Nancy Pham

All Publications

• Update on Imaging of Nasopharyngeal Carcinoma. Radiologic clinics of North America Fischbein, N. J., Colevas, A. D., Le, Q. T., Pham, N. 2026; 64 (1): 17-34

  Abstract

  Nasopharyngeal carcinoma (NPC) has a unique epidemiologic profile and a strong association with the Epstein-Barr virus. Radiologists should be familiar with the recently updated American Joint Committee on Cancer/Union for International Cancer Control version 9 staging system, effective January 1, 2025 and reviewed herein. NPC is usually treated with radiation and chemotherapy, with surgery reserved for persistent or recurrent resectable disease at the primary site or neck. Following primary treatment, patients typically undergo both clinical/laboratory and imaging surveillance, and radiologists should recognize recurrent disease and be familiar with the imaging appearance of treatment-related complications.

  View details for DOI 10.1016/j.rcl.2025.03.019

  View details for PubMedID 41233053

• Prospective MR Evaluation of Endolymphatic Hydrops at Multiple Flip Angles Using Single-Dose Gadolinium Contrast. AJNR. American journal of neuroradiology Pham, N., Kullar, P., Fischbein, N., Malik, S., Landegger, L. D., Fu, F., Blevins, N. 2025

  Abstract

  Technical advancements in inner ear MRI promise improved diagnosis and management of Ménière disease (MD), but a key challenge in optimizing 3D-FLAIR protocols for inner ear imaging lies in selecting the optimal flip angle. This study evaluates the 3 most common flip angle parameters used in 3D-FLAIR imaging for MD through a prospective, head-to-head comparison of image quality at constant flip angle (CFA) 120°, CFA 140°, and variable flip angle (VFA) obtained 4 hours after IV administration of a single-dose gadolinium-based contrast agent.We prospectively enrolled 16 consecutive patients at our institution's otology clinic on the basis of the 2015 American Academy of Otolaryngology-Head and Neck Surgery criteria for MD, including acute or fluctuating symptoms of vertigo, hearing loss, tinnitus, or aural fullness. Each patient underwent delayed inner ear MRI at 3T with the 3 most commonly used flip angles: CFA 120°, CFA 140°, and VFA. The contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR) were determined for each flip angle. Assessment of blood-labyrinthine barrier (BLB) permeability, utricle-saccule discrimination, and endolymphatic hydrops (EH) was performed by 2 head and neck neuroradiologists.Thirty-one ears were analyzed. One ear was excluded on the basis of a prior history of left labyrinthectomy after failed medical management of MD. There were 17 symptomatic and 14 asymptomatic ears determined by clinical and hearing evaluation. The SNR of the perilymphatic space and CNR of the endolymphatic space were significantly higher at CFA 140°, followed by CFA 120°, and then VFA (P < .05). There was significantly improved visualization of EH, the utricle-saccule complex, and BLB permeability at CFA 140° (P < .05), with excellent interobserver agreement (κ > 0.80).Our study demonstrates that 3D-FLAIR inner ear imaging using CFA 140° and single-dose IV gadolinium contrast at 3T is a reliable method for detecting EH.

  View details for DOI 10.3174/ajnr.A8880

  View details for PubMedID 41298110

• Sleep apnea at the frontier- an integrated multidisciplinary functional framework. Sleep medicine reviews Beache, G. M., Hutchinson, B., Raman, B., Macey, P. M., Pham, N., Rodriguez-Lozano, P. F., Redeker, N. S., Somers, V. K. 2025; 84: 102190

  Abstract

  In this review, we propose a systems-motivated approach to sleep apnea, as a well characterized disorder illustrative of the sleep-wake process. We advance a framework with mechanistic underpinning of the insulin-resistant cardiometabolic effects of obesity and its putative bi-directional relationship with sleep apnea. Such a physiological construct affords an integrated perspective where pathophysiological outcomes in the brain and heart can be objectively characterized by imaging methods that index functional derangements, including those related to clinical measures of metabolism and ischemia, as well as to translational indices of neurotransmitter signaling. A provocative complexity-analysis network model is explored as a novel formalism for brain macro-phenomena, such as the sleep-wake process, as an emergent property arising from the collective interactions of its micro-constituent very large number of neurons. Clinical management is highlighted at the intersection of guideline-directed cardiometabolic- and sleep- medicine, biopsychosocial interventions, and incorporation of newer pharmacological therapeutic advancements. Together, these disparate developments herald a new functional/physiological synergistic era in sleep medicine.

  View details for DOI 10.1016/j.smrv.2025.102190

  View details for PubMedID 41274210

• Artificial Intelligence in Primary Malignant Bone Tumor Imaging: A Narrative Review. Diagnostics (Basel, Switzerland) Papageorgiou, P. S., Christodoulou, R., Korfiatis, P., Papagelopoulos, D. P., Papakonstantinou, O., Pham, N., Woodward, A., Papagelopoulos, P. J. 2025; 15 (13)

  Abstract

  Artificial Intelligence (AI) has emerged as a transformative force in orthopedic oncology, offering significant advances in the diagnosis, classification, and prediction of treatment response for primary malignant bone tumors (PBT). Through machine learning and deep learning techniques, AI leverages computational algorithms and large datasets to enhance medical imaging interpretation and support clinical decision-making. The integration of radiomics with AI enables the extraction of quantitative features from medical images, allowing for precise tumor characterization and the development of personalized therapeutic strategies. Notably, convolutional neural networks have demonstrated exceptional capabilities in pattern recognition, significantly improving tumor detection, segmentation, and differentiation. This narrative review synthesizes the evolving applications of AI in PBTs, focusing on early tumor detection, imaging analysis, therapy response prediction, and histological classification. AI-driven radiomics and predictive models have yielded promising results in assessing chemotherapy efficacy, optimizing preoperative imaging, and predicting treatment outcomes, thereby advancing the field of precision medicine. Innovative segmentation techniques and multimodal imaging models have further enhanced healthcare efficiency by reducing physician workload and improving diagnostic accuracy. Despite these advancements, challenges remain. The rarity of PBTs limits the availability of robust, high-quality datasets for model development and validation, while the lack of standardized imaging protocols complicates reproducibility. Ethical considerations, including data privacy and the interpretability of complex AI algorithms, also warrant careful attention. Future research should prioritize multicenter collaborations, external validation of AI models, and the integration of explainable AI systems into clinical practice. Addressing these challenges will unlock AI's full potential to revolutionize PBT management, ultimately improving patient outcomes and advancing personalized care.

  View details for DOI 10.3390/diagnostics15131714

  View details for PubMedID 40647712

  View details for PubMedCentralID PMC12248882

• The State of High-Resolution Imaging of the Human Inner Ear: A Look Into the Black Box. Advanced science (Weinheim, Baden-Wurttemberg, Germany) Batts, S., Pham, N., Tearney, G., Stankovic, K. M. 2025: e00556

  Abstract

  Unlike most medical fields, otology has not benefited from the transformative impact of high-resolution, cellular-level imaging. The sensorineural cells required for human hearing-located within the cochlea-are just 10-50 µm, placing them outside the resolution of magnetic resonance imaging, computed tomography, and positron emission tomography. These cells are highly mechano- and chemo-sensitive, and their death or dysfunction underlie the vast majority of hearing loss. Further, the cochlea is only 4-7 mm in diameter, has complex anatomy, and is deeply embedded in bone. Cochlear blood flow is partially separated by a blood barrier, limiting access to radiotracers or fluorophores. These and other features have left the human cochlea as a "black box" that cannot be assessed with high precision in vivo, limiting the development of novel hearing loss therapies. The benefits and drawbacks of existing medical imaging techniques used to diagnose disorders of the human inner ear are discussed, as well as those of emerging technologies that may help overcome challenges to access, resolution, and functional detail. A comprehensive and up-to-date discussion is provided on research efforts to improve and adapt current clinical imaging methods and introduce recent innovations that have shown exciting promise for deriving both structural and metabolic information from cochlear cells.

  View details for DOI 10.1002/advs.202500556

  View details for PubMedID 40470704

• Deep Learning Applications in Imaging of Acute Ischemic Stroke: A Systematic Review and Narrative Summary. Radiology Jiang, B., Pham, N., van Staalduinen, E. K., Liu, Y., Nazari-Farsani, S., Sanaat, A., van Voorst, H., Fettahoglu, A., Kim, D., Ouyang, J., Kumar, A., Srivatsan, A., Hussein, R., Lansberg, M. G., Boada, F., Zaharchuk, G. 2025; 315 (1): e240775

  Abstract

  Background Acute ischemic stroke (AIS) is a major cause of morbidity and mortality, requiring swift and precise clinical decisions based on neuroimaging. Recent advances in deep learning-based computer vision and language artificial intelligence (AI) models have demonstrated transformative performance for several stroke-related applications. Purpose To evaluate deep learning applications for imaging in AIS in adult patients, providing a comprehensive overview of the current state of the technology and identifying opportunities for advancement. Materials and Methods A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of four databases from January 2016 to January 2024 was performed, targeting deep learning applications for imaging of AIS, including automated detection of large vessel occlusion and measurement of Alberta Stroke Program Early CT Score. Articles were selected based on predefined inclusion and exclusion criteria, focusing on convolutional neural networks and transformers. The top-represented areas were addressed, and the relevant information was extracted and summarized. Results Of 380 studies included, 171 (45.0%) focused on stroke lesion segmentation, 129 (33.9%) on classification and triage, 31 (8.2%) on outcome prediction, 15 (3.9%) on generative AI and large language models, and 11 (2.9%) on rapid or low-dose imaging specific to stroke applications. Detailed data extraction was performed for 68 studies. Public AIS datasets are also highlighted, for researchers developing AI models for stroke imaging. Conclusion Deep learning applications have permeated AIS imaging, particularly for stroke lesion segmentation. However, challenges remain, including the need for standardized protocols and test sets, larger public datasets, and performance validation in real-world settings. © RSNA, 2025 Supplemental material is available for this article.

  View details for DOI 10.1148/radiol.240775

  View details for PubMedID 40197098

• Clival fibrous dysplasia in which short interval disease progression posed a diagnostic challenge in a skeletally mature patient: a case report. Journal of medical case reports Tinnut, S., Pham, N., Nayak, J., Fernandez-Miranda, J. C., Vogel, H., Fischbein, N. 2025; 19 (1): 83

  Abstract

  Fibrous dysplasia is an uncommon bone disorder in which medullary bone is replaced by disorganized fibro-osseous tissue. Fibrous dysplasia typically exhibits slow growth that stabilizes with skeletal maturity. We report a case in which rapid progression of a clival lesion otherwise typical for fibrous dysplasia in an adult male led to concern for a malignant rather than a benign lesion.A 38 year-old white male developed eye pain, and magnetic resonance imaging of the brain was interpreted as normal. A total of 2 years later, the patient again presented with eye pain, and a repeat magnetic resonance imaging study demonstrated interval development of a lesion replacing much of the clivus. Though the lesion appeared fairly typical of fibrous dysplasia, with magnetic resonance imaging and subsequent computed tomography revealing a well-defined and mildly expansile clival lesion, lesions of fibrous dysplasia do not typically appear in skeletally mature patients, and they are generally indolent. On the basis of concern for malignant degeneration or possibly an alternative diagnosis, as the patient had been referred to our center with a diagnosis of clival chordoma, the lesion was treated with endoscopic resection. The diagnosis of typical fibrous dysplasia was ultimately confirmed through histopathological, immunohistochemical, and genetic analysis.This case demonstrates the potential for development and progression of benign fibrous dysplasia lesions beyond skeletal maturity, a phenomenon rarely reported in literature and not previously demonstrated in the clivus.

  View details for DOI 10.1186/s13256-025-05104-6

  View details for PubMedID 40022171

  View details for PubMedCentralID 3495859

• Case report: Dramatic impact of DNA next generation sequencing results using specific targeted therapies-ALK and PIK3CA. Frontiers in oncology Cullum, S., Vang, H., Glover, M., Alammarah, H., Morton, H., Pham, N., Rahman, M., Khan, S. A. 2024; 14: 1462930

  Abstract

  In the era of targeted therapies, the clinical importance and utility of next-generation sequencing (NGS) has expanded significantly. Owing to the relative ease and financial feasibility of NGS, the use of personalized treatment strategies has the potential to revolutionize cancer care. In this case report, we explored the use of NGS in salivary gland carcinoma (SGC) and spindle cell neoplasm of the scalp. In our patient with SGC, NGS revealed a GPHN-ALK variant that allowed off-label treatment with alectinib, with a remarkable response in primary and metastatic foci. Similarly, the use of NGS in a cutaneous neoplasm in which no definitive diagnosis could be reached by pathology and which had progressed through standard of care treatment elucidated a PIK3CA mutation in which alpelisib was added and ultimately halted POD. Here, we discuss the use of NGS, future projections, and our recommendations.

  View details for DOI 10.3389/fonc.2024.1462930

  View details for PubMedID 39659799

  View details for PubMedCentralID PMC11628483

• Phosphaturic Mesenchymal Tumor and Tumor-Induced Osteomalacia: A Report of 5 Cases, Including 2 Skull Base Cases With Arterial Spin Label Perfusion. Journal of computer assisted tomography Grewal, I., Fischbein, N., Dodd, R., Lee, K. C., Fernandez-Miranda, J., Sellmeyer, E. D., Pham, N. 2024

  Abstract

  Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by renal phosphate wasting and impaired bone mineralization secondary to secretion of fibroblast growth factor 23 (FGF23) from mesenchymal tumors (phosphaturic mesenchymal tumors, PMTs). PMTs have wide anatomical distribution but typically affect extremities and craniofacial bones. Diagnosis of TIO/PMT is often delayed, and a high index of suspicion is essential in patients with unexplained fractures, but many physicians lack familiarity with TIO/PMT and simply attribute fractures to the more common diagnosis of osteoporosis. We present 5 cases of TIO, with 4 having long histories of multiple insufficiency fractures prior to recognition of TIO and localization of a PMT. Four patients were treated surgically, while 1 preferred medical management. Two patients had lesions localized to the skull base, both of which showed marked hypervascularity on arterial spin label perfusion imaging. Thus, arterial spin label may not only help to localize these tumors, but may also be a helpful supplemental imaging finding in supporting this diagnosis. PMT should be considered in the differential diagnosis for hypervascular skull base masses, especially if the patient has any history of insufficiency fracture or imaging evidence of osteopenia, as early diagnosis of TIO can help prevent disabling complications.

  View details for DOI 10.1097/RCT.0000000000001676

  View details for PubMedID 39511819

• Cochlear Implantation: Current and Future Roles of Imaging Before, During, and After Implantation CURRENT RADIOLOGY REPORTS Walker, N., Pham, N., Ledbetter, L. 2023

  View details for DOI 10.1007/s40134-023-00414-3

  View details for Web of Science ID 001005811200001