Current Role at Stanford

Lead Clinical Scientist, Cardiovascular Imaging, Department of Radiology

Honors & Awards

  • Cardiovascular Imaging T32 Fellow, Stanford University (2020)
  • Editors' Award for Distinction in Reviewing, Journal of Thoracic Imaging Editorial Board (2020)
  • Reviewer of the Year Award, European Radiology Experimental (ER-X) (2019)
  • Editors’ Award for Distinction in Reviewing, Journal of Thoracic Imaging (JTI) (2018)
  • Invest in the Youth Programme - European Congress of Radiology (ECR), European Society of Radiology (ESR) (2018)
  • ISMRM Trainee Research Prize, International Society for Magnetic Resonance in Medicine (ISMRM) (2017)
  • AHA-CVRI Young Investigator Award Winner, North American Society for Cardiovascular Imaging (NASCI) (2017)
  • Student Travel Award, Radiological Society of North America (RSNA) (2017)

Education & Certifications

  • Residency, "G. d'Annunzio University" - Chieti, Italy, Radiology (2018)
  • MD, "G. d'Annunzio University" - Chieti, Italy, Medicine (2012)

Service, Volunteer and Community Work

  • Stanford CVI Early Career Comittee Member, Stanford Cardiovascular Institute (2021 - Present)


    Stanford, CA

All Publications

  • Inter-observer variability of expert-derived morphologic risk predictors in aortic dissection. European radiology Willemink, M. J., Mastrodicasa, D., Madani, M. H., Codari, M., Chepelev, L. L., Mistelbauer, G., Hanneman, K., Ouzounian, M., Ocazionez, D., Afifi, R. O., Lacomis, J. M., Lovato, L., Pacini, D., Folesani, G., Hinzpeter, R., Alkadhi, H., Stillman, A. E., Sailer, A. M., Turner, V. L., Hinostroza, V., Baumler, K., Chin, A. S., Burris, N. S., Miller, D. C., Fischbein, M. P., Fleischmann, D. 2022


    OBJECTIVES: Establishing the reproducibility of expert-derived measurements on CTA exams of aortic dissection is clinically important and paramount for ground-truth determination for machine learning.METHODS: Four independent observers retrospectively evaluated CTA exams of 72 patients with uncomplicated Stanford type B aortic dissection and assessed the reproducibility of a recently proposed combination of four morphologic risk predictors (maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and intercostal arteries). For the first inter-observer variability assessment, 47 CTA scans from one aortic center were evaluated by expert-observer 1 in an unconstrained clinical assessment without a standardized workflow and compared to a composite of three expert-observers (observers 2-4) using a standardized workflow. A second inter-observer variability assessment on 30 out of the 47 CTA scans compared observers 3 and 4 with a constrained, standardized workflow. A third inter-observer variability assessment was done after specialized training and tested between observers 3 and 4 in an external population of 25 CTA scans. Inter-observer agreement was assessed with intraclass correlation coefficients (ICCs) and Bland-Altman plots.RESULTS: Pre-training ICCs of the four morphologic features ranged from 0.04 (-0.05 to 0.13) to 0.68 (0.49-0.81) between observer 1 and observers 2-4 and from 0.50 (0.32-0.69) to 0.89 (0.78-0.95) between observers 3 and 4. ICCs improved after training ranging from 0.69 (0.52-0.87) to 0.97 (0.94-0.99), and Bland-Altman analysis showed decreased bias and limits of agreement.CONCLUSIONS: Manual morphologic feature measurements on CTA images can be optimized resulting in improved inter-observer reliability. This is essential for robust ground-truth determination for machine learning models.KEY POINTS: Clinical fashion manual measurements of aortic CTA imaging features showed poor inter-observer reproducibility. A standardized workflow with standardized training resulted in substantial improvements with excellent inter-observer reproducibility. Robust ground truth labels obtained manually with excellent inter-observer reproducibility are key to develop reliable machine learning models.

    View details for DOI 10.1007/s00330-022-09056-z

    View details for PubMedID 36029344

  • Radiologists staunchly support patient safety and autonomy, in opposition to the SCOTUS decision to overturn Roe v Wade. Clinical imaging Karandikar, A., Solberg, A., Fung, A., Lee, A. Y., Farooq, A., Taylor, A. C., Oliveira, A., Narayan, A., Senter, A., Majid, A., Tong, A., McGrath, A. L., Malik, A., Brown, A. L., Roberts, A., Fleischer, A., Vettiyil, B., Zigmund, B., Park, B., Curran, B., Henry, C., Jaimes, C., Connolly, C., Robson, C., Meltzer, C. C., Phillips, C. H., Dove, C., Glastonbury, C., Pomeranz, C., Kirsch, C. F., Burgan, C. M., Scher, C., Tomblinson, C., Fuss, C., Santillan, C., Daye, D., Brown, D. B., Young, D. J., Kopans, D., Vargas, D., Martin, D., Thompson, D., Jordan, D. W., Shatzkes, D., Sun, D., Mastrodicasa, D., Smith, E., Korngold, E., Dibble, E. H., Arleo, E. K., Hecht, E. M., Morris, E., Maltin, E. P., Cooke, E. A., Schwartz, E. S., Lehrman, E., Sodagari, F., Shah, F., Doo, F. X., Rigiroli, F., Vilanilam, G. K., Landinez, G., Kim, G. G., Rahbar, H., Choi, H., Bandesha, H., Ojeda-Fournier, H., Ikuta, I., Dragojevic, I., Schroeder, J. L., Ivanidze, J., Katzen, J. T., Chiang, J., Nguyen, J., Robinson, J. D., Broder, J. C., Kemp, J., Weaver, J. S., Conyers, J. M., Robbins, J. B., Leschied, J. R., Wen, J., Park, J., Mongan, J., Perchik, J., Barbero, J. P., Jacob, J., Ledbetter, K., Macura, K. J., Maturen, K. E., Frederick-Dyer, K., Dodelzon, K., Cort, K., Kisling, K., Babagbemi, K., McGill, K. C., Chang, K. J., Feigin, K., Winsor, K. S., Seifert, K., Patel, K., Porter, K. K., Foley, K. M., Patel-Lippmann, K., McIntosh, L. J., Padilla, L., Groner, L., Harry, L. M., Ladd, L. M., Wang, L., Spalluto, L. B., Mahesh, M., Marx, M. V., Sugi, M. D., Sammer, M. B., Sun, M., Barkovich, M. J., Miller, M. J., Vella, M., Davis, M. A., Englander, M. J., Durst, M., Oumano, M., Wood, M. J., McBee, M. P., Fischbein, N. J., Kovalchuk, N., Lall, N., Eclov, N., Madhuripan, N., Ariaratnam, N. S., Vincoff, N. S., Kothary, N., Yahyavi-Firouz-Abadi, N., Brook, O. R., Glenn, O. A., Woodard, P. K., Mazaheri, P., Rhyner, P., Eby, P. R., Raghu, P., Gerson, R. F., Patel, R., Gutierrez, R. L., Gebhard, R., Andreotti, R. F., Masum, R., Woods, R., Mandava, S., Harrington, S. G., Parikh, S., Chu, S., Arora, S. S., Meyers, S. M., Prabhu, S., Shams, S., Pittman, S., Patel, S. N., Payne, S., Hetts, S. W., Hijaz, T. A., Chapman, T., Loehfelm, T. W., Juang, T., Clark, T. J., Potigailo, V., Shah, V., Planz, V., Kalia, V., DeMartini, W., Dillon, W. P., Gupta, Y., Koethe, Y., Hartley-Blossom, Z., Wang, Z. J., McGinty, G., Haramati, A., Allen, L. M., Germaine, P. 2022

    View details for DOI 10.1016/j.clinimag.2022.07.011

    View details for PubMedID 36064645

  • Multi-modality Imaging Evaluation of a Rare and Complex Case of Single Ventricle Physiology; the important role of Cardiac MR. Acta bio-medica : Atenei Parmensis Mantini, C., Mastrodicasa, D., Di Mascio, V., Procaccini, L., Olivieri, M., Scarano, M., Ricci, F., Cademartiri, F. 2022; 93 (S1): e2022110


    Congenital heart diseases (CHD) represent a major clinical and diagnostic challenge for correct abnormality identification and subsequent successful therapy; even more challenging is following-up patient health after multiple post-interventional corrections often required in complex cardio-vascular abnormalities. We describe a multi-modality imaging evaluation of a complex congenital cardio-vascular diseases, underlining the relevance of cardiac magnetic resonance to non invasively solve some issues related to postsurgical changes.

    View details for DOI 10.23750/abm.v92iS1.10864

    View details for PubMedID 35671106

  • Tetralogy of Fallot and Aortic Dissection: Implications in Management. JACC. Case reports Vaikunth, S. S., Chan, J. L., Woo, J. P., Bykhovsky, M. R., Lui, G. K., Ma, M., Romfh, A. W., Lamberti, J., Mastrodicasa, D., Fleischmann, D., Fischbein, M. P. 2022; 4 (10): 581-586


    We present the case of a 61-year-old man with tetralogy of Fallot postrepair and mechanical aortic valve replacement with an aortic root/ascending/arch aneurysm with chronic type A aortic dissection. He underwent uncomplicated aortic root and total arch replacement. Continued surveillance for aortic aneurysm is necessary in the tetralogy of Fallot population. (Level of Difficulty: Intermediate.).

    View details for DOI 10.1016/j.jaccas.2022.02.021

    View details for PubMedID 35615213

  • Vieussens' ring coronary collateral circulation: a natural bypass history. Acta bio-medica : Atenei Parmensis Mantini, C., Di Mascio, V., Mastrodicasa, D., Olivieri, M., Procaccini, L., Clemente, A., Ricci, F., Cademartiri, F. 2022; 93 (S1): e2022111


    "Vieussens' ring" or "arterial circle of Vieussens" is a crucial hetero-coronaric pathway, bridging proximal right coronary artery (RCA) and left anterior descending artery (LAD) when a hemodynamically stenosis is established in the either of the vessel. In detail such coronary collateral circulation is usually supplied by branches of the conus artery. We present a case of a 62-year-old man who was admitted to our emergency department complaining of chest pain. Coronary angiography showed LAD occlusion at the mid tract with delayed and slight opacification of its distal segment sustained by Vieussens' ring. Coronary computed tomography angiography (CCTA) was subsequently performed which confirmed the presence of such natural bypass and evaluated its relationship with adjacent structures. Imaging, particularly CCTAoffers a valid tool in assessing the hetero-coronaric collateral vessel. Due to its high spatial resolution it may provide many information about the coronary anatomy by delineating their origin, course and termination.

    View details for DOI 10.23750/abm.v93iS1.10865

    View details for PubMedID 35380556

  • Conspicuity and muscle-invasiveness assessment for bladder cancer using VI-RADS: a multi-reader, contrast-free MRI study to determine optimal b-values for diffusion-weighted imaging. Abdominal radiology (New York) Delli Pizzi, A., Mastrodicasa, D., Taraschi, A., Civitareale, N., Mincuzzi, E., Censi, S., Marchioni, M., Primiceri, G., Castellan, P., Castellucci, R., Cocco, G., Chiacchiaretta, P., Colasante, A., Corvino, A., Schips, L., Caulo, M. 2022


    OBJECTIVE: To (1) compare bladder cancer (BC) muscle invasiveness among three b-values using a contrast-free approach based on Vesical Imaging-Reporting and Data System (VI-RADS), to (2) determine if muscle-invasiveness assessment is affected by the reader experience, and to (3) compare BC conspicuity among three b-values, qualitatively and quantitatively.METHODS: Thirty-eight patients who underwent a bladder MRI on a 3.0-T scanner were enrolled. The gold standard was histopathology report following transurethral resection of BC. Three sets of images, including T2w and different b-values for DWI, set 1 (b=1000s/mm2), set 2 (b=1500s/mm2), and set 3 (b=2000 s/mm2), were reviewed by three differently experienced readers. Descriptive statistics and Intraclass Correlation Coefficient (ICC) were calculated. Comparisons among readers and DWI sets were performed with the Wilcoxon test. Receiver operating characteristic (ROC) analysis was performed. Areas under the curves (AUCs) and pairwise comparison were calculated.RESULTS: AUCs of muscle-invasiveness assessment ranged from 0.896 to 0.984 (reader 1), 0.952-0.968 (reader 2), and 0.952-0.984 (reader 3) without significant differences among different sets and readers (p>0.05). The mean conspicuity qualitative scores were higher in Set 1 (2.21-2.33), followed by Set 2 (2-2.16) and Set 3 (1.82-2.14). The quantitative conspicuity assessment showed that mean normalized intensity of tumor was significantly higher in Set 2 (4.217-4.737) than in Set 1 (3.923-4.492) and Set 3 (3.833-3.992) (p<0.05).CONCLUSION: Muscle invasiveness can be assessed with high accuracy using a contrast-free protocol with T2W and DWI, regardless of reader's experience. b=1500s/mm2 showed the best tumor delineation, while b=1000s/mm2 allowed for better tumor-wall interface assessment.

    View details for DOI 10.1007/s00261-022-03490-9

    View details for PubMedID 35303112

  • Low-dose coronary calcium scoring CT using a dedicated reconstruction filter for kV-independent calcium measurements. European radiology Jubran, A., Mastrodicasa, D., van Praagh, G. D., Willemink, M. J., Kino, A., Wang, J., Fleischmann, D., Nieman, K. 1800


    In this prospective, pilot study, we tested a kV-independent coronary artery calcium scoring CT protocol, using a novel reconstruction kernel (Sa36f). From December 2018 to November 2019, we performed an additional research scan in 61 patients undergoing clinical calcium scanning. For the standard protocol (120 kVp), images were reconstructed with a standard, medium-sharp kernel (Qr36d). For the research protocol (automated kVp selection), images were reconstructed with a novel kernel (Sa36f). Research scans were sequentially performed using a higher (cohort A, n=31) and a lower (cohort B, n=30) dose optimizer setting within the automatic system with customizable kV selection. Agatston scores, coronary calcium volumes, and radiation exposure of the standard and research protocol were compared. A phantom study was conducted to determine inter-scan variability. There was excellent correlation for the Agatston score between the two protocols (r=0.99); however, the standard protocol resulted in slightly higher Agatston scores (29.4 [0-139.0] vs 17.4 [0-158.2], p=0.028). The median calcium volumes were similar (11.5 [0-109.2] vs 11.2 [0-118.0] mm3; p=0.176), and the number of calcified lesions was not significantly different (p=0.092). One patient was reclassified to another risk category. The research protocol could be performed at a lower kV and resulted in a substantially lower radiation exposure, with a median volumetric CT dose index of 4.1 vs 5.2mGy, respectively (p<0.001). Our results showed that a consistent coronary calcium scoring can be achieved using a kV-independent protocol that lowers radiation doses compared to the standard protocol. KEY POINTS: The Sa36f kernel enables kV-independent Agatston scoring without changing the original Agatston weighting threshold. Agatston scores and calcium volumes of the standard and research protocols showed an excellent correlation. The research protocol resulted in a significant reduction in radiation exposure with a mean reduction of 22% in DLP and 25% in CTDIvol.

    View details for DOI 10.1007/s00330-021-08451-2

    View details for PubMedID 34989838

  • Radiomics-based machine learning differentiates "ground-glass" opacities due to COVID-19 from acute non-COVID-19 lung disease. Scientific reports Delli Pizzi, A., Chiarelli, A. M., Chiacchiaretta, P., Valdesi, C., Croce, P., Mastrodicasa, D., Villani, M., Trebeschi, S., Serafini, F. L., Rosa, C., Cocco, G., Luberti, R., Conte, S., Mazzamurro, L., Mereu, M., Patea, R. L., Panara, V., Marinari, S., Vecchiet, J., Caulo, M. 2021; 11 (1): 17237


    Ground-glass opacities (GGOs) are a non-specific high-resolution computed tomography (HRCT) finding tipically observed in early Coronavirus disesase 19 (COVID-19) pneumonia. However, GGOs are also seen in other acute lung diseases, thus making challenging the differential diagnosis. To this aim, we investigated the performance of a radiomics-based machine learning method to discriminate GGOs due to COVID-19 from those due to other acute lung diseases. Two sets of patients were included: a first set of 28 patients (COVID) diagnosed with COVID-19 infection confirmed by real-time polymerase chain reaction (RT-PCR) between March and April 2020 having (a) baseline HRCT at hospital admission and (b) predominant GGOs pattern on HRCT; a second set of 30 patients (nCOVID) showing (a) predominant GGOs pattern on HRCT performed between August 2019 and April 2020 and (b) availability of final diagnosis. Two readers independently segmented GGOs on HRCTs using a semi-automated approach, and radiomics features were extracted using a standard open source software (PyRadiomics). Partial least square (PLS) regression was used as the multivariate machine-learning algorithm. A leave-one-out nested cross-validation was implemented. PLS beta-weights of radiomics features, including the 5% features with the largest beta-weights in magnitude (top 5%), were obtained. The diagnostic performance of the radiomics model was assessed through receiver operating characteristic (ROC) analysis. The Youden's test assessed sensitivity and specificity of the classification. A null hypothesis probability threshold of 5% was chosen (p<0.05). The predictive model delivered an AUC of 0.868 (Youden's index=0.68, sensitivity=93%, specificity 75%, p=4.2*10-7). Of the seven features included in the top 5% features, five were texture-related. A radiomics-based machine learning signature showed the potential to accurately differentiate GGOs due to COVID-19 pneumonia from those due to other acute lung diseases. Most of the discriminant radiomics features were texture-related. This approach may assist clinician to adopt the appropriate management early, while improving the triage of patients.

    View details for DOI 10.1038/s41598-021-96755-0

    View details for PubMedID 34446812

  • Coronary Artery Calcium Scoring: Toward a New Standard. Investigative radiology van Praagh, G. D., Wang, J., van der Werf, N. R., Greuter, M. J., Mastrodicasa, D., Nieman, K., van Hamersvelt, R. W., Oostveen, L. J., Lange, F. d., Slart, R. H., Leiner, T., Fleischmann, D., Willemink, M. J. 2021


    OBJECTIVES: Although the Agatston score is a commonly used quantification method, rescan reproducibility is suboptimal, and different CT scanners result in different scores. In 2007, McCollough et al (Radiology 2007;243:527-538) proposed a standard for coronary artery calcium quantification. Advancements in CT technology over the last decade, however, allow for improved acquisition and reconstruction methods. This study aims to investigate the feasibility of a reproducible reduced dose alternative of the standardized approach for coronary artery calcium quantification on state-of-the-art CT systems from 4 major vendors.MATERIALS AND METHODS: An anthropomorphic phantom containing 9 calcifications and 2 extension rings were used. Images were acquired with 4 state-of-the-art CT systems using routine protocols and a variety of tube voltages (80-120 kV), tube currents (100% to 25% dose levels), slice thicknesses (3/2.5 and 1/1.25 mm), and reconstruction techniques (filtered back projection and iterative reconstruction). Every protocol was scanned 5 times after repositioning the phantom to assess reproducibility. Calcifications were quantified as Agatston scores.RESULTS: Reducing tube voltage to 100 kV, dose to 75%, and slice thickness to 1 or 1.25 mm combined with higher iterative reconstruction levels resulted in an on average 36% lower intrascanner variability (interquartile range) compared with the standard 120 kV protocol. Interscanner variability per phantom size decreased by 34% on average. With the standard protocol, on average, 6.2 ± 0.4 calcifications were detected, whereas 7.0 ± 0.4 were detected with the proposed protocol. Pairwise comparisons of Agatston scores between scanners within the same phantom size demonstrated 3 significantly different comparisons at the standard protocol (P < 0.05), whereas no significantly different comparisons arose at the proposed protocol (P > 0.05).CONCLUSIONS: On state-of-the-art CT systems of 4 different vendors, a 25% reduced dose, thin-slice calcium scoring protocol led to improved intrascanner and interscanner reproducibility and increased detectability of small and low-density calcifications in this phantom. The protocol should be extensively validated before clinical use, but it could potentially improve clinical interscanner/interinstitutional reproducibility and enable more consistent risk assessment and treatment strategies.

    View details for DOI 10.1097/RLI.0000000000000808

    View details for PubMedID 34261083

  • Impact of Upstream Medical Image Processing on Downstream Performance of a Head CT Triage Neural Network. Radiology. Artificial intelligence Hooper, S. M., Dunnmon, J. A., Lungren, M. P., Mastrodicasa, D., Rubin, D. L., Re, C., Wang, A., Patel, B. N. 2021; 3 (4): e200229


    Purpose: To develop a convolutional neural network (CNN) to triage head CT (HCT) studies and investigate the effect of upstream medical image processing on the CNN's performance.Materials and Methods: A total of 9776 HCT studies were retrospectively collected from 2001 through 2014, and a CNN was trained to triage them as normal or abnormal. CNN performance was evaluated on a held-out test set, assessing triage performance and sensitivity to 20 disorders to assess differential model performance, with 7856 CT studies in the training set, 936 in the validation set, and 984 in the test set. This CNN was used to understand how the upstream imaging chain affects CNN performance by evaluating performance after altering three variables: image acquisition by reducing the number of x-ray projections, image reconstruction by inputting sinogram data into the CNN, and image preprocessing. To evaluate performance, the DeLong test was used to assess differences in the area under the receiver operating characteristic curve (AUROC), and the McNemar test was used to compare sensitivities.Results: The CNN achieved a mean AUROC of 0.84 (95% CI: 0.83, 0.84) in discriminating normal and abnormal HCT studies. The number of x-ray projections could be reduced by 16 times and the raw sensor data could be input into the CNN with no statistically significant difference in classification performance. Additionally, CT windowing consistently improved CNN performance, increasing the mean triage AUROC by 0.07 points.Conclusion: A CNN was developed to triage HCT studies, which may help streamline image evaluation, and the means by which upstream image acquisition, reconstruction, and preprocessing affect downstream CNN performance was investigated, bringing focus to this important part of the imaging chain.Keywords Head CT, Automated Triage, Deep Learning, Sinogram, DatasetSupplemental material is available for this article.©RSNA, 2021.

    View details for DOI 10.1148/ryai.2021200229

    View details for PubMedID 34350412

  • Diagnostic performance of single-phase dual-energy CT to differentiate vascular and nonvascular incidental renal lesions on portal venous phase: comparison with CT. European radiology Mastrodicasa, D., Willemink, M. J., Madhuripan, N., Chima, R. S., Ho, A. A., Ding, Y., Marin, D., Patel, B. N. 2021


    OBJECTIVES: To determine whether single-phase dual-energy CT (DECT) differentiates vascular and nonvascular renal lesions in the portal venous phase (PVP). Optimal iodine threshold was determined and compared to Hounsfield unit (HU) measurements.METHODS: We retrospectively included 250 patients (266 renal lesions) who underwent a clinically indicated PVP abdominopelvic CT on a rapid-kilovoltage-switching single-source DECT (rsDECT) or a dual-source DECT (dsDECT) scanner. Iodine concentration and HU measurements were calculated by four experienced readers. Diagnostic accuracy was determined using biopsy results and follow-up imaging as reference standard. Area under the curve (AUC) was calculated for each DECT scanner to differentiate vascular from nonvascular lesions and vascular lesions from hemorrhagic/proteinaceous cysts. Univariable and multivariable logistic regression analyses evaluated the association between variables and the presence of vascular lesions.RESULTS: A normalized iodine concentration threshold of 0.25 mg/mL yielded high accuracy in differentiating vascular and nonvascular lesions (AUC 0.93, p < 0.001), with comparable performance to HU measurements (AUC 0.93). Both iodine concentration and HU measurements were independently associated with vascular lesions when adjusted for age, gender, body mass index, and lesion size (AUC 0.95 and 0.95, respectively). When combined, diagnostic performance was higher (AUC 0.96). Both absolute and normalized iodine concentrations performed better than HU measurements (AUC 0.92 vs. AUC 0.87) in differentiating vascular lesions from hemorrhagic/proteinaceous cysts.CONCLUSION: A single-phase (PVP) DECT scan yields high accuracy to differentiate vascular from nonvascular renal lesions. Iodine concentration showed a slightly higher performance than HU measurements in differentiating vascular lesions from hemorrhagic/proteinaceous cysts.KEY POINTS: A single-phase dual-energy CT scan in the portal venous phase differentiates vascular from nonvascular renal lesions with high accuracy (AUC 0.93). When combined, iodine concentration and HU measurements showed the highest diagnostic performance (AUC 0.96) to differentiate vascular from nonvascular renal lesions. Compared to HU measurements, iodine concentration showed a slightly higher performance in differentiating vascular lesions from hemorrhagic/proteinaceous cysts.

    View details for DOI 10.1007/s00330-021-08097-0

    View details for PubMedID 34114058

  • A highly-detailed anatomical study of normal pericardial structures as revealed by in-vivo computed tomography and magnetic resonance images and ex-vivo novel 3D reconstructions from Visible Human Server IMAGING Mantini, C., Corradi, F., Mastrodicasa, D., Procaccini, L., Olivieri, M., Ricci, F., Cademartiri, F., Caulo, M., De Caterina, R. 2021; 13 (1): 1-12
  • An international survey on AI in radiology in 1041 radiologists and radiology residents part 2: expectations, hurdles to implementation, and education. European radiology Huisman, M., Ranschaert, E., Parker, W., Mastrodicasa, D., Koci, M., Pinto de Santos, D., Coppola, F., Morozov, S., Zins, M., Bohyn, C., Koc, U., Wu, J., Veean, S., Fleischmann, D., Leiner, T., Willemink, M. J. 2021


    OBJECTIVES: Currently, hurdles to implementation of artificial intelligence (AI) in radiology are a much-debated topic but have not been investigated in the community at large. Also, controversy exists if and to what extent AI should be incorporated into radiology residency programs.METHODS: Between April and July 2019, an international survey took place on AI regarding its impact on the profession and training. The survey was accessible for radiologists and residents and distributed through several radiological societies. Relationships of independent variables with opinions, hurdles, and education were assessed using multivariable logistic regression.RESULTS: The survey was completed by 1041 respondents from 54 countries. A majority (n = 855, 82%) expects that AI will cause a change to the radiology field within 10 years. Most frequently, expected roles of AI in clinical practice were second reader (n = 829, 78%) and work-flow optimization (n = 802, 77%). Ethical and legal issues (n = 630, 62%) and lack of knowledge (n = 584, 57%) were mentioned most often as hurdles to implementation. Expert respondents added lack of labelled images and generalizability issues. A majority (n = 819, 79%) indicated that AI should be incorporated in residency programs, while less support for imaging informatics and AI as a subspecialty was found (n = 241, 23%).CONCLUSIONS: Broad community demand exists for incorporation of AI into residency programs. Based on the results of the current study, integration of AI education seems advisable for radiology residents, including issues related to data management, ethics, and legislation.KEY POINTS: There is broad demand from the radiological community to incorporate AI into residency programs, but there is less support to recognize imaging informatics as a radiological subspecialty. Ethical and legal issues and lack of knowledge are recognized as major bottlenecks for AI implementation by the radiological community, while the shortage in labeled data and IT-infrastructure issues are less often recognized as hurdles. Integrating AI education in radiology curricula including technical aspects of data management, risk of bias, and ethical and legal issues may aid successful integration of AI into diagnostic radiology.

    View details for DOI 10.1007/s00330-021-07782-4

    View details for PubMedID 33974148

  • Emerging methods for the characterization of ischemic heart disease: ultrafast Doppler angiography, micro-CT, photon-counting CT, novel MRI and PET techniques, and artificial intelligence. European radiology experimental Willemink, M. J., Varga-Szemes, A., Schoepf, U. J., Codari, M., Nieman, K., Fleischmann, D., Mastrodicasa, D. 2021; 5 (1): 12


    After an ischemic event, disruptive changes in the healthy myocardium may gradually develop and may ultimately turn into fibrotic scar. While these structural changes have been described by conventional imaging modalities mostly on a macroscopic scale-i.e., late gadolinium enhancement at magnetic resonance imaging (MRI)-in recent years, novel imaging methods have shown the potential to unveil an even more detailed picture of the postischemic myocardial phenomena. These new methods may bring advances in the understanding of ischemic heart disease with potential major changes in the current clinical practice. In this review article, we provide an overview of the emerging methods for the non-invasive characterization of ischemic heart disease, including coronary ultrafast Doppler angiography, photon-counting computed tomography (CT), micro-CT (for preclinical studies), low-field and ultrahigh-field MRI, and 11C-methionine positron emission tomography. In addition, we discuss new opportunities brought by artificial intelligence, while addressing promising future scenarios and the challenges for the application of artificial intelligence in the field of cardiac imaging.

    View details for DOI 10.1186/s41747-021-00207-3

    View details for PubMedID 33763754

  • CTA pulmonary artery enlargement in patients with severe aortic stenosis: Prognostic impact after TAVR. Journal of cardiovascular computed tomography Turner, V. L., Jubran, A., Kim, J. B., Maret, E., Moneghetti, K. J., Haddad, F., Amsallem, M., Codari, M., Hinostroza, V., Mastrodicasa, D., Sailer, A. M., Kobayashi, Y., Nishi, T., Yeung, A. C., Watkins, A. C., Lee, A. M., Miller, D. C., Fischbein, M. P., Fearon, W. F., Willemink, M. J., Fleischmann, D. 2021


    BACKGROUND: Identifying high-risk patients who will not derive substantial survival benefit from TAVR remains challenging. Pulmonary hypertension is a known predictor of poor outcome in patients undergoing TAVR and correlates strongly with pulmonary artery (PA) enlargement on CTA. We sought to evaluate whether PA enlargement, measured on pre-procedural computed tomography angiography (CTA), is associated with 1-year mortality in patients undergoing TAVR.METHODS: We retrospectively included 402 patients undergoing TAVR between July 2012 and March 2016. Clinical parameters, including Society of Thoracic Surgeons (STS) score and right ventricular systolic pressure (RVSP) estimated by transthoracic echocardiography were reviewed. PA dimensions were measured on pre-procedural CTAs. Association between PA enlargement and 1-year mortality was analyzed. Kaplan-Meier and Cox proportional hazards regression analyses were performed.RESULTS: The median follow-up time was 433 (interquartiles 339-797) days. A total of 56/402 (14%) patients died within 1 year after TAVR. Main PA area (area-MPA) was independently associated with 1-year mortality (hazard ratio per standard deviation equal to 2.04 [95%-confidence interval (CI) 1.48-2.76], p​<​0.001). Area under the curve (95%-CI) of the clinical multivariable model including STS-score and RVSP increased slightly from 0.67 (0.59-0.75) to 0.72 (0.72-0.89), p​=​0.346 by adding area-MPA. Although the AUC increased, differences were not significant (p​=​0.346). Kaplan-Meier analysis showed that mortality was significantly higher in patients with a pre-procedural non-indexed area-MPA of ≥7.40​cm2 compared to patients with a smaller area-MPA (mortality 23% vs. 9%; p​<​0.001).CONCLUSIONS: Enlargement of MPA on pre-procedural CTA is independently associated with 1-year mortality after TAVR.

    View details for DOI 10.1016/j.jcct.2021.03.004

    View details for PubMedID 33795188

  • An international survey on AI in radiology in 1,041 radiologists and radiology residents part 1: fear of replacement, knowledge, and attitude. European radiology Huisman, M., Ranschaert, E., Parker, W., Mastrodicasa, D., Koci, M., Pinto de Santos, D., Coppola, F., Morozov, S., Zins, M., Bohyn, C., Koc, U., Wu, J., Veean, S., Fleischmann, D., Leiner, T., Willemink, M. J. 2021


    OBJECTIVES: Radiologists' perception is likely to influence the adoption of artificial intelligence (AI) into clinical practice. We investigated knowledge and attitude towards AI by radiologists and residents in Europe and beyond.METHODS: Between April and July 2019, a survey on fear of replacement, knowledge, and attitude towards AI was accessible to radiologists and residents. The survey was distributed through several radiological societies, author networks, and social media. Independent predictors of fear of replacement and a positive attitude towards AI were assessed using multivariable logistic regression.RESULTS: The survey was completed by 1,041 respondents from 54 mostly European countries. Most respondents were male (n = 670, 65%), median age was 38 (24-74) years, n = 142 (35%) residents, and n = 471 (45%) worked in an academic center. Basic AI-specific knowledge was associated with fear (adjusted OR 1.56, 95% CI 1.10-2.21, p = 0.01), while intermediate AI-specific knowledge (adjusted OR 0.40, 95% CI 0.20-0.80, p = 0.01) or advanced AI-specific knowledge (adjusted OR 0.43, 95% CI 0.21-0.90, p = 0.03) was inversely associated with fear. A positive attitude towards AI was observed in 48% (n = 501) and was associated with only having heard of AI, intermediate (adjusted OR 11.65, 95% CI 4.25-31.92, p < 0.001), or advanced AI-specific knowledge (adjusted OR 17.65, 95% CI 6.16-50.54, p < 0.001).CONCLUSIONS: Limited AI-specific knowledge levels among radiology residents and radiologists are associated with fear, while intermediate to advanced AI-specific knowledge levels are associated with a positive attitude towards AI. Additional training may therefore improve clinical adoption.KEY POINTS: Forty-eight percent of radiologists and residents have an open and proactive attitude towards artificial intelligence (AI), while 38% fear of replacement by AI. Intermediate and advanced AI-specific knowledge levels may enhance adoption of AI in clinical practice, while rudimentary knowledge levels appear to be inhibitive. AI should be incorporated in radiology training curricula to help facilitate its clinical adoption.

    View details for DOI 10.1007/s00330-021-07781-5

    View details for PubMedID 33744991

  • MRI-based clinical-radiomics model predicts tumor response before treatment in locally advanced rectal cancer. Scientific reports Delli Pizzi, A., Chiarelli, A. M., Chiacchiaretta, P., d'Annibale, M., Croce, P., Rosa, C., Mastrodicasa, D., Trebeschi, S., Lambregts, D. M., Caposiena, D., Serafini, F. L., Basilico, R., Cocco, G., Di Sebastiano, P., Cinalli, S., Ferretti, A., Wise, R. G., Genovesi, D., Beets-Tan, R. G., Caulo, M. 2021; 11 (1): 5379


    Neoadjuvant chemo-radiotherapy (CRT) followed by total mesorectal excision (TME) represents the standard treatment for patients with locally advanced (≥T3 or N+) rectal cancer (LARC). Approximately 15% of patients with LARC shows a complete response after CRT. The use of pre-treatment MRI as predictive biomarker could help to increase the chance of organ preservation by tailoring the neoadjuvant treatment. We present a novel machine learning model combining pre-treatment MRI-based clinical and radiomic features for the early prediction of treatment response in LARC patients. MRI scans (3.0T, T2-weighted) of 72 patients with LARC were included. Two readers independently segmented each tumor. Radiomic features were extracted from both the "tumor core" (TC) and the "tumor border" (TB). Partial least square (PLS) regression was used as the multivariate, machine learning, algorithm of choice and leave-one-out nested cross-validation was used to optimize hyperparameters of the PLS. The MRI-Based "clinical-radiomic" machine learning model properly predicted the treatment response (AUC=0.793, p=5.6*10-5). Importantly, the prediction improved when combining MRI-based clinical features and radiomic features, the latter extracted frombothTC and TB. Prospective validation studies in randomized clinical trials are warranted to better define the role of radiomics in the development of rectal cancer precision medicine.

    View details for DOI 10.1038/s41598-021-84816-3

    View details for PubMedID 33686147

  • Quantitative image features from radiomic biopsy differentiate oncocytoma from chromophobe renal cell carcinoma. Journal of medical imaging (Bellingham, Wash.) Jaggi, A., Mastrodicasa, D., Charville, G. W., Jeffrey, R. B., Napel, S., Patel, B. 2021; 8 (5): 054501


    Purpose: To differentiate oncocytoma and chromophobe renal cell carcinoma (RCC) using radiomics features computed from spherical samples of image regions of interest, "radiomic biopsies" (RBs). Approach: In a retrospective cohort study of 102 CT cases [68 males (67%), 34 females (33%); mean age ± SD, 63 ± 12    years ], we pathology-confirmed 42 oncocytomas (41%) and 60 chromophobes (59%). A board-certified radiologist performed two RB rounds. From each RB round, we computed radiomics features and compared the performance of a random forest and AdaBoost binary classifier trained from the features. To control for overfitting, we performed 10 rounds of 70% to 30% train-test splits with feature-selection, cross-validation, and hyperparameter-optimization on each split. We evaluated the performance with test ROC AUC. We tested models on data from the other RB round and compared with the same round testing with the DeLong test. We clustered important features for each round and measured a bootstrapped adjusted Rand index agreement. Results: Our best classifiers achieved an average AUC of 0.71 ± 0.024 . We found no evidence of an effect for RB round ( p = 1 ). We also found no evidence for a decrease in model performance when tested on the other RB round ( p = 0.85 ). Feature clustering produced seven clusters in each RB round with high agreement ( Rand index = 0.981 ± 0.002 , p < 0.00001 ). Conclusions: A consistent radiomic signature can be derived from RBs and could help distinguish oncocytoma and chromophobe RCC.

    View details for DOI 10.1117/1.JMI.8.5.054501

    View details for PubMedID 34514033

    View details for PubMedCentralID PMC8423237

  • Deep Learning-Based 3D Segmentation of True Lumen, False Lumen, and False Lumen Thrombosis in Type-B Aortic Dissection. Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual International Conference Wobben, L. D., Codari, M., Mistelbauer, G., Pepe, A., Higashigaito, K., Hahn, L. D., Mastrodicasa, D., Turner, V. L., Hinostroza, V., Baumler, K., Fischbein, M. P., Fleischmann, D., Willemink, M. J. 2021; 2021: 3912-3915


    Patients with initially uncomplicated typeB aortic dissection (uTBAD) remain at high risk for developing late complications. Identification of morphologic features for improving risk stratification of these patients requires automated segmentation of computed tomography angiography (CTA) images. We developed three segmentation models utilizing a 3D residual U-Net for segmentation of the true lumen (TL), false lumen (FL), and false lumen thrombosis (FLT). Model 1 segments all labels at once, whereas model 2 segments them sequentially. Best results for TL and FL segmentation were achieved by model 2, with median (interquartiles) Dice similarity coefficients (DSC) of 0.85 (0.77-0.88) and 0.84 (0.82-0.87), respectively. For FLT segmentation, model 1 was superior to model 2, with median (interquartiles) DSCs of 0.63 (0.40-0.78). To purely test the performance of the network to segment FLT, a third model segmented FLT starting from the manually segmented FL, resulting in median (interquartiles) DSCs of 0.99 (0.98-0.99) and 0.85 (0.73-0.94) for patent FL and FLT, respectively. While the ambiguous appearance of FLT on imaging remains a significant limitation for accurate segmentation, our pipeline has the potential to help in segmentation of aortic lumina and thrombosis in uTBAD patients.Clinical relevance- Most predictors of aortic dissection (AD) degeneration are identified through anatomical modeling, which is currently prohibitive in clinical settings due to the timeintense human interaction. False lumen thrombosis, which often develops in patients with type B AD, has proven to show significant prognostic value for predicting late adverse events. Our automated segmentation algorithm offers the potential of personalized treatment for AD patients, leading to an increase in long-term survival.

    View details for DOI 10.1109/EMBC46164.2021.9631067

    View details for PubMedID 34892087

  • Aliased Flow Signal Planimetry by Cardiovascular Magnetic Resonance Imaging for Grading Aortic Stenosis Severity: A Prospective Pilot Study. Frontiers in cardiovascular medicine Mantini, C., Khanji, M. Y., D'Ugo, E., Olivieri, M., Caputi, C. G., Bufano, G., Mastrodicasa, D., Calvo Garcia, D., Rotondo, D., Candeloro, M., Tana, C., Cademartiri, F., Ionescu, A., Caulo, M., Gallina, S., Ricci, F. 2021; 8: 752340


    Objectives: Transthoracic echocardiography (TTE) is the standard technique for assessing aortic stenosis (AS), with effective orifice area (EOA) recommended for grading severity. EOA is operator-dependent, influenced by a number of pitfalls and requires multiple measurements introducing independent and random sources of error. We tested the diagnostic accuracy and precision of aliased orifice area planimetry (AOAcmr), a new, simple, non-invasive technique for grading of AS severity by low-VENC phase-contrast cardiovascular magnetic resonance (CMR) imaging. Methods: Twenty-two consecutive patients with mild, moderate, or severe AS and six age- and sex-matched healthy controls had TTE and CMR examinations on the same day. We performed analysis of agreement and correlation among (i) AOAcmr; (ii) geometric orifice area (GOAcmr) by direct CMR planimetry; (iii) EOAecho by TTE-continuity equation; and (iv) the "gold standard" multimodality EOA (EOAhybrid) obtained by substituting CMR LVOT area into Doppler continuity equation. Results: There was excellent pairwise positive linear correlation among AOAcmr, EOAhybrid, GOAcmr, and EOAecho (p < 0.001); AOAcmr had the highest correlation with EOAhybrid (R 2 = 0.985, p < 0.001). There was good agreement between methods, with the lowest bias (0.019) for the comparison between AOAcmr and EOAhybrid. AOAcmr yielded excellent intra- and inter-rater reliability (intraclass correlation coefficient: 0.997 and 0.998, respectively). Conclusions: Aliased orifice area planimetry by 2D phase contrast imaging is a simple, reproducible, accurate "one-stop shop" CMR method for grading AS, potentially useful when echocardiographic severity assessment is inconclusive or discordant. Larger studies are warranted to confirm and validate these promising preliminary results.

    View details for DOI 10.3389/fcvm.2021.752340

    View details for PubMedID 34733896

  • Non-invasive assessment of cirrhosis using multiphasic dual-energy CT iodine maps: correlation with model for end-stage liver disease score. Abdominal radiology (New York) Mastrodicasa, D., Willemink, M. J., Duran, C., Pizzi, A. D., Hinostroza, V., Molvin, L., Khalaf, M., Jeffrey, R. B., Patel, B. N. 2020


    PURPOSE: To determine whether multiphasic dual-energy (DE) CT iodine quantitation correlates with the severity of chronic liver disease.METHODS: We retrospectively included 40 cirrhotic and 28 non-cirrhotic patients who underwent a multiphasic liver protocol DECT. All three phases (arterial, portal venous (PVP), and equilibrium) were performed in DE mode. Iodine (I) values (mg I/ml) were obtained by placing regions of interest in the liver, aorta, common hepatic artery, and portal vein (PV). Iodine slopes (lambda) were calculated as follows: (Iequilibrium-Iarterial)/time and (Iequilibrium-IPVP)/time. Spearman correlations between lambda and MELD scores were evaluated, and the area under the curve of the receiver operating characteristic (AUROC) was calculated to distinguish cirrhotic and non-cirrhotic patients.RESULTS: Cirrhotic and non-cirrhotic patients had significantly different lambdaequilibrium-arterial [IQR] for the caudate (lambda=2.08 [1.39-2.98] vs 1.46 [0.76-1.93], P=0.007), left (lambda=2.05 [1.50-2.76] vs 1.51 [0.59-1.90], P=0.002) and right lobes (lambda=1.72[1.12-2.50] vs 1.13 [0.41-0.43], P=0.003) and for the PV (lambda=3.15 [2.20-5.00] vs 2.29 [0.85-2.71], P=0.001). lambdaequilibrium-PVP were significantly different for the right (lambda=0.11 [-0.45-1.03] vs -0.44 [-0.83-0.12], P=0.045) and left lobe (lambda=0.30 [-0.25-0.98] vs -0.10 [-0.35-0.24], P=0.001). Significant positive correlations were found between MELD scores and lambdaequilibrium-arterial for the caudate lobe (rho=0.34, P=0.004) and lambdaequilibrium-PVP for the caudate (rho=0.26, P=0.028) and right lobe (rho=0.33, P=0.007). AUROC in distinguishing cirrhotic and non-cirrhotic patients were 0.72 (P=0.002), 0.71 (P=0.003), and 0.75 (P=0.001) using lambdaequilibrium-arterial for the left lobe, right lobe, and PV, respectively. The lambdaequilibrium-PVP AUROC of the right lobe was 0.73 (P=0.001).CONCLUSION: Multiphasic DECT iodine quantitation over time is significantly different between cirrhotic and non-cirrhotic patients, correlates with the MELD score, and it could potentially serve as a non-invasive measure of cirrhosis and disease severity with acceptable diagnostic accuracy.

    View details for DOI 10.1007/s00261-020-02857-0

    View details for PubMedID 33211150

  • Bladder cancer: do we need contrast injection for MRI assessment of muscle invasion? A prospective multi-reader VI-RADS approach. European radiology Delli Pizzi, A., Mastrodicasa, D., Marchioni, M., Primiceri, G., Di Fabio, F., Cianci, R., Seccia, B., Sessa, B., Mincuzzi, E., Romanelli, M., Castellan, P., Castellucci, R., Colasante, A., Schips, L., Basilico, R., Caulo, M. 2020


    OBJECTIVES: (1) To investigate whether a contrast-free biparametric MRI (bp-MRI) including T2-weighted images (T2W) and diffusion-weighted images (DWI) can be considered an accurate alternative to the standard multiparametric MRI (mp-MRI), consisting of T2, DWI, and dynamic contrast-enhanced (DCE) imaging for the muscle-invasiveness assessment of bladder cancer (BC), and (2) to evaluate how the diagnostic performance of differently experienced readers is affected according to the type of MRI protocol.METHODS: Thirty-eight patients who underwent a clinically indicated bladder mp-MRI on a 3-T scanner were prospectively enrolled. Trans-urethral resection of bladder was the gold standard. Two sets of images, set 1 (bp-MRI) and set 2 (mp-MRI), were independently reviewed by four readers. Descriptive statistics, including sensitivity and specificity, were calculated for each reader. Receiver operating characteristic (ROC) analysis was performed, and the areas under the curve (AUCs) were calculated for the bp-MRI and the standard mp-MRI. Pairwise comparison of the ROC curves was performed.RESULTS: The AUCs for bp- and mp-MRI were respectively 0.91-0.92 (reader 1), 0.90 (reader 2), 0.95-0.90 (reader 3), and 0.90-0.87 (reader 4). Sensitivity was 100% for both protocols and specificity ranged between 79.31 and 89.66% and between 79.31 and 83.33% for bp-MRI and mp-MRI, respectively. No significant differences were shown between the two MRI protocols (p > 0.05). No significant differences were shown accordingly to the reader's experience (p > 0.05).CONCLUSIONS: A bp-MRI protocol consisting of T2W and DWI has comparable diagnostic accuracy to the standard mp-MRI protocol for the detection of muscle-invasive bladder cancer. The experience of the reader does not significantly affect the diagnostic performance using VI-RADS.KEY POINTS: The contrast-free MRI protocol shows a comparable accuracy to the standard multiparametric MRI protocol in the bladder cancer muscle-invasiveness assessment. VI-RADS classification helps non-expert radiologists to assess the muscle-invasiveness of bladder cancer. DCE should be carefully interpreted by less experienced readers due to inflammatory changes representing a potential pitfall.

    View details for DOI 10.1007/s00330-020-07473-6

    View details for PubMedID 33211143

  • Multimodality Imaging of Hepatocellular Carcinoma: From Diagnosis to Treatment Response Assessment in Everyday Clinical Practice. Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes Delli Pizzi, A., Mastrodicasa, D., Cianci, R., Serafini, F. L., Mincuzzi, E., Di Fabio, F., Giammarino, A., Mannetta, G., Basilico, R., Caulo, M. 2020: 846537120923982


    The Liver Imaging Reporting and Data System (LI-RADS) is a recently developed classification aiming to improve the standardization of liver imaging assessment in patients at risk of developing hepatocellular carcinoma (HCC). The LI-RADS v2017 implemented new algorithms for ultrasound (US) screening and surveillance, contrast-enhanced US diagnosis and computed tomography/magnetic resonance imaging treatment response assessment. A minor update of LI-RADS was released in 2018 to comply with the American Association for the Study of the Liver Diseases guidance recommendations. The scope of this review is to provide a practical overview of LI-RADS v2018 focused both on the multimodality HCC diagnosis and treatment response assessment.

    View details for DOI 10.1177/0846537120923982

    View details for PubMedID 32436394

  • Cost-effectiveness of dual-energy CT versus multiphasic single-energy CT and MRI for characterization of incidental indeterminate renal lesions. Abdominal radiology (New York) Patel, B. N., Boltyenkov, A. T., Martinez, M. G., Mastrodicasa, D., Marin, D., Jeffrey, R. B., Chung, B., Pandharipande, P., Kambadakone, A. 2020


    PURPOSE: To evaluate the cost-effectiveness of DECT versus multiphasic CT and MRI for characterizing small incidentally detected indeterminate renal lesions using a Markov Monte Carlo decision-analytic model.BACKGROUND: Incidental renal lesions are commonly encountered due to the increasing utilization of medical imaging and the increasing prevalence of renal lesions with age. Currently recommended imaging modalities to further characterize incidental indeterminate renal lesions have some inherent drawbacks. Single-phase DECT may overcome these limitations, but its cost-effectiveness remains uncertain.MATERIALS AND METHODS: A decision-analytic (Markov) model was constructed to estimate life expectancy and lifetime costs for otherwise healthy 64-year-old patients with small (≤4cm) incidentally detected, indeterminate renal lesions on routine imaging (e.g., ultrasound or single-phase CT). Three strategies for evaluating renal lesions for enhancement were compared: multiphase SECT (e.g., true unenhanced and nephrographic phase), multiphasic MRI, and single-phase DECT (nephrographic phase in dual-energy mode). The model incorporated modality-specific diagnostic test performance, incidence, and prevalence of incidental renal cell carcinomas (RCCs), effectiveness, costs, and health outcomes. An incremental cost-effectiveness analysis was performed to identify strategy preference at willingness-to-pay (WTP) thresholds of $50,000 and $100,000 per quality-adjusted life-year (QALY) gained. Deterministic and probabilistic sensitivity analysis were performed.RESULTS: In the base case analysis, expected mean costs per patient undergoing characterization of incidental renal lesions were $2567 for single-phase DECT, $3290 for multiphasic CT, and $3751 for multiphasic MRI. Associated quality-adjusted life-years were the highest for single-phase DECT at 0.962, for multiphasic MRI it was 0.940, and was the lowest for multiphasic CT at 0.925. Because of lower associated costs and higher effectiveness, the single-phase DECT strategy dominated the other two strategies.CONCLUSIONS: Single-phase DECT is potentially more cost-effective than multiphasic SECT and MRI for evaluating small incidentally detected indeterminate renal lesions.

    View details for DOI 10.1007/s00261-019-02380-x

    View details for PubMedID 31894384

  • Predictive Value of Cardiac CT Angiography, Cardiac MRI, and Transthoracic Echocardiography for Cardioembolic Stroke Recurrence. AJR. American journal of roentgenology Apfaltrer, G. n., Lavra, F. n., De Cecco, C. N., Varga-Szemes, A. n., van Assen, M. n., Mastrodicasa, D. n., Scarabello, M. n., Eid, M. H., Griffith, L. P., Nance, J. W., Litwin, S. E., Saba, L. n., Schoepf, U. J. 2020


    Background: Transthoracic echocardiography (TTE) is the standard of care for initial evaluation of patients with suspected cardioembolic stroke. While TTE is useful for assessing certain sources of cardiac emboli, its diagnostic capability is limited in the detection of other sources, including left atrial thrombus and aortic plaques. Objectives: To investigate sensitivity, specificity and predictive value of cardiac CT angigography (cCTA), cardiac MRI (CMR), and TTE for recurrence in patients with suspected cardioembolic stroke. Methods: We retrospectively included 151 patients with suspected cardioembolic stroke who underwent TTE and either CMR (n=75) or cCTA (n=76) between January 2013 and May 2017. We evaluated for presence of left atrial thrombus, left ventricular thrombus, vulnerable aortic plaque, cardiac tumors, and valvular vegetation as causes of cardioembolic stroke. The end-point was stroke recurrence. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for recurrent stroke were calculated; the diagnostic accuracy of CMR, cCTA, and TTE was compared between and within groups using area under the curves (AUCs). Results: Twelve and 14 recurrent strokes occurred in the cCTA and CMR groups, respectively. Sensitivity, specificity, PPV and NPV were: 33.3%, 93.7%, 50.0%, and 88.2% for cCTA; 14.3%, 80.3%, 14.3%, and 80.3% for CMR; 14.3%, 83.6%, 16.7%, 80.9% for TTE in the CMR group, and 8.3%, 93.7%, 20.0% and 84.5% for TTE in the cCTA group. Accuracy was not different (p>0.05) between cCTA (0.63, 95% CI [0.49, 0.77]), CMR (0.53, [0.42, 0.63]), TTE in CMR group (0.51, [0.40, 0.61], and TTE in cCTA group (0.51, [0.42, 0.59]). In cCTA group, atrial and ventricular thrombus were detected by cCTA in 3 patients and TTE in 1 patient; in CMR group, thrombus was detected by CMR in 1 patient and TTE in 2 patients. Conclusion: cCTA, CMR, and TTE showed comparably high specificity and NPV for cardioembolic stroke recurrence. cCTA and CMR may be valid alternatives to TTE. cCTA may be preferred given potentially better detection of atrial and ventricular thrombus. Clinical impact: cCTA and CMR have similar clinical performance as TTE for predicting cardioembolic stroke recurrence. This observation may be especially important when TTE provides equivocal findings.

    View details for DOI 10.2214/AJR.20.23903

    View details for PubMedID 32936016

  • Value of Machine Learning-based Coronary CT Fractional Flow Reserve Applied to Triple-Rule-Out CT Angiography in Acute Chest Pain. Radiology. Cardiothoracic imaging Martin, S. S., Mastrodicasa, D. n., van Assen, M. n., De Cecco, C. N., Bayer, R. R., Tesche, C. n., Varga-Szemes, A. n., Fischer, A. M., Jacobs, B. E., Sahbaee, P. n., Griffith, L. P., Matuskowitz, A. J., Vogl, T. J., Schoepf, U. J. 2020; 2 (3): e190137


    To evaluate the additional value of noninvasive artificial intelligence (AI)-based CT-derived fractional flow reserve (CT FFR), derived from triple-rule-out coronary CT angiography for acute chest pain (ACP) in the emergency department (ED) setting.AI-based CT FFR from triple-rule-out CT angiography data sets was retrospectively obtained in 159 of 271 eligible patients (102 men; mean age, 57.0 years ± 9.7 [standard deviation]) presenting to the ED with ACP. The agreement between CT FFR (≤ 0.80) and stenosis at triple-rule-out CT angiography (≥ 50%), as well as downstream cardiac diagnostic testing, was investigated. Furthermore, the predictive value of CT FFR for coronary revascularization and major adverse cardiac events (MACE) was assessed over a 1-year follow-up period.CT FFR and triple-rule-out CT angiography demonstrated agreement in severity of coronary artery disease (CAD) in 52% (82 of 159) of all cases. CT FFR of 0.80 and less served as a better predictor for coronary revascularization and MACE than stenosis of 50% and greater at triple-rule-out CT angiography (odds ratio, 3.4; 95% confidence interval: 1.4, 8.2 vs odds ratio, 2.2; 95% confidence interval: 0.9, 5.3) (P < .01). In the subgroup of patients with additional noninvasive cardiac testing (94 of 159), there was higher agreement as to the presence or absence of significant disease with CT FFR (55%) than with coronary triple-rule-out CT angiography (47%) (P = .23).CT FFR derived from triple-rule-out CT angiography was a better predictor for coronary revascularization and MACE and showed better agreement with additional diagnostic testing than triple-rule-out CT angiography. Therefore, CT FFR may improve the specificity in identifying patients with ACP with significant CAD in the ED setting and reduce unnecessary downstream testing.© RSNA, 2020See also the commentary by Ihdayhid and Ben Zekry in this issue.

    View details for DOI 10.1148/ryct.2020190137

    View details for PubMedID 33778579

    View details for PubMedCentralID PMC7978005

  • Computed Tomographic Angiography-Based Fractional Flow Reserve Compared With Catheter-Based Dobutamine-Stress Diastolic Fractional Flow Reserve in Symptomatic Patients With a Myocardial Bridge and No Obstructive Coronary Artery Disease. Circulation. Cardiovascular imaging Jubran, A. n., Schnittger, I. n., Tremmel, J. n., Pargaonkar, V. n., Rogers, I. n., Becker, H. C., Yang, S. n., Mastrodicasa, D. n., Willemink, M. n., Fleischmann, D. n., Nieman, K. n. 2020; 13 (2): e009576

    View details for DOI 10.1161/CIRCIMAGING.119.009576

    View details for PubMedID 32069114

  • Machine learning for endoleak detection after endovascular aortic repair. Scientific reports Talebi, S. n., Madani, M. H., Madani, A. n., Chien, A. n., Shen, J. n., Mastrodicasa, D. n., Fleischmann, D. n., Chan, F. P., Mofrad, M. R. 2020; 10 (1): 18343


    Diagnosis of endoleak following endovascular aortic repair (EVAR) relies on manual review of multi-slice CT angiography (CTA) by physicians which is a tedious and time-consuming process that is susceptible to error. We evaluate the use of a deep neural network for the detection of endoleak on CTA for post-EVAR patients using a novel data efficient training approach. 50 CTAs and 20 CTAs with and without endoleak respectively were identified based on gold standard interpretation by a cardiovascular subspecialty radiologist. The Endoleak Augmentor, a custom designed augmentation method, provided robust training for the machine learning (ML) model. Predicted segmentation maps underwent post-processing to determine the presence of endoleak. The model was tested against 3 blinded general radiologists and 1 blinded subspecialist using a held-out subset (10 positive endoleak CTAs, 10 control CTAs). Model accuracy, precision and recall for endoleak diagnosis were 95%, 90% and 100% relative to reference subspecialist interpretation (AUC = 0.99). Accuracy, precision and recall was 70/70/70% for generalist1, 50/50/90% for generalist2, and 90/83/100% for generalist3. The blinded subspecialist had concordant interpretations for all test cases compared with the reference. In conclusion, our ML-based approach has similar performance for endoleak diagnosis relative to subspecialists and superior performance compared with generalists.

    View details for DOI 10.1038/s41598-020-74936-7

    View details for PubMedID 33110113

  • AppendiXNet: Deep Learning for Diagnosis of Appendicitis from A Small Dataset of CT Exams Using Video Pretraining. Scientific reports Rajpurkar, P. n., Park, A. n., Irvin, J. n., Chute, C. n., Bereket, M. n., Mastrodicasa, D. n., Langlotz, C. P., Lungren, M. P., Ng, A. Y., Patel, B. N. 2020; 10 (1): 3958


    The development of deep learning algorithms for complex tasks in digital medicine has relied on the availability of large labeled training datasets, usually containing hundreds of thousands of examples. The purpose of this study was to develop a 3D deep learning model, AppendiXNet, to detect appendicitis, one of the most common life-threatening abdominal emergencies, using a small training dataset of less than 500 training CT exams. We explored whether pretraining the model on a large collection of natural videos would improve the performance of the model over training the model from scratch. AppendiXNet was pretrained on a large collection of YouTube videos called Kinetics, consisting of approximately 500,000 video clips and annotated for one of 600 human action classes, and then fine-tuned on a small dataset of 438 CT scans annotated for appendicitis. We found that pretraining the 3D model on natural videos significantly improved the performance of the model from an AUC of 0.724 (95% CI 0.625, 0.823) to 0.810 (95% CI 0.725, 0.895). The application of deep learning to detect abnormalities on CT examinations using video pretraining could generalize effectively to other challenging cross-sectional medical imaging tasks when training data is limited.

    View details for DOI 10.1038/s41598-020-61055-6

    View details for PubMedID 32127625

  • Bone marrow magnetic resonance imaging: physiologic and pathologic findings that radiologist should know. La Radiologia medica Chiarilli, M. G., Delli Pizzi, A. n., Mastrodicasa, D. n., Febo, M. P., Cardinali, B. n., Consorte, B. n., Cifaratti, A. n., Panara, V. n., Caulo, M. n., Cannataro, G. n. 2020


    Magnetic resonance imaging (MRI) plays a leading role in the non-invasive evaluation of bone marrow (BM). Normal BM pattern depends on the ratio and distribution of yellow and red marrow, which are subject to changes with age, pathologies, and treatments. Neonates show almost entirely red marrow. Over time, yellow marrow conversion takes place with a characteristic sequence leading to a red marrow persistence in proximal metaphyses of long bones. In adults, normal BM is composed of both red (40% water, 40% fat) and yellow marrow (15% water, 80% fat). Due to the higher content of fat, yellow marrow normally appears hyperintense on T1-weighted (T1w) fast spin echo (FSE) sequences and hypo-/iso-intense in short tau inversion recovery (STIR) T2-weighted (T2w); red marrow appears slightly hyperintense in T1w FSE and hyper-/iso-intense in STIR T2w. Pathologic BM has reduced fat and increased water percentages, resulting hypointense in T1w FSE and hyperintense in STIR T2w. In oncologic patients, BM MRI signal largely depends on the treatment (irradiation and/or chemotherapy) and its timing. BM fat and water amount and location in normal red/yellow and pathologic marrow are responsible for different signals in MRI sequences whose knowledge by radiologists may help to differentiate between normal and pathologic findings. Our aim was to discuss and illustrate the MRI of BM physiologic conversion and pathologic reconversion occurring in malignancies and after treatments in cancer patients.

    View details for DOI 10.1007/s11547-020-01239-2

    View details for PubMedID 32557107

  • Coronary Computed Tomography Angiography in Diagnosing Obstructive Coronary Artery Disease in Patients with Advanced Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Cardiorenal medicine Cheng, X. S., Mohanty, S. n., Turner, V. n., Mastrodicasa, D. n., Winther, S. n., Fleischmann, D. n., Tan, J. C., Fearon, W. F. 2020: 1–8


    Coronary computed tomography angiography (CCTA) is emerging as an important noninvasive testing modality for coronary angiography. The performance characteristic of CCTA in patients with advanced kidney disease is unknown.We performed a systematic review and meta-analysis of studies specifically investigating the sensitivity and specificity of CCTA compared to coronary angiogram as a reference standard in patients with advanced kidney disease, defined as dialysis dependence or nearing kidney transplantation. Two independent investigators assessed studies for inclusion/exclusion, quality, and characteristics, while a third investigator adjudicated.We identified 4 studies including a total of 217 patients, of whom 159 were dialysis dependent. Three of the 4 studies had a high risk of bias in patient selection and study flow, while 1 study rated low in all areas of bias. The studies were heterogeneous in their patient selection and CCTA protocol but consistent in their definition of obstructive coronary artery disease. The pooled sensitivity and specificity for CCTA were 0.96 (0.87-0.99) and 0.66 (0.57-0.74), respectively. When we restricted the analysis to dialysis-dependent patients, the pooled sensitivity and specificity for CCTA were 0.99 (0.74-1.00) and 0.67 (0.49-0.82), respectively.Based on limited data, CCTA appears to have comparable sensitivity but lower specificity relative to the non-kidney disease population.

    View details for DOI 10.1159/000510402

    View details for PubMedID 33321489

  • Artificial intelligence machine learning-based coronary CT fractional flow reserve (CT-FFRML): Impact of iterative and filtered back projection reconstruction techniques JOURNAL OF CARDIOVASCULAR COMPUTED TOMOGRAPHY Mastrodicasa, D., Albrecht, M. H., Schoepf, U., Varga-Szemes, A., Jacobs, B. E., Gassenmaier, S., De Santis, D., Eid, M. H., van Assen, M., Tesche, C., Mantini, C., De Cecco, C. N. 2019; 13 (6): 331–35
  • Prognostic value of CT myocardial perfusion imaging and CT-derived fractional flow reserve for major adverse cardiac events in patients with coronary artery disease. Journal of cardiovascular computed tomography van Assen, M., De Cecco, C. N., Eid, M., von Knebel Doeberitz, P., Scarabello, M., Lavra, F., Bauer, M. J., Mastrodicasa, D., Duguay, T. M., Zaki, B., Lo, G. G., Choe, Y. H., Wang, Y., Sahbaee, P., Tesche, C., Oudkerk, M., Vliegenthart, R., Schoepf, U. J. 2019


    The purpose of this study was to analyze the prognostic value of dynamic CT perfusion imaging (CTP) and CT derived fractional flow reserve (CT-FFR) for major adverse cardiac events (MACE).81 patients from 4 institutions underwent coronary computed tomography angiography (CCTA) with dynamic CTP imaging and CT-FFR analysis. Patients were followed-up at 6, 12, and 18 months after imaging. MACE were defined as cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, or revascularization. CT-FFR was computed for each major coronary artery using an artificial intelligence-based application. CTP studies were analyzed per vessel territory using an index myocardial blood flow, the ratio between territory and global MBF. The prognostic value of CCTA, CT-FFR, and CTP was investigated with a univariate and multivariate Cox proportional hazards regression model.243 vessels in 81 patients were interrogated by CCTA with CT-FFR and 243 vessel territories (1296 segments) were evaluated with dynamic CTP imaging. Of the 81 patients, 25 (31%) experienced MACE during follow-up. In univariate analysis, a positive index-MBF resulted in the largest risk for MACE (HR 11.4) compared to CCTA (HR 2.6) and CT-FFR (HR 4.6). In multivariate analysis, including clinical factors, CCTA, CT-FFR, and index-MBF, only index-MBF significantly contributed to the risk of MACE (HR 10.1), unlike CCTA (HR 1.2) and CT-FFR (HR 2.2).Our study provides initial evidence that dynamic CTP alone has the highest prognostic value for MACE compared to CCTA and CT-FFR individually or a combination of the three, independent of clinical risk factors.

    View details for DOI 10.1016/j.jcct.2019.02.005

    View details for PubMedID 30796003

  • The Multi-modality Cardiac Imaging Approach to Cardiac Sarcoidosis CURRENT MEDICAL IMAGING REVIEWS Ricci, F., Mantini, C., Grigoratos, C., Bianco, F., Bucciarelli, V., Tana, C., Mastrodicasa, D., Caulo, M., Aquaro, G., Cotroneo, A., Gallina, S. 2019; 15 (1): 10–20
  • Multiple liver pseudotumors due to hepatic steatosis and fatty sparing: A non-invasive imaging approach EUROPEAN JOURNAL OF RADIOLOGY OPEN Delli Pizzi, A., Mastrodicasa, D., Sessa, B., Cianci, R., Caulo, M., Basilico, R. 2019; 6: 56–59
  • Tumor detectability and conspicuity comparison of standard b1000 and ultrahigh b2000 diffusion-weighted imaging in rectal cancer. Abdominal radiology (New York) Delli Pizzi, A. n., Caposiena, D. n., Mastrodicasa, D. n., Trebeschi, S. n., Lambregts, D. n., Rosa, C. n., Cianci, R. n., Seccia, B. n., Sessa, B. n., Di Flamminio, F. M., Chiacchiaretta, P. n., Caravatta, L. n., Cinalli, S. n., Di Sebastiano, P. n., Caulo, M. n., Genovesi, D. n., Beets-Tan, R. n., Basilico, R. n. 2019


    To compare tumor detectability and conspicuity of standard b = 1000 s/mm2 (b1000) versus ultrahigh b = 2000 s/mm2 (b2000) diffusion-weighted imaging (DWI) in rectal cancer.Fifty-five patients for a total of 81 3T DWI-MR scans were retrospectively evaluated by two differently experienced readers. A comparison between b1000 and b2000 for tumor detectability and conspicuity was performed. The conspicuity was qualitatively and quantitatively assessed by using three-point scale and whole tumor volume manual delineation, respectively. Receiver-operating characteristic curve (ROC) with area under the curve (AUC) analysis provided diagnostic accuracy in tumor detectability of restaging MR scans. Qualitative scores and quantitative features including mean signal intensity, variance, 10th percentile and 90th percentile, were compared using the Wilcoxon test. Interobserver agreement (IOA) for qualitative and quantitative data was calculated using Cohen's Kappa and intraclass correlation coefficient (ICC) respectively.Diagnostic accuracy was comparable between b1000 and b2000 for both readers (p > 0.05). Overall quality scores were significantly better for b2000 than b1000 (2.29 vs 1.65 Reader 1, p = 0.01; 2.18 vs 1.69 Reader 2, p = 0.04). IOA was equally good for both b values (k = 0.86 b1000, k = 0.86 b2000). Quantitative analysis revealed more uniform signal (measured in variance) of b2000 in both healthy surrounding tissue (p < 0.05) and tumor (p < 0.05), with less outliers (measured using 10th and 90th percentile). Additionally, b2000 offered lower mean signal intensity in tissue sorrounding the tumor (p < 0.05). Finally, ICC improved from 0.92 (b1000) to 0.97 (b2000).Ultrahigh b value (b2000) may improve rectal cancer conspicuity and introbserver agreement maintaining comparable diagnostic accuracy to standard b1000.

    View details for DOI 10.1007/s00261-019-02177-y

    View details for PubMedID 31444557

  • Prenatal planning of placenta previa: diagnostic accuracy of a novel MRI-based prediction model for placenta accreta spectrum (PAS) and clinical outcome. Abdominal radiology (New York) Delli Pizzi, A., Tavoletta, A., Narciso, R., Mastrodicasa, D., Trebeschi, S., Celentano, C., Mastracchio, J., Cianci, R., Seccia, B., Marrone, L., Liberati, M., Cotroneo, A. R., Caulo, M., Basilico, R. 2019


    PURPOSE: To investigate the diagnostic accuracy of MRI for placenta accreta spectrum (PAS) and clinical outcome prediction in women with placenta previa, using a novel MRI-based predictive model.METHODS: Thirty-eight placental MRI exams performed on a 1.5T scanner were retrospectively reviewed by two radiologists in consensus. The presence of T2 dark bands, myometrial thinning, abnormal vascularity, uterine bulging, placental heterogeneity, placental protrusion sign, placental recess, and percretism signs was scored using a 5-point scale. Pathology and clinical intrapartum findings were the standard of reference for PAS, while intrapartum/peripartum bleeding and emergency hysterectomy defined the clinical outcome. Receiver-operating characteristic (ROC) analysis and discriminant function analysis were performed to test the predictive power of MRI findings for both PAS and clinical outcome prediction.RESULTS: Abnormal vascularity and percretism signs were the two most predictive MRI features of PAS. The area under the curve (AUC) of the predictive function was 0.833 (cutoff 0.39, 67% sensitivity, 100% specificity, p=0.001). Percretism signs and myometrial thinning were the two most predictive MRI features of poor outcome. AUC of the predictive function was 0.971 (cutoff -0.55, 100% sensitivity, 77% specificity, p<0.001).CONCLUSION: The diagnostic accuracy of MRI, especially considering the combination of the most predictive MRI findings, is higher when the target of the prediction is the clinical outcome rather than the PAS.

    View details for PubMedID 30600374

  • Dual-Energy CT of the Pancreas. Seminars in ultrasound, CT, and MR Mastrodicasa, D. n., Delli Pizzi, A. n., Patel, B. N. 2019; 40 (6): 509–14


    This article explores the technical background of dual-energy CT (DECT) imaging along with its basic principles, before turning to a review of the various DECT applications specific to pancreatic imaging. In light of the most recent literature, we will review the constellation of DECT applications available for pancreatic imaging in both oncologic and non-oncologic applications. We emphasize the increased lesion conspicuity and the improved tissue characterization available with DECT post-processing tools. Finally, future clinical applications and opportunities for research will be overviewed.

    View details for DOI 10.1053/j.sult.2019.05.002

    View details for PubMedID 31806149

  • Prevalence and Clinical Relevance of Extracardiac Findings in Cardiovascular Magnetic Resonance Imaging JOURNAL OF THORACIC IMAGING Mantini, C., Mastrodicasa, D., Bianco, F., Bucciarelli, V., Scarano, M., Mannetta, G., Gabrielli, D., Gallina, S., Petersen, S. E., Ricci, F., Cademartiri, F. 2019; 34 (1): 48–55


    To assess the prevalence of extracardiac findings (ECF) during cardiovascular magnetic resonance (CMR) examinations and their downstream effect on clinical management.We retrospectively identified 500 consecutive patients. Trans-axial balanced steady-state free precession nongated images acquired from the upper thorax to the upper abdomen were evaluated independently by 2 radiologists. ECF were classified as nonsignificant (benign, with no need for further investigation), significant (mandatory to be reported/monitored), and major (clinically remarkable pathology, mandatory to be reported/investigated/treated). Fifteen-month clinical follow-up information was collected through hospital records.Of 500 patients, 108 (21.6%) showed a total of 153 ECF: 59 (11.8% of the entire study population; 38.5% of all ECF) nonsignificant, 76 (15.2%; 49.7%) significant, and 18 (3.6%; 11.8%) major ECF. The most frequent ECF were pleural effusion, hepatic cyst, renal cyst, and ascending aorta dilatation. Of 94 significant and major ECF, 46 were previously unknown and more common in older patients. Newly diagnosed major ECF (n=11, 2.2% of the entire study population, and 7.2% of all ECF)-including 5 tumors (1% of study population)-were confirmed by downstream evaluations and required specific treatment. Patients with major ECF were significantly older than patients without with major ECF. Newly diagnosed clinically significant and major ECF prompted downstream diagnostic tests in 44% and 100% of cases, respectively.The detection of significant and major ECF is common during CMR reporting. The knowledge and the correct identification of most frequent ECF enable earlier diagnoses and faster treatment initiation of unknown extracardiac pathologies in patients referred to CMR imaging.

    View details for DOI 10.1097/RTI.0000000000000360

    View details for Web of Science ID 000458277000010

    View details for PubMedID 30142138

  • Computer-assisted detection of acute pulmonary embolism at CT pulmonary angiography in children and young adults: a diagnostic performance analysis. Acta radiologica (Stockholm, Sweden : 1987) Tang, C. X., Zhou, C. S., Schoepf, U. J., Mastrodicasa, D., Duguay, T., Cline, A., Zhao, Y. E., Lu, L., Li, X., Tao, S. M., Lu, M. J., Lu, G. M., Zhang, L. J. 2018: 284185118808547


    To diagnose pulmonary embolism (PE) in children and adults since evaluating tiny pulmonary vasculature beyond segmental level is a challenging and demanding task with thousands of images.To evaluate the effect of computer-assisted detection (CAD) on acute PE on CTPA in children and young adults by readers with varying experience levels.Six radiologists were retrospectively divided into three groups according to experience levels and assessed the CTPA studies on a per-emboli basis. All readers identified independently the PE presence, and ranked diagnostic confidence on a 5-point scale with and without CAD. Reading time, sensitivities, specificities, accuracies, positive predictive values (PPVs), and negative predictive values (NPVs) were calculated for each reading.The sensitivities and NPVs differed significantly in most readers ( P = 0.004, 0.001, 0.010, 0.010, and 0.012 for sensitivities and P = 0.011, 0.003, 0.016, 0.017, and 0.019 for NPVs) except for reader 6 ( P = 0.148 and 0.165, respectively), and the accuracies of all readers differed significantly (all P < 0.05) in peripheral PE (beyond segmental level) detection readings with CAD versus without CAD between two reading methods. The overall time using CAD was longer than those without CAD (76.6 ± 54.4 s vs. 49.4 ± 17.7 s, P = 0.000) for all readers. Significant differences were found for confidence scores in inter-group measurements with CAD ( P = 0.045) and without CAD ( P < 0.001).At the expense of longer reading time, the use of the CAD algorithms improves sensitivities, NPVs, and the accuracies of readers in peripheral PE detection, especially for readers with a poor level of interpretation experience.

    View details for DOI 10.1177/0284185118808547

    View details for PubMedID 30376717

  • Artificial intelligence machine learning-based coronary CT fractional flow reserve (CT-FFRML): Impact of iterative and filtered back projection reconstruction techniques. Journal of cardiovascular computed tomography Mastrodicasa, D., Albrecht, M. H., Schoepf, U. J., Varga-Szemes, A., Jacobs, B. E., Gassenmaier, S., De Santis, D., Eid, M. H., van Assen, M., Tesche, C., Mantini, C., De Cecco, C. N. 2018


    BACKGROUND: The influence of computed tomography (CT) reconstruction algorithms on the performance of machine-learning-based CT-derived fractional flow reserve (CT-FFRML) has not been investigated. CT-FFRML values and processing time of two reconstruction algorithms were compared using an on-site workstation.METHODS: CT-FFRML was computed on 40 coronary CT angiography (CCTA) datasets that were reconstructed with both iterative reconstruction in image space (IRIS) and filtered back-projection (FBP) algorithms. CT-FFRML was computed on a per-vessel and per-segment basis as well as distal to lesions with ≥50% stenosis on CCTA. Processing times were recorded. Significant flow-limiting stenosis was defined as invasive FFR and CT-FFRML values ≤ 0.80. Pearson's correlation, Wilcoxon, and McNemar statistical testing were used for data analysis.RESULTS: Per-vessel analysis of IRIS and FBP reconstructions demonstrated significantly different CT-FFRML values (p ≤ 0.05). Correlation of CT-FFRML values between algorithms was high for the left main (r = 0.74), left anterior descending (r = 0.76), and right coronary (r = 0.70) arteries. Proximal and middle segments showed a high correlation of CT-FFRML values (r = 0.73 and r = 0.67, p ≤ 0.001, respectively), despite having significantly different averages (p ≤ 0.05). No difference in diagnostic accuracy was observed (both 81.8%, p = 1.000). Of the 40 patients, 10 had invasive FFR results. Per-lesion correlation with invasive FFR values was moderate for IRIS (r = 0.53, p = 0.117) and FBP (r = 0.49, p = 0.142). Processing time was significantly shorter using IRIS (15.9 vs. 19.8 min, p ≤ 0.05).CONCLUSION: CT reconstruction algorithms influence CT-FFRML analysis, potentially affecting patient management. Additionally, iterative reconstruction improves CT-FFRML post-processing speed.

    View details for PubMedID 30391256

  • Cardiac implantable electronic devices and chemotherapy: A risky combination COR ET VASA Scarano, M., Gizzi, G., Mastrodicasa, D., Mantini, C. 2018; 60 (5): E469–E471
  • Quantitative inversion time prescription for myocardial late gadolinium enhancement using T1-mapping-based synthetic inversion recovery imaging: reducing subjectivity in the estimation of inversion time INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING Gassenmaier, S., van der Geest, R. J., Schoepf, U., Suranyi, P., Rehwald, W. G., De Cecco, C. N., Mastrodicasa, D., Albrecht, M. H., De Santis, D., Lesslie, V. W., Ruzsics, B., Varga-Szemes, A. 2018; 34 (6): 921–29


    To develop a quantitative T1-mapping-based synthetic inversion recovery (IRsynth) approach to calculate the optimal inversion time (TI0) for late gadolinium enhancement (LGE) imaging. Prospectively enrolled patients (n = 130, 58 ± 16 years) underwent cardiac MRI on a 1.5T system including Look-Locker TI-scout (LL), modified LL IR (MOLLI)-based T1-mapping, and LGE acquisitions. Patients were randomized into two groups: LL group (TI-scout followed T1-mapping) or MOLLI group (T1-mapping followed TI-scout). In both groups, the second acquisition was used to determine the TI0 for LGE. IRsynth images were generated from T1-maps between TI = 200-400 ms in 5 ms increments. Image quality was rated on a 3-point scale and the remote/background signal intensity ratio (SIR) was calculated. In the LL group (n = 53), the TI-scout-based TI0 was significantly shorter compared to IRsynth [230 ms (219-242) vs. 280 ms (263-297), P < 0.0001]. The TI0 used for LGE was set 30-40 ms longer [261 ms (247-276), P < 0.0001] than the TI-scout-based TI0, resulting in a TI0 ~ 20 ms shorter than what was obtained by IRsynth (P = 0.0156). In the MOLLI group (n = 63), IRsynth-based TI0 was significantly longer than the TI-scout-based TI0 [298 ms (262-334) vs. 242 ms (217-267), P = 0.0313]. The quality of myocardial nulling was rated higher [2.4 (2.2-2.5) vs. 2.0 (1.8-2.1), P = 0.0042] and the remote/background SIR was found to be more optimal (1.6 [1.1-2.1] vs. 2.6 [1.8-3.3], P = 0.0256) in the MOLLI group. T1-based IRsynth selects TI0 for LGE more accurately than conventional TI-scout imaging. IRsynth improves TI0 selection by providing excellent visualization of the representative image contrast for LGE images, reducing operator dependence in LGE acquisition.

    View details for DOI 10.1007/s10554-017-1294-9

    View details for Web of Science ID 000437753200010

    View details for PubMedID 29305739

  • Nonbinary quantification technique accounting for myocardial infarct heterogeneity: Feasibility of applying percent infarct mapping in patients. Journal of magnetic resonance imaging : JMRI Mastrodicasa, D., Elgavish, G. A., Schoepf, U. J., Suranyi, P., van Assen, M., Albrecht, M. H., De Cecco, C. N., van der Geest, R. J., Hardy, R., Mantini, C., Griffith, L. P., Ruzsics, B., Varga-Szemes, A. 2018


    Binary threshold-based quantification techniques ignore myocardial infarct (MI) heterogeneity, yielding substantial misquantification of MI.To assess the technical feasibility of MI quantification using percent infarct mapping (PIM), a prototype nonbinary algorithm, in patients with suspected MI.Prospective cohort POPULATION: Patients (n = 171) with suspected MI referred for cardiac MRI.Inversion recovery balanced steady-state free-precession for late gadolinium enhancement (LGE) and modified Look-Locker inversion recovery (MOLLI) T1 -mapping on a 1.5T system.Infarct volume (IV) and infarct fraction (IF) were quantified by two observers based on manual delineation, binary approaches (2-5 standard deviations [SD] and full-width at half-maximum [FWHM] thresholds) in LGE images, and by applying the PIM algorithm in T1 and LGE images (PIMT1 ; PIMLGE ).IV and IF were analyzed using repeated measures analysis of variance (ANOVA). Agreement between the approaches was determined with Bland-Altman analysis. Interobserver agreement was assessed by intraclass correlation coefficient (ICC) analysis.MI was observed in 89 (54.9%) patients, and 185 (38%) short-axis slices. IF with 2, 3, 4, 5SDs and FWHM techniques were 15.7 ± 6.6, 13.4 ± 5.6, 11.6 ± 5.0, 10.8 ± 5.2, and 10.0 ± 5.2%, respectively. The 5SD and FWHM techniques had the best agreement with manual IF (9.9 ± 4.8%) determination (bias 1.0 and 0.2%; P = 0.1426 and P = 0.8094, respectively). The 2SD and 3SD algorithms significantly overestimated manual IF (9.9 ± 4.8%; both P < 0.0001). PIMLGE measured significantly lower IF (7.8 ± 3.7%) compared to manual values (P < 0.0001). PIMLGE , however, showed the best agreement with the PIMT1 reference (7.6 ± 3.6%, P = 0.3156). Interobserver agreement was rated good to excellent for IV (ICCs between 0.727-0.820) and fair to good for IF (0.589-0.736).The application of the PIMLGE technique for MI quantification in patients is feasible. PIMLGE , with its ability to account for voxelwise MI content, provides significantly smaller IF than any thresholding technique and shows excellent agreement with the T1 -based reference.2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018.

    View details for DOI 10.1002/jmri.25973

    View details for PubMedID 29446527

  • Uncommon Isolated Unilocular Myocardial Cyst in a Dog-Friendly Young Female Patient - Multimodality Imaging - CIRCULATION JOURNAL Mantini, C., Capparuccia, C., Cademartiri, F., Messalli, G., Mastrodicasa, D., Cinalli, S., Cotroneo, A., Caputo, M. 2017; 81 (7): 1056-+

    View details for DOI 10.1253/circj.CJ-16-1215

    View details for Web of Science ID 000403906300025

    View details for PubMedID 28132983

  • Results of Late Gadolinium Enhancement in Children Affected by Dilated Cardiomyopathy FRONTIERS IN PEDIATRICS Muscogiuri, G., Ciliberti, P., Mastrodicasa, D., Chinali, M., Rinelli, G., Santangelo, T., Napolitano, C., Leonardi, B., Secinaro, A., MD Paedigree Study Investigators 2017; 5: 13


    Little is known about the clinical value of late gadolinium enhancement (LGE), in children affected by dilated cardiomyopathy (DCM).We retrospectively evaluated 15 patients (8 ± 6 years, 6 males) with diagnosis of DCM who underwent cardiac magnetic resonance since 2014. All scans were performed with a 1.5 T system (Aera, Siemens). Study protocol included cine steady-state free precession sequences, followed by administration of 0.2 mmol/kg of gadolinium-based contrast agent. Inversion recovery Turbo Flash sequences, in the same position of cine images, were acquired 10-15 min after the injection of contrast agent, in order to assess the presence of LGE. The latter was considered positive with a signal intensity >6 SD from normal myocardial tissue. Indexed end-diastolic volume (EDVi) and end-systolic volume (ESVi), and left ventricle (LV) ejection fraction (EF) were calculated by using dedicated software on off-line workstation. Global longitudinal strain and diastolic function were evaluated by echocardiography. Clinical follow-up, including death, transplant, and listing for heart transplant [major adverse cardiac events (MACE)], were evaluated. Patients were divided into two different subgroups: negative (Group A) and positive (Group B) for presence of LGE. Statistical analysis was performed by using Mann-Whitney U test (p < 0.05 considered as statistically significant).Seven patients (47%) showed LGE. A global diffuse subendocardial pattern was evident in all patients presenting LGE (7/7, 100%). The following main LV indexes were observed in the two subgroups. Group A: EDVi = 96 ± 33 ml, ESVi = 56 ± 29 ml, LV EF = 45 ± 10%, global longitudinal strain = -16 ± 5%, E/e' ratio = 10 ± 3, MACE = 1. Group B: EDVi = 130 ± 60 ml, ESVi = 89 ± 43 ml, LV EF = 31 ± 6%, global longitudinal strain = -13 ± 4%, E/e' ratio = 9 ± 3, MACE = 3. There was no statistically significant difference between the two groups, in terms of EDVi (p: 0.2), ESVi (p: 0.2), and E/e' ratio (0.9), whereas a significant difference of LV EF, presence of significative mitral regurgitation, and global longitudinal strain were observed (respectively, p: 0.03, p: 0.009, and p: 0.03).In our population of children with DCM, LGE shows a global diffuse subendocardial pattern. Presence of LGE seems to play a role in these patients determining a worst global systolic function.

    View details for DOI 10.3389/fped.2017.00013

    View details for Web of Science ID 000393308600002

    View details for PubMedID 28220144

    View details for PubMedCentralID PMC5292614

  • New Imaging Techniques for Atherosclerotic Plaque Characterization Current Radiology Reports Lavra, F., De Cecco, C. N., Varga-Szemes, A., De Santis, D., Albrecht, M. H., Lesslie, V. W., van Assen, M., von Knebel Doeberitz, P., Mastrodicasa, D., Eid, M., Apfaltrer, G., Stalcup, S., Bayer, R. R., Saba, L., Schoepf, J. U. 2017
  • Unexplained Cardiac Arrest After Near Drowning in a Young Experienced Swimmer: Insight from Cardiovascular Magnetic Resonance Imaging IRANIAN JOURNAL OF RADIOLOGY Mantini, C., Messalli, G., Paloscia, L., Mastrodicasa, D., Francone, M., Mascellanti, M., D'Alleva, A., Cotroneo, A. 2016; 13 (4): e36779


    Cardiac magnetic resonance imaging (cMRI) is a well-established noninvasive imaging modality in clinical cardiology. Its ability to provide tissue characterization make it well suited for the study of patients with cardiac diseases. We describe a multi-modality imaging evaluation of a 45-year-old man who experienced a near drowning event during swimming. We underline the unique capability of tissue characterization provided by cMRI, which allowed detection of subtle, clinically unrecognizable myocardial damage for understanding the causes of sudden cardiac arrest and also showed the small damages caused by cardiopulmonary resuscitation.

    View details for DOI 10.5812/iranjradiol.36779

    View details for Web of Science ID 000395456300007

    View details for PubMedID 27895877

    View details for PubMedCentralID PMC5116988