to facilitate earlier diagnosis and to improve treatment and prognosis. We report a case of gallbladder perforation after blunt abdominal trauma diagnosed on the basis of computed tomography (CT) and sonography.

  View details for Web of Science ID 000178888200011

  View details for PubMedID 12418769

• Sonography in primary hyperparathyroidism - Review with emphasis on scanning technique JOURNAL OF ULTRASOUND IN MEDICINE Reeder, S. B., Desser, T. S., Weigel, R. J., Jeffrey, R. B. 2002; 21 (5): 539-552

  Abstract

  To review the sonographic features and focused sonographic scanning techniques that may assist in the preoperative localization of parathyroid adenomas in patients with primary hyperparathyroidism.The sonographic findings were reviewed in 54 of 58 consecutive patients with pathologically proven parathyroid adenomas. A systematic scanning approach including real-time gray scale, color and power Doppler, and graded compression gray scale imaging was used in all patients.Fifty-four (93%) of 58 proven adenomas were correctly identified by sonography. Gray scale imaging alone was sufficient for identifying 26 (100%) of 26 large (> or =1-cm) and 3 (11%) of 25 small (<1-cm) parathyroid adenomas. However, for 25 (89%) of 28 small adenomas, a combination of color and power Doppler and graded compression real-time gray scale imaging was required for sonographic localization and identification.Knowledge of typical locations and characteristic imaging features, as well as a systematic scanning approach, can result in accurate preoperative sonographic localization of parathyroid adenomas.

  View details for PubMedID 12008817

• Tissue harmonic imaging techniques: Physical principles and clinical applications SEMINARS IN ULTRASOUND CT AND MRI Desser, T. S., Jeffrey, R. B. 2001; 22 (1): 1-10

  Abstract

  Tissue harmonic imaging (THI) is a new gray-scale sonographic technique that improves image clarity. Harmonics form within the insonated tissue as a consequence of nonlinear sound propagation. Imaging with endogenously formed harmonics means that the distorting layer of the body wall is traversed only once by the harmonic beam--during echo reception. Both image contrast and lateral resolution are improved in harmonic mode compared with conventional (fundamental mode) sonography. This article summarizes the physics and various implementations of harmonic imaging mode, and reviews the clinical applications that have emerged to date.

  View details for DOI 10.1053/sult.2001.20872

  View details for PubMedID 11300583

• Thickened submucosal layer: a sonographic sign of acute gastrointestinal abnormality representing submucosal edema or hemorrhage. 2000 ARRS Executive Council Award II. American Roentgen Ray Society. AJR. American journal of roentgenology Frisoli, J. K., Desser, T. S., Jeffrey, R. B. 2000; 175 (6): 1595-1599

  Abstract

  We correlated the sonographic appearance of bowel wall thickening with the acuity of the underlying disease process.Sonograms of thickened bowel walls were reviewed in 37 patients with proven gastrointestinal abnormalities. Sonographic findings were correlated with clinical presentation, endoscopy, histology, laboratory data, barium studies, and CT.Twenty-eight patients presented acutely, and nine patients had chronic or subacute disease processes. Two of the 28 patients had concurrent acute and chronic processes. In 27 of 28 patients with acute processes, the abnormal bowel segments were characterized by an echogenic submucosal layer thicker than 2.5 mm. In contrast, nine patients with chronic or subacute processes had relatively uniform hypoechoic thickening of the bowel wall with loss of visualization of a discrete echogenic submucosal layer. CT was available for comparison in 30 of 37 patients. Of the 28 patients with acute abnormalities, the thickened echogenic submucosal layer on sonography corresponded to either low-attenuation submucosal edema (n = 25) or acute submucosal hemorrhage (n = 3).The finding of a thickened submucosal layer suggests an acute disease process of the bowel and corresponds to either submucosal edema or hemorrhage.

  View details for PubMedID 11090383

• Thickened submucosal layer: A sonographic sign of acute gastrointestinal abnormality representing submucosal edema or hemorrhage AMERICAN JOURNAL OF ROENTGENOLOGY Frisoli, J. K., Desser, T. S., Jeffrey, R. B. 2000; 175 (6): 1595-1599

  Abstract

  We correlated the sonographic appearance of bowel wall thickening with the acuity of the underlying disease process.Sonograms of thickened bowel walls were reviewed in 37 patients with proven gastrointestinal abnormalities. Sonographic findings were correlated with clinical presentation, endoscopy, histology, laboratory data, barium studies, and CT.Twenty-eight patients presented acutely, and nine patients had chronic or subacute disease processes. Two of the 28 patients had concurrent acute and chronic processes. In 27 of 28 patients with acute processes, the abnormal bowel segments were characterized by an echogenic submucosal layer thicker than 2.5 mm. In contrast, nine patients with chronic or subacute processes had relatively uniform hypoechoic thickening of the bowel wall with loss of visualization of a discrete echogenic submucosal layer. CT was available for comparison in 30 of 37 patients. Of the 28 patients with acute abnormalities, the thickened echogenic submucosal layer on sonography corresponded to either low-attenuation submucosal edema (n = 25) or acute submucosal hemorrhage (n = 3).The finding of a thickened submucosal layer suggests an acute disease process of the bowel and corresponds to either submucosal edema or hemorrhage.

  View details for Web of Science ID 000165454600022

• Parathyroid localization with high-resolution ultrasound and technetium Tc 99m sestamibi 70th Annual Session of the Pacific-Coast-Surgical-Association Purcell, G. P., Dirbas, F. M., Jeffrey, R. B., Lane, M. J., Desser, T., McDougall, R., Weigel, R. J. AMER MEDICAL ASSOC. 1999: 824–28

  Abstract

  High-resolution ultrasound and technetium Tc 99m sestamibi scanning can be used for preoperative localization of abnormal parathyroid glands in patients with hyperparathyroidism.Ultrasound and sestamibi scanning were performed in patients undergoing neck exploration for hyperparathyroidism. If the 2 scans agreed in identifying a single adenoma, and surgery confirmed the location of a single adenoma and an ipsilateral normal gland, a unilateral exploration was performed.University tertiary care center.Sixty-one consecutive patients undergoing surgery for hyperparathyroidism from September 1, 1994, through September 30, 1997.High-resolution ultrasound was performed in 59 patients and sestamibi scanning in 58 patients; all patients underwent neck exploration by a single surgeon.The results of preoperative ultrasound and sestamibi scanning were compared with operative and histological findings.All patients were cured of hypercalcemia. Specificity of ultrasound and sestamibi scanning was 98% and 99%, respectively; however, their sensitivity was only 57% and 54%, respectively. Both imaging modalities had lower sensitivities in the setting of multigland disease. If both imaging studies were considered as a single test, sensitivity for imaging in patients with primary hyperparathyroidism reached 78%. Our localization protocol allowed a unilateral approach in 43% of patients (23 of 53).These results confirm the value of preoperative localization in patients with hyperparathyroidism. A unilateral approach can be used with a high degree of success in cases when ultrasound and sestamibi scanning agree in the identification of a single adenoma confirmed by surgical exploration with the identification of a normal ipsilateral gland.

  View details for Web of Science ID 000081876300006

  View details for PubMedID 10443804

• Advantages bf performing sonourethrography with lidocaine hydrochloride jelly in a prepackaged delivery system AMERICAN JOURNAL OF ROENTGENOLOGY Desser, T. S., Nino-Murcia, M., Olcott, E. W., Terris, M. K. 1999; 173 (1): 39-40

  View details for Web of Science ID 000081010900009

  View details for PubMedID 10397096

• Polymeric gadolinium chelate magnetic resonance imaging contrast agents: Design, synthesis, and properties BIOCONJUGATE CHEMISTRY Ladd, D. L., Hollister, R., Peng, X., Wei, D., Wu, G., Delecki, D., Snow, R. A., Toner, J. L., Kellar, K., Eck, J., Desai, V. C., Raymond, G., Kinter, L. B., Desser, T. S., Rubin, D. L. 1999; 10 (3): 361-370

  Abstract

  We have synthesized and evaluated five series of polymeric gadolinium chelates which are of interest as potential MRI blood pool contrast agents. The polymers were designed so that important physical properties including molecular weight, relaxivity, metal content, viscosity, and chelate stability could be varied. We have shown that, by selecting polymers of the appropriate MW, extended blood pool retention can be achieved. In addition, relaxivity can be manipulated by changing the polymer rigidity, metal content affected by monomer selection, viscosity by polymer shape, and chelate stability by chelator selection.

  View details for Web of Science ID 000080553100007

  View details for PubMedID 10346865

• Tissue harmonic imaging: Utility in abdominal and pelvic sonography JOURNAL OF CLINICAL ULTRASOUND Desser, T. S., Jeffrey, R. B., Lane, M. J., Ralls, P. W. 1999; 27 (3): 135-142

  View details for PubMedID 10064411

• Blood pool and liver enhancement in CT with liposomal iodixanol: Comparison with iohexol ACADEMIC RADIOLOGY Desser, T. S., Rubin, D. L., Muller, H., McIntire, G. L., Bacon, E. R., Toner, J. L. 1999; 6 (3): 176-183

  Abstract

  The authors compared the time course and blood pool and hepatic enhancement of three different doses of liposomal iodixanol with those of iohexol.A liposomal iodixanol formulation was prepared with 200 mg of iodine per milliliter total and 80 mg of iodine per milliliter encapsulated. Twelve normal New Zealand white rabbits divided into four groups received 75-, 100-, or 150-mg encapsulated iodine per kilogram doses of liposomal iodixanol or 2 mL/kg iohexol with 300 mg of iodine per milliliter. A liver section was scanned with serial computed tomography (CT) before the injection, immediately afterward, and at 1-minute intervals for 10 minutes. Region-of-interest measurements of the aorta and liver were plotted at each time point, and contrast enhancement was plotted as a function of time and iodine dose.All liposomal iodixanol doses produced greater liver enhancement than iohexol. Results were significant (P < .05) for 100 mg and 150 mg iodine per kilogram dose groups at time points beyond 2 minutes. Peak hepatic enhancement (change in attenuation) was 54.9 HU +/- 7.6 with iohexol, compared with 59.6 HU +/- 6.1, 73.3 HU +/- 3.6, and 104.1 HU +/- 8.8 for 75, 100, and 150 mg encapsulated iodine per kilogram doses, respectively. Hepatic enhancement increased rapidly after injection of liposomal iodixanol, plateauing 2-3 minutes later. Blood pool enhancement decreased rapidly. Steady-state liver enhancement with liposomal iodixanol increased linearly with dose. Aortic enhancement was greater with iohexol.Liposomal iodixanol yielded greater hepatic enhancement at lower total iodine doses than iohexol. Although liver enhancement occurred rapidly after injection, blood pool enhancement was brief.

  View details for Web of Science ID 000086025000006

  View details for PubMedID 10898037

• Interstitial MR and CT lymphography with Gd-DTPA-co-alpha,omega-diaminoPEG(1450) and Gd-DTPA-co-1,6-diaminohexane polymers: Preliminary experience ACADEMIC RADIOLOGY Desser, T. S., Rubin, D. L., Muller, H., McIntire, G. L., Bacon, E. R., Hollister, K. R. 1999; 6 (2): 112-118

  Abstract

  The authors assessed the efficacy of two gadolinium-based polymers used as lymphotrophic contrast media for computed tomography (CT) and magnetic resonance (MR) imaging.Two gadolinium-based polymers, gadolinium diethylenetriaminepentaacetic acid (DTPA)-co-1,6-diaminohexane (NC 22181) and Gd-DTPA-co-alpha, omega-diamino-polyethylene glycol(1450) (NC-66368), were formulated at a concentration of 80 mmol/L gadolinium. Doses of 0.1, 0.25, 1.0, or 2.0 mL per paw were administered subcutaneously into the hindpaws of normal rabbits. Spin-echo T1-weighted MR imaging (1.5 T) of rabbit popliteal and iliac nodes was performed before and immediately, 10 minutes, 2-3 hours, and 24 hours after injection. CT was performed 2-3 hours after injection of the high doses only.MR imaging revealed prompt enhancement of the popliteal nodes with both polymers at doses of 0.25 mL and above. For doses of 1.0 mL or less per paw, nodal percentage enhancement was maximal at 2 hours and then declined at 24 hours. At the highest doses, however, a reservoir of subcutaneous contrast material remained at the injection site and resulted in peak enhancement at 24 hours. At CT, popliteal node enhancement was faintly visible 2-3 hours after the administration of NC 22181. At lower doses, no enhancement was appreciable at CT.At 80 mmol/L formulations, the two gadolinium-based polymers provide excellent popliteal nodal enhancement on MR images. In addition, high doses of one polymer (NC 22181) were sufficiently concentrated in popliteal nodes to be visible on CT scans. Thus, this agent may be useful for both CT and MR lymphography.

  View details for Web of Science ID 000086024500006

  View details for PubMedID 12680433

• A multicenter, randomized, double-blind study to evaluate the safety, tolerability, and efficacy of OptiMARK (gadoversetamide injection) compared with magnevist (gadopentetate dimeglumine) in patients with liver pathology: Results of a phase III clinical trial JOURNAL OF MAGNETIC RESONANCE IMAGING Rubin, D. L., Desser, T. S., Semelka, R., Brown, J., Nghiem, H. V., Stevens, W. R., Bluemke, D., Nelson, R., Fultz, P., Reimer, P., Ho, V., Kristy, R. M., Pierro, J. A. 1999; 9 (2): 240-250

  Abstract

  The purpose of this study was to evaluate the safety and efficacy of OptiMARK (gadoversetamide injection) compared with Magnevist (gadopentetate dimeglumine) in hepatic MRI of patients with suspected liver pathology. A Phase III, multicenter, randomized, double-blind, parallel group study was performed in adults with suspected liver pathology. All patients underwent contrast-enhanced computed tomography within 3 weeks prior to magnetic resonance scanning. Ninety-nine patients received OptiMARK, and 94 patients received Magnevist at a dose of 0.1 mmol/kg. Precontrast T1- and T2-weighted spin-echo imaging and T1-weighted gradient-echo imaging were performed, followed by T1-weighted gradient-echo imaging at 15-20 seconds, 1 minute, and 5 minutes after intravenous contrast injection. Three primary efficacy endpoints (confidence in lesion diagnosis, level of conspicuity, and lesion border delineation) were evaluated on the precontrast image set and compared with the pre plus postcontrast image set. Vital signs, physical examination, electrocardiograms (ECGs), and laboratory parameters (chemistry, hematology, and urinalysis) were measured at various time points. Adverse events were recorded. The study design and statistical analyses were chosen to demonstrate presumed equivalence of OptiMARK and Magnevist. There were no statistically significant differences in efficacy between OptiMARK and Magnevist as assessed by either blinded readers or the on-site principal investigators. No serious or unexpected adverse events were noted. Of the 193 patients receiving contrast media, 82 experienced a total of 154 adverse events. Thirty-three (21.4%) of these 154 adverse events were felt by the on-site investigators to be probably related to either study agent: 15 events in 9 patients in the OptiMARK group, and 18 events in 13 patients in the Magnevist group. Headache was the most common adverse event, occurring in 10.1% of the OptiMARK patients and 12.8% of the Magnevist patients. No clinically relevant trends were observed in any laboratory parameter or ECG findings in either treatment group. The results demonstrate the safety, efficacy, and equivalence of OptiMARK and Magnevist at a dose of 0.1 mmol/kg in hepatic magnetic resonance imaging of patients with suspected liver pathology.

  View details for Web of Science ID 000080144400014

  View details for PubMedID 10077020

• Use of color and power Doppler sonography to identify feeding arteries associated with parathyroid adenomas AMERICAN JOURNAL OF ROENTGENOLOGY Lane, M. J., Desser, T. S., Weigel, R. J., Jeffrey, R. B. 1998; 171 (3): 819-823

  Abstract

  The objective of our study was to determine the value of using color and power Doppler sonography to reveal extrathyroidal feeding arteries in the detection of abnormal parathyroid glands.Forty-four patients with primary hyperparathyroidism were imaged prospectively with high-resolution gray-scale, color flow, and power Doppler sonography. The presence of extrathyroidal arteries supplying the adenomas was noted. All patients underwent subsequent neck exploration. The locations of the abnormal glands were recorded.At surgery, 51 abnormal parathyroid glands were removed in the 44 patients. Sonography correctly revealed an adenoma in 40 of the 44 patients. Likewise, sonography revealed 42 of the 51 adenomas. Nine false-negative and two false-positive interpretations of the sonograms were made. Thus, overall sensitivity was 83%, specificity was 98%, and accuracy was 94%. Three of the false-negative interpretations were ectopic glands within the superior mediastinum. Excluding these three glands from analysis, the sensitivity for detection of adenomas within the neck was 88%, specificity was 98%, and accuracy was 95%. An extrathyroidal artery leading to a parathyroid adenoma was seen in 35 of the 42 adenomas revealed by sonography. The presence of an extrathyroidal artery leading to an adenoma was found to aid in the detection of an otherwise inconspicuous parathyroid gland in five patients, which improved sensitivity from 73% to 83%.Prominent vessels supplying parathyroid adenomas are frequently revealed by color flow and power Doppler sonography. These vessels can serve as "road maps" to abnormal parathyroid glands.

  View details for Web of Science ID 000075496700057

  View details for PubMedID 9725323

• Color and Power Doppler Sonography: Techniques, Clinical Applications, and Trade-offs for Image Optimization Ultrasound Quarterly Desser TS, Jedrzejewicz, Haller M 1998; 14 (3): 128-49
• Pictorial essay: Solitary fibrous tumor of the pleura JOURNAL OF THORACIC IMAGING Desser, T. S., Stark, P. 1998; 13 (1): 27-35

  Abstract

  Solitary fibrous tumor of the pleura (previously known as benign fibrous mesothelioma or pleural fibroma) can have a wide variety of appearances on imaging examinations. This essay reviews some of the lesion's more dramatic features.

  View details for Web of Science ID 000071112300007

  View details for PubMedID 9440836

• NANOPARTICULATE CONTRAST-MEDIA - BLOOD-POOL AND LIVER-SPLEEN IMAGING 1993 Meeting of Contrast Media Research (CMR 93) Rubin, D. L., Desser, T. S., Qing, F., Muller, H. H., Young, S. W., McIntire, G. L., Bacon, E., Cooper, E., Toner, J. LIPPINCOTT WILLIAMS & WILKINS. 1994: S280–S283

  View details for Web of Science ID A1994NX79500096

  View details for PubMedID 7928256

• QUANTITATION OF SATURATION EFFECTS VERSUS DOSE IN 3-DIMENSIONAL TIME-OF-FLIGHT MAGNETIC-RESONANCE ANGIOGRAPHY WITH BLOOD-POOL CONTRAST AGENTS 1993 Meeting of Contrast Media Research (CMR 93) Desser, T. S., Rubin, D. L., Fan, Q., Muller, H. H., Young, S. W., Kellar, K. E., WELLONS, J. A., Ladd, D. L., Toner, J. L., Snow, R. A. LIPPINCOTT WILLIAMS & WILKINS. 1994: S65–S68

  View details for Web of Science ID A1994NX79500022

  View details for PubMedID 7928274

• DYNAMICS OF TUMOR IMAGING WITH GD-DTPA POLYETHYLENE-GLYCOL POLYMERS - DEPENDENCE ON MOLECULAR-WEIGHT JOURNAL OF MAGNETIC RESONANCE IMAGING Desser, T. S., Rubin, D. L., Muller, H. H., Qing, F., KHODOR, S., Zanazzi, G., Young, S. W., Ladd, D. L., WELLONS, J. A., Kellar, K. E., Toner, J. L., Snow, R. A. 1994; 4 (3): 467-472

  Abstract

  Macromolecular contrast media offer potential advantages over freely diffusible agents in magnetic resonance (MR) imaging outside the central nervous system. To identify an optimum molecular weight for macromolecular contrast media, the authors studied a novel macromolecular contrast agent, gadolinium diethylenetriaminepentaacetic acid polyethylene glycol (DTPA-PEG), synthesized in seven polymer (average) molecular weights ranging from 10 to 83 kd. Twenty-eight rabbits bearing V2 carcinoma in thighs underwent T1-weighted spin-echo imaging before injection and 5-60 minutes and 24 hours after injection of the Gd-DTPA-PEG polymers or Gd-DTPA at a gadolinium dose of 0.1 mmol/kg. Tumor region-of-interest measurements were obtained at each time point to determine contrast enhancement dynamics. Blood-pool enhancement dynamics were observed for the Gd-DTPA-PEG polymers larger than 20 kd. Polymers smaller than 20 kd displayed dynamics similar to those of the freely diffusible agent Gd-DTPA. Above the 20 kd threshold, tumor enhancement was more rapid for smaller polymers. The authors conclude that the 21.9-kd Gd-DTPA-PEG polymer is best suited for clinical MR imaging.

  View details for Web of Science ID A1994NP29200033

  View details for PubMedID 8061449

• SCAPHOID FRACTURES AND KIENBOCKS DISEASE OF THE LUNATE - MR IMAGING WITH HISTOPATHOLOGIC CORRELATION MAGNETIC RESONANCE IMAGING Desser, T. S., McCarthy, S., Trumble, T. 1990; 8 (4): 357-361

  Abstract

  Thirteen patients with scaphoid fractures and four patients with Kienbock's disease of the lunate underwent magnetic resonance imaging (MRI) prior to surgery. A total of 28 specimens had MR-histologic correlation. Biopsy specimens obtained by curettage provided pathologic correlation. MRI proved accurate in prospective evaluation of bone viability for both scaphoid fractures and Kienbock's disease. Normal marrow signal was shown to correlate with the presence of osteoid and osteocytes on light microscopy and a surface layer of fluorescence reflecting tetracycline uptake in viable bone. Decreased marrow signal corresponded to non-viable trabeculae with scant osteoid, without osteocytes and no tetracycline labeling. By virtue of its accurate identification of avascular necrosis, MRI may prove valuable in predicting prognosis for patients with scaphoid fractures and Kienbock's disease of the lunate.

  View details for Web of Science ID A1990DP66500002

  View details for PubMedID 2392023

• BRACHIAL-PLEXUS - CORRELATION OF MR IMAGING WITH CT AND PATHOLOGIC FINDINGS RADIOLOGY Rapoport, S., Blair, D. N., McCarthy, S. M., Desser, T. S., Hammers, L. W., Sostman, H. D. 1988; 167 (1): 161-165

  Abstract

  Thirty-two patients with symptoms referable to the brachial plexus were evaluated with magnetic resonance (MR) imaging. Sixteen patients had undergone concurrent computed tomography (CT). MR imaging demonstrated normal findings in 16, 12 neoplasms, three cases of trauma, and one case of possible neural edema. Of the 16 patients with normal findings on MR images, eight had CT scans that were also normal. In one patient, MR images showed that the "mass" seen on CT was actually a tortuous blood vessel. In six of the 12 cases of neoplasm in which CT scans were available, MR imaging revealed more extensive disease. In the other six cases of tumor, MR imaging provided sufficient clinical information to obviate the need for CT or any other imaging modality. MR imaging provided definitive diagnoses in the three cases of trauma without further imaging. In one patient with paresthesia, MR imaging showed high signal intensity of the nerves on T2-weighted images, which was compatible with neural edema. A concurrent CT scan was normal.

  View details for Web of Science ID A1988M653600035

  View details for PubMedID 3347719