Clinical Focus

  • Diagnostic Radiology
  • Genitourinary Imaging
  • Urology Imaging
  • Gynecology Imaging

Academic Appointments

  • Clinical Assistant Professor, Radiology

Administrative Appointments

  • Co-Medical Director, Point of Care Ultrasound (2021 - Present)

Honors & Awards

  • Distinguished Honors Scholar, University of Cincinnati Honors Program (2008)
  • Summa Cum Laude, Unversity of Cincinnati (2008)
  • Phi Beta Kappa Society, University of Cincinnati (2008)
  • Alpha Omega Alpha Honor Medical Society, University of Cincinnati College of Medicine (2011)

Boards, Advisory Committees, Professional Organizations

  • Member, Society of Point of Care Ultrasound (2022 - Present)
  • Member, SRU Research Committee (2022 - 2022)
  • Editorial board member, European Journal of Radiology Open (EJRO) (2021 - Present)
  • Member, SAR International Task Force Committee (2021 - Present)
  • Member, SAR Disease Focused Panel (DFP) Pelvic Floor Dysfunction (2021 - Present)
  • Member, Society of Radiologists in Ultrasound (SRU) (2021 - Present)
  • Member, Society of Advanced Body Imaging (SABI) (2021 - 2021)
  • Member, American College of Radiology (ACR) (2019 - Present)
  • Member, Society of Abdominal Radiology (SAR) (2019 - Present)
  • Peer reviewer, European Journal of Radiology (2019 - 2020)
  • Peer reviewer, Journal of Abdominal Radiology (2018 - Present)
  • Member, European Society of Radiology (ESR) (2016 - 2020)
  • Member, Radiological Society of North America (RSNA) (2013 - Present)

Professional Education

  • Fellowship: UCLA Radiology Fellowships (2018) CA
  • Residency: UCLA Radiology Residency (2017) CA
  • Internship: University of California Irvine Dept of Internal Medicine (2013) CA
  • Medical Education: University of Cincinnati College of Medicine Registrar (2012) OH
  • Board Certification: American Board of Radiology, Diagnostic Radiology (2018)

Community and International Work

  • RAD-AID Radiology Serving the World, China


    RAD-AID China

    Populations Served

    Underserved areas in China



    Ongoing Project


    Opportunities for Student Involvement


Current Research and Scholarly Interests

GU and Gyn clinical imaging

All Publications

  • Interobserver agreement between eight observers using IOTA simple rules and O-RADS lexicon descriptors for adnexal masses. Abdominal radiology (New York) Antil, N., Raghu, P. R., Shen, L., Tiyarattanachai, T., Chang, E. M., Ferguson, C. W., Ho, A. A., Lutz, A. M., Mariano, A. J., Morimoto, L. N., Kamaya, A. 2022


    PURPOSE: To evaluate interobserver agreement in assigning imaging features and classifying adnexal masses using the IOTA simple rules versus O-RADS lexicon and identify causes of discrepancy.METHODS: Pelvic ultrasound (US) examinations in 114 women with 118 adnexal masses were evaluated by eight radiologists blinded to the final diagnosis (4 attendings and 4 fellows) using IOTA simple rules and O-RADS lexicon. Each feature category was analyzed for interobserver agreement using intraclass correlation coefficient (ICC) for ordinal variables and free marginal kappa for nominal variables. The two-tailed significance level (a) was set at 0.05.RESULTS: For IOTA simple rules, interobserver agreement was almost perfect for three malignant lesion categories (M2-4) and substantial for the remaining two (M1, M5) with k-values of 0.80-0.82 and 0.68-0.69, respectively. Interobserver agreement was almost perfect for two benign feature categories (B2, B3), substantial for two (B4, B5) and moderate for one (B1) with k-values of 0.81-0.90, 0.69-0.70 and 0.60, respectively. For O-RADS, interobserver agreement was almost perfect for two out of ten feature categories (ascites and peritoneal nodules) with k-values of 0.89 and 0.97. Interobserver agreement ranged from fair to substantial for the remaining eight feature categories with k-values of 0.39-0.61. Fellows and attendings had ICC values of 0.725 and 0.517, respectively.CONCLUSION: O-RADS had variable interobserver agreement with overall good agreement. IOTA simple rules had more uniform interobserver agreement with overall excellent agreement. Greater reader experience did not improve interobserver agreement with O-RADS.

    View details for DOI 10.1007/s00261-022-03580-8

    View details for PubMedID 35763052

  • Outcomes of LI-RADS US-2 Subthreshold Observations Detected on Surveillance Ultrasound. AJR. American journal of roentgenology Tse, J. R., Shen, L., Bird, K. N., Yoon, L., Kamaya, A. 2022


    Background: Ultrasound LI-RADS version 2017 recommends that patients with US-2 subthreshold observations undergo repeat surveillance ultrasound in 3-6 months and return to routine surveillance if the observation shows no growth for 2 years. However, outcomes of US-2 observations are unknown. Objective: To determine imaging outcomes of US-2 observations detected on surveillance ultrasound examinations. Methods: This retrospective study included 175 patients (median age, 59 years; 70 women, 105 men) at high risk for hepatocellular carcinoma (HCC) with US-2 observations (i.e., subcentimeter observations) on surveillance ultrasound. Observations were classified on ≥2-year follow-up ultrasound as showing no correlate, stable (if remaining subcentimeter), or progressed (if measuring ≥10 mm, meeting US-3 criteria). Observations were classified on follow-up multiphasic CT or MR (stratified as <2-year vs ≥2-year follow-up) as showing no correlate or, if showing a correlate, using CT/MRI LI-RADS version 2018. Results: A total of 111 patients had ≥2-year follow-up ultrasound and 106 had follow-up CT or MRI (79 before 2 years, 27 after 2 years). Based on final follow-up examinations, 173/175 observations were stable on ≥2-year follow-up ultrasound (n=68); showed no correlate on follow-up ultrasound, CT, or MRI (n=88); or were classified as LR-1 or LR-2 on CT or MRI (n=17). The remaining 2/175 observations were LR-3 on CT or MRI. No observations progressed to US-3 on follow-up ultrasound or were classified as ≥LR-4 on CT or MRI. A correlate was observed in 25 of the 106 follow-up CT or MRI examinations, (LR-1 or LR-2 in 23; LR-3 in 2). Eight patients developed HCC at a median of 2.0 years after initial US-2 observation detection; all HCCs were in separate locations from the baseline observations and were preceded by a surveillance ultrasound that could not re-identify the baseline observation. In three patients who underwent liver transplant, the explant showed no dysplastic nodule or HCC. Conclusion: US-2 subthreshold observations are unlikely to progress or become HCC and commonly have no correlate on follow-up imaging. Clinical Impact: Because of the low progression rate of US-2 subthreshold observations, it is unclear if an extended period of intensive surveillance, as recommended by multiple professional societies, is warranted.

    View details for DOI 10.2214/AJR.22.27812

    View details for PubMedID 35703411

  • Nyquist sampling theorem and Bosniak classification, version 2019: effect of thin axial sections on categorization and agreement. European radiology Tse, J. R., Shen, L., Shen, J., Yoon, L., Kamaya, A. 2022


    To determine if CT axial images reconstructed at current standard of care (SOC; 2.5-3 mm) or thin (≤ 1 mm) sections affect categorization and inter-rater agreement of cystic renal masses assessed with Bosniak classification, version 2019.In this retrospective single-center study, 3 abdominal radiologists reviewed 131 consecutive cystic renal masses from 100 patients performed with CT renal mass protocol from 2015 to 2021. Images were reviewed in two sessions: first with SOC and then the addition of thin sections. Individual and overall categorizations are reported, latter of which is based on majority opinion with 3-way discrepancies resolved by a fourth reader. Major categorization changes were defined as differences between classes I-II, IIF, or III-IV.Thin sections led to a statistically significant major category change with class II for all readers individually (p = 0.004-0.041; McNemar test), upgrading 10-17% of class II masses, most commonly to class IIF followed by III. Modal reason for upgrades was due to identification of additional septa followed by larger measurement of enhancing features. Masses categorized as class I, III, or IV on SOC sections were unaffected, as were identification of protrusions. Inter-rater agreements using weighted Cohen's kappa were 0.679 for SOC and 0.691 for thin sections (both substantial).Thin axial sections upgraded up to one in six class II masses to IIF or III through identification of additional septa or larger feature. Other classes, including III-IV, were unaffected. Inter-rater agreements were substantial regardless of section thickness.• Thin axial sections (≤ 1 mm) compared to standard of care sections (2.5-3 mm) led to identification of additional septa but did not affect identification of protrusions. • Thin axial sections (≤ 1 mm) compared to standard of care sections (2.5-3 mm) can upgrade a small proportion of cystic renal masses from class II to IIF or III when applying Bosniak classification, version 2019. • Inter-rater agreements were substantial regardless of section thickness.

    View details for DOI 10.1007/s00330-022-08876-3

    View details for PubMedID 35705828

  • Safety of percutaneous, image-guided biopsy of hepatocellular carcinoma with and without concurrent ablation. Abdominal radiology (New York) Tse, J. R., Terashima, K., Shen, L., McWilliams, J. P., Lu, D. S., Raman, S. S. 2022


    PURPOSE: To determine the prevalence of adverse events after image-guided biopsy of histologically proven hepatocellular carcinomas (HCC) using a standardized, indirect access, coaxial biopsy technique.METHODS: In this IRB-approved, HIPAA compliant, and retrospective study, we evaluated all consecutive adult patients from 2011 to 2016 who underwent image-guided biopsy of HCC with and without concurrent ablation. Tumor seeding was defined as any new lesion along the needle tract on subsequent imaging. Adverse events were graded using both the Clavien-Dindo Complication Classification system and the most recently proposed Society of Interventional Radiology (SIR) Adverse Event Classification System.RESULTS: A total of 383 patients underwent 398 biopsies (64±11years; 112 women, 271 men). Most patients (282; 71%) underwent concurrent ablation. Adverse events occurred after 18 biopsies (4.5%): 13 were Grade I (Clavien-Dindo) or minor (SIR) and included hematoma (7), hepatic vein thrombus (2), portal vein thrombus (2), moderate pleural effusion (1), and small pneumothorax (1). The remaining 5 (1.3%) adverse events were classified as Grade II-IIIa (Clavien-Dindo) or moderate (SIR) and included hematoma requiring blood products (n=1), arrhythmia (n=1), and symptomatic pleural effusions requiring treatment (n=3). Baseline age, sex, cause of liver disease, HCC diameter, and HCC grade were not associated with adverse events. There were no tumor seeding events after a median follow-up of 611days (interquartile range of 211-1104).CONCLUSION: Percutaneous image-guided tissue sampling using a standardized, indirect access, coaxial technique can be performed safely with and without concurrent ablation by trained cross-sectional interventional radiologists at a tertiary liver transplant center.

    View details for DOI 10.1007/s00261-022-03494-5

    View details for PubMedID 35396970

  • Growth kinetics and progression rates of cystic renal masses on active surveillance. Tse, J., Shen, L., Yoon, L., Kamaya, A. LIPPINCOTT WILLIAMS & WILKINS. 2022
  • Evaluation of early sonographic predictors of gangrenous cholecystitis: mucosal discontinuity and echogenic pericholecystic fat. Abdominal radiology (New York) Tse, J. R., Gologorsky, R., Shen, L., Bingham, D. B., Jeffrey, R. B., Kamaya, A. 1800


    PURPOSE: To identify early sonographic features of gangrenous cholecystitis.MATERIALS AND METHODS: 101 patients with acute cholecystitis and a pre-operative sonogram were retrospectively reviewed by three radiologists in this IRB-approved and HIPAA-compliant study. Imaging data were correlated with histologic findings and compared using the Fisher's exact test or Student t test with p<0.05 to determine statistical significance.RESULTS: Forty-eight patients had gangrenous cholecystitis and 53 had non-gangrenous acute cholecystitis. Patients with gangrenous cholecystitis tended to be older (67±17 vs 48±18years; p=0.0001), male (ratio of male:female 2:1 vs 0.6:1; p=0.005), tachycardic (60% vs 28%; p=0.001), and diabetic (25% vs 8%; p=0.001). Median time between pre-operative sonogram and surgery was 1day. On imaging, patients with gangrenous cholecystitis were more likely to have echogenic pericholecystic fat (p=0.001), mucosal discontinuity (p=0.010), and frank perforation (p=0.004), while no statistically significant differences were seen in the presence of sloughed mucosa (p=0.104), pericholecystic fluid (p=0.523) or wall striations (p=0.839). In patients with gangrenous cholecystitis and echogenic pericholecystic fat, a smaller subset had concurrent mucosal discontinuity (57%), and a smaller subset of those had concurrent frank perforation (58%). The positive likelihood ratios for gangrenous cholecystitis with echogenic fat and mucosal discontinuity were 4.6 (95% confidence interval 1.9-11.3) and 14.4 (2.0-106), respectively.CONCLUSION: Echogenic pericholecystic fat and mucosal discontinuity are early sonographic findings that may help identify gangrenous cholecystitis prior to late findings of frank perforation.

    View details for DOI 10.1007/s00261-021-03320-4

    View details for PubMedID 34985635

  • Growth Kinetics and Progression Rate of Bosniak Classification, Version 2019 III and IV Cystic Renal Masses on Imaging Surveillance. AJR. American journal of roentgenology Tse, J. R., Shen, L., Shen, J., Yoon, L., Chung, B. I., Kamaya, A. 2022


    Background: Active surveillance is increasingly used as first-line management for localized renal masses. Triggers for intervention primarily reflect growth kinetics, which are poorly investigated for cystic masses defined by Bosniak classification version 2019 (v2019). Objective: To determine growth kinetics and incidence rates of progression of class III and IV cystic renal masses, as defined by Bosniak classification v2019. Methods: This retrospective study included 105 patients (68 men, 37 women; median age, 67 years) with 112 Bosniak v2019 class III or IV cystic renal masses on baseline renal-mass protocol CT or MRI examinations from January 2005 to September 2021. Mass dimensions were measured. Progression was defined as any of: linear growth rate (LGR) ≥5 mm per year (representing clinical guideline threshold for intervention), volume doubling time <1 year, T category increase, or N1 or M1 disease. Class III and IV masses were compared. Time-to-progression was estimated using Kaplan-Meier curve analysis. Results: At baseline, 58 masses were class III and 54 were class IV. Median follow-up was 406 days. Median LGR was for class III masses 0.0 mm per year [interquartile range (IQR) -1.3 to 1.8] and for class IV masses 2.3 mm per year (IQR 0.0¬¬-5.7) (p<.001). LGR exceeded 5 mm per year in 4 (7%) class 3 masses and 15 (28%) class IV masses (p=.005). Two patients, both with class IV masses, developed distant metastases. Incidence rate of progression was for class III masses 11.0 (95% CI 4.5-22.8) and for class IV masses 73.6 (95% CI 47.8-108.7) per 100,000 person-days of follow-up. Median time-to-progression was undefined for class III mases given small number of progression events and 710 days for class IV masses. Hazard ratio of progression for class IV relative to class III masses was 5.1 (95% CI 2.5-10.8) (p<.001). Conclusion: During active surveillance of cystic masses evaluated using Bosniak classification v2019, class IV masses grew faster and were more likely to progress than class III masses. Clinical Impact: In comparison with current active surveillance guidelines that treat class III and IV masses similarly, future iterations may incorporate relatively more intensive surveillance for class IV masses.

    View details for DOI 10.2214/AJR.22.27400

    View details for PubMedID 35293234

  • Inflammatory pseudotumor-like follicular dendritic cell tumor of the spleen: a case report and approach to differential diagnosis. Radiology case reports Nguyen, A., Negrete, L. M., Bulterys, P. L., Shen, L. 2021; 16 (11): 3213-3216


    We present a case of an inflammatory pseudotumor-like follicular dendritic cell tumor of the spleen. The patient is a 44-year-old woman, without significant underlying history, who presented with nonspecific abdominal pain for a few months. Both a contrast enhanced computed tomography and magnetic resonance imaging revealed a new 2.5 cm enhancing splenic lesion, which demonstrated hypermetabolic activity on subsequent positron emission tomography and computed tomography scan. Since the lesion was new compared to more remote imaging and hypermetabolic, a splenectomy was performed. Pathology confirmed the diagnosis and demonstrated positivity for Epstein-Barr Virus .

    View details for DOI 10.1016/j.radcr.2021.07.078

    View details for PubMedID 34484521

  • Prevalence of Malignancy and Histopathologic Association of Bosniak Classification, Version 2019 Class III and IV Cystic Renal Masses. The Journal of urology Tse, J. R., Shen, L., Shen, J., Yoon, L., Kamaya, A. 2020: 101097JU0000000000001438


    PURPOSE: Bosniak Classification, version 2019 (v2019) describes two types of class III and IV masses each: 1) thick, wall/septa ≥4 mm (III-WS), 2) obtuse protrusion ≤3 mm (III-OP), 3) obtuse protrusion ≥4 mm (IV-OP), and 4) acute protrusion of any size (IV-AP). The purposes were to determine the prevalence of malignancy and histopathologic features of class III and IV masses and subclasses.MATERIALS AND METHODS: In this IRB-approved and HIPAA-compliant study, three fellowship-trained abdominal radiologists (R1-3) reviewed cystic renal masses that had tissue pathology and pre-operative renal mass protocol CT or MRI. Classes based on v2019 and prior classification systems were retrospectively re-assigned and associated with malignancy, aggressive histologic features (necrosis or high Fuhrman grade), and radiologic progression following resection.RESULTS: The final sample included 79 masses (59 malignant, 20 benign) from 74 patients. Based on v2019, prevalence of malignancy ranged from 56-61% (mean 60%) for class III and 83-83% (mean 83%) for class IV (p=0.036, 0.013, 0.036 for R1-3). Prevalence of malignancy within subclasses were: III-WS (47-53%); III-OP (71-85%); IV-OP (75-87%); IV-AP (87-95%; p=0.029, 0.001, 0.005). All readers were more likely to classify malignancies with aggressive histologic features as class IV (88-100%) rather than class III (0-12%; p=0.012, <0.001, 0.002), corresponding to a negative predictive value of 96-100%. Following treatment (mean follow-up length 1210 days), one patient developed metastases.CONCLUSIONS: Bosniak Classification, version 2019 can help risk stratification of class III-IV masses by identifying those likely to be malignant and have aggressive histologic features.

    View details for DOI 10.1097/JU.0000000000001438

    View details for PubMedID 33085925

  • Bosniak Classification of Cystic Renal Masses Version 2019: Comparison of Categorization using CT and MRI. AJR. American journal of roentgenology Tse, J. R., Shen, J. n., Shen, L. n., Yoon, L. n., Kamaya, A. n. 2020


    Please see the Author Video associated with this article. Background: Bosniak Classification, version 2019 recently proposed refinements for cystic renal mass characterization and now formally incorporates MRI, which may improve concordance with CT. Purpose: To compare concordance of CT and MRI in evaluation of cystic renal masses using Bosniak Classification, version 2019. Materials and Methods: In this IRB-approved and HIPAA compliant study, three abdominal radiologists (R1-R3) retrospectively reviewed 68 consecutive cystic renal masses from 45 patients assessed with both CT and MR renal mass protocols within a year between 2005-2019. CT and MRI were reviewed independently and in separate sessions, using both the original and version 2019 Bosniak Classification systems. Results: Using Bosniak Classification, version 2019, cystic renal masses were classified into 12 category I, 19 category II, 13 category IIF, 4 category III, and 20 category IV by CT and 8 category I, 15 category II, 23 category IIF, 9 category III, and 13 category IV by MRI. Among individual features, MRI depicted more septa (p<0.001, p=0.046, p=0.005 for R1-R3; McNemar's test) for all radiologists, though both CT and MRI showed a similar number of protrusions (p=0.823, 1.0, 0.302) and maximal septa/wall thickness (p=1.0, 1.0, 0.145). Of discordant cases with version 2019, MRI led to the higher category in 12 masses. Reason for upgrade was most commonly due to protrusions identified only on MRI (n=4), increased number of septa (n=3), and a new category of heterogeneously T1-hyperintense (n=3). Neither modality was more likely to lead to a category change for both version 2019 (p=0.502; McNemar's test) and the original Bosniak classification system (p=0.823). Overall inter-rater agreement was substantial for both CT (κ=0.745) and MRI (κ=0.655) using version 2019 and was slightly higher than that of the original system (CT κ=0.707; MRI κ=0.623). Conclusion: CT and MRI were concordant in the majority of cases using Bosniak Classification, version 2019 and category changes by modality were not statistically significant. Inter-rater agreements were substantial for both CT and MRI. Clinical Impact: Bosniak Classification, version 2019 applied to cystic renal masses has substantial inter-rater agreement and does not lead to systematic category upgrades with either CT or MRI.

    View details for DOI 10.2214/AJR.20.23656

    View details for PubMedID 32755181

  • Human-machine partnership with artificial intelligence for chest radiograph diagnosis. NPJ digital medicine Patel, B. N., Rosenberg, L. n., Willcox, G. n., Baltaxe, D. n., Lyons, M. n., Irvin, J. n., Rajpurkar, P. n., Amrhein, T. n., Gupta, R. n., Halabi, S. n., Langlotz, C. n., Lo, E. n., Mammarappallil, J. n., Mariano, A. J., Riley, G. n., Seekins, J. n., Shen, L. n., Zucker, E. n., Lungren, M. n. 2019; 2: 111


    Human-in-the-loop (HITL) AI may enable an ideal symbiosis of human experts and AI models, harnessing the advantages of both while at the same time overcoming their respective limitations. The purpose of this study was to investigate a novel collective intelligence technology designed to amplify the diagnostic accuracy of networked human groups by forming real-time systems modeled on biological swarms. Using small groups of radiologists, the swarm-based technology was applied to the diagnosis of pneumonia on chest radiographs and compared against human experts alone, as well as two state-of-the-art deep learning AI models. Our work demonstrates that both the swarm-based technology and deep-learning technology achieved superior diagnostic accuracy than the human experts alone. Our work further demonstrates that when used in combination, the swarm-based technology and deep-learning technology outperformed either method alone. The superior diagnostic accuracy of the combined HITL AI solution compared to radiologists and AI alone has broad implications for the surging clinical AI deployment and implementation strategies in future practice.

    View details for DOI 10.1038/s41746-019-0189-7

    View details for PubMedID 31754637

    View details for PubMedCentralID PMC6861262

  • Author Correction: Human-machine partnership with artificial intelligence for chest radiograph diagnosis. NPJ digital medicine Patel, B. N., Rosenberg, L. n., Willcox, G. n., Baltaxe, D. n., Lyons, M. n., Irvin, J. n., Rajpurkar, P. n., Amrhein, T. n., Gupta, R. n., Halabi, S. n., Langlotz, C. n., Lo, E. n., Mammarappallil, J. n., Mariano, A. J., Riley, G. n., Seekins, J. n., Shen, L. n., Zucker, E. n., Lungren, M. P. 2019; 2 (1): 129


    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

    View details for DOI 10.1038/s41746-019-0198-6

    View details for PubMedID 33293693

  • Erratum: Author Correction: Human-machine partnership with artificial intelligence for chest radiograph diagnosis. NPJ digital medicine Patel, B. N., Rosenberg, L. n., Willcox, G. n., Baltaxe, D. n., Lyons, M. n., Irvin, J. n., Rajpurkar, P. n., Amrhein, T. n., Gupta, R. n., Halabi, S. n., Langlotz, C. n., Lo, E. n., Mammarappallil, J. n., Mariano, A. J., Riley, G. n., Seekins, J. n., Shen, L. n., Zucker, E. n., Lungren, M. P. 2019; 2: 129


    [This corrects the article DOI: 10.1038/s41746-019-0189-7.].

    View details for DOI 10.1038/s41746-019-0198-6

    View details for PubMedID 31840097

    View details for PubMedCentralID PMC6904441

  • Translabial US: Preoperative Detection of Midurethral Sling Erosion in Stress Urinary Incontinence. Radiology Viragh, K. A., Cohen, S. A., Shen, L., Kurzbard-Roach, N., Raz, S., Raman, S. S. 2018; 289 (3): 721-727


    Purpose To evaluate the performance of translabial (TL) US in preoperative detection of sling erosion into pelvic organs with cystourethroscopic and surgical correlation. Materials and Methods The study cohort included women who underwent surgery at a subspecialty center (from 2008 to 2016) for suspected mesh complications in the setting of previous midurethral sling placement for stress urinary incontinence (from 1999 to 2012) with available preoperative TL US imaging. Clinical information, the finding of sling erosion identified intraoperatively and at cystourethroscopy, and blinded dual-reader radiologic analysis of the TL US studies for mesh location (intraluminal, mural, or extramural) relative to pelvic organs (bladder, urethra, vagina, or rectum) were evaluated. The diagnostic performance of TL US was correlated with the reference standard of surgical findings. The consensus of two radiologists was recorded, and interobserver agreement was evaluated with the κ statistic. Results Of the 124 women who were suspected of having sling erosion (mean age, 57.5 years ± 11.1 [standard deviation]), 15 women (12.1%) had sling erosion into the urethra or bladder at surgery. Sensitivity and specificity for erosion at TL US were 53% (95% confidence interval: 45%, 62%) and 100% (95% confidence interval: 97%, 100%), respectively, when erosion was defined as only intraluminal mesh products. Sensitivity and specificity for erosion at TL US were 93% (95% confidence interval: 89%, 98%) and 72% (95% confidence interval: 65%, 80%), respectively, when erosion was defined as visualizing either intraluminal or intramural mesh products. Interobserver agreement (κ value) was 0.95. Cystourethroscopy had 67% sensitivity and 100% specificity for sling erosion. Conclusion Preoperative translabial US can be used to detect sling erosion into the lower urinary tract, with sensitivity up to 93% and specificity up to 100%. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Benson and Phillips in this issue.

    View details for DOI 10.1148/radiol.2018180786

    View details for PubMedID 30106346

  • Pathological and 3 Tesla Volumetric Magnetic Resonance Imaging Predictors of Biochemical Recurrence after Robotic Assisted Radical Prostatectomy: Correlation with Whole Mount Histopathology. The Journal of urology Tan, N., Shen, L., Khoshnoodi, P., Alcalá, H. E., Yu, W., Hsu, W., Reiter, R. E., Lu, D. Y., Raman, S. S. 2018; 199 (5): 1218-1223


    We sought to identify the clinical and magnetic resonance imaging variables predictive of biochemical recurrence after robotic assisted radical prostatectomy in patients who underwent multiparametric 3 Tesla prostate magnetic resonance imaging.We performed an institutional review board approved, HIPAA (Health Insurance Portability and Accountability Act) compliant, single arm observational study of 3 Tesla multiparametric magnetic resonance imaging prior to robotic assisted radical prostatectomy from December 2009 to March 2016. Clinical, magnetic resonance imaging and pathological information, and clinical outcomes were compiled. Biochemical recurrence was defined as prostate specific antigen 0.2 ng/cc or greater. Univariate and multivariate regression analysis was performed.Biochemical recurrence had developed in 62 of the 255 men (24.3%) included in the study at a median followup of 23.5 months. Compared to the subcohort without biochemical recurrence the subcohort with biochemical recurrence had a greater proportion of patients with a high grade biopsy Gleason score, higher preoperative prostate specific antigen (7.4 vs 5.6 ng/ml), intermediate and high D'Amico classifications, larger tumor volume on magnetic resonance imaging (0.66 vs 0.30 ml), higher PI-RADS® (Prostate Imaging-Reporting and Data System) version 2 category lesions, a greater proportion of intermediate and high grade radical prostatectomy Gleason score lesions, higher pathological T3 stage (all p <0.01) and a higher positive surgical margin rate (19.3% vs 7.8%, p = 0.016). On multivariable analysis only tumor volume on magnetic resonance imaging (adjusted OR 1.57, p = 0.016), pathological T stage (adjusted OR 2.26, p = 0.02), positive surgical margin (adjusted OR 5.0, p = 0.004) and radical prostatectomy Gleason score (adjusted OR 2.29, p = 0.004) predicted biochemical recurrence.In this cohort tumor volume on magnetic resonance imaging and pathological variables, including Gleason score, staging and positive surgical margins, significantly predicted biochemical recurrence. This suggests an important new imaging biomarker.

    View details for DOI 10.1016/j.juro.2017.10.042

    View details for PubMedID 29128577

    View details for PubMedCentralID PMC6946378

  • Automatic Classification of Ultrasound Screening Examinations of the Abdominal Aorta. Journal of digital imaging Morioka, C., Meng, F., Taira, R., Sayre, J., Zimmerman, P., Ishimitsu, D., Huang, J., Shen, L., El-Saden, S. 2016; 29 (6): 742-748


    Our work facilitates the identification of veterans who may be at risk for abdominal aortic aneurysms (AAA) based on the 2007 mandate to screen all veteran patients that meet the screening criteria. The main research objective is to automatically index three clinical conditions: pertinent negative AAA, pertinent positive AAA, and visually unacceptable image exams. We developed and evaluated a ConText-based algorithm with the GATE (General Architecture for Text Engineering) development system to automatically classify 1402 ultrasound radiology reports for AAA screening. Using the results from JAPE (Java Annotation Pattern Engine) transducer rules, we developed a feature vector to classify the radiology reports with a decision table classifier. We found that ConText performed optimally on precision and recall for pertinent negative (0.99 (0.98-0.99), 0.99 (0.99-1.00)) and pertinent positive AAA detection (0.98 (0.95-1.00), 0.97 (0.92-1.00)), and respectably for determination of non-diagnostic image studies (0.85 (0.77-0.91), 0.96 (0.91-0.99)). In addition, our algorithm can determine the AAA size measurements for further characterization of abnormality. We developed and evaluated a regular expression based algorithm using GATE for determining the three contextual conditions: pertinent negative, pertinent positive, and non-diagnostic from radiology reports obtained for evaluating the presence or absence of abdominal aortic aneurysm. ConText performed very well at identifying the contextual features. Our study also discovered contextual trigger terms to detect sub-standard ultrasound image quality. Limitations of performance included unknown dictionary terms, complex sentences, and vague findings that were difficult to classify and properly code.

    View details for DOI 10.1007/s10278-016-9889-6

    View details for PubMedID 27400914

    View details for PubMedCentralID PMC5114229

  • MR anatomy and pathology of the ulnar nerve involving the cubital tunnel and Guyon's canal. Clinical imaging Shen, L., Masih, S., Patel, D. B., Matcuk, G. R. 2015; 40 (2): 263-74


    Ulnar neuropathy is a common and frequent reason for referral to hand surgeons. Ulnar neuropathy mostly occurs in the cubital tunnel of the elbow or Guyon's canal of the wrist, and it is important for radiologists to understand the imaging anatomy at these common sites of impingement. We will review the imaging and anatomy of the ulnar nerve at the elbow and wrist, and we will present magnetic resonance imaging examples of different causes of ulnar neuropathy, including trauma, overuse, arthritis, masses and mass-like lesions, and systemic diseases. Treatment options will also be briefly discussed.

    View details for DOI 10.1016/j.clinimag.2015.11.008

    View details for PubMedID 26995584