Mohammad Madani

All Publications

• Subacute pacemaker lead migration with cardiac perforation and extracardiac extension into lung parenchyma with associated pneumothorax. Radiology case reports Liang, A., Starr, V. L., Adodra, S., Anchala, P., Madani, M. H. 2026; 21 (5): 1984-1988

  Abstract

  Cardiac perforation with extracardiac extension by a pacemaker lead is a rare but serious complication of pacemaker placement. We present a unique case with imaging of a patient who underwent pacemaker placement complicated by subacute migration of the pacemaker lead, resulting in perforation involving interventricular septum, right ventricular apex, pericardium, epicardial fat, pleura and left upper lobe parenchyma with left-sided pneumothorax.

  View details for DOI 10.1016/j.radcr.2026.01.040

  View details for PubMedID 41756557

  View details for PubMedCentralID PMC12933555

• Pulmonary artery enlargement predicts mortality on low-dose lung cancer screening CT. Clinical imaging Zoghi, S., Rokni, M., Abdelhafez, Y. G., Nardo, L., Madani, M. H. 2026; 134: 110806

  Abstract

  Although pulmonary artery (PA) enlargement on computed tomography (CT) has been linked to adverse cardiopulmonary outcomes, its prognostic significance in asymptomatic individuals undergoing low-dose lung cancer screening CT's remains unclear.To evaluate the prognostic value of PA enlargement for predicting mortality in asymptomatic patients undergoing low-dose CT lung cancer screenings.A total of 777 patients undergoing low-dose screening CT's at a tertiary academic center (2014-2018) were retrospectively identified. PA diameter and PA:AA ratio were measured. The primary endpoint was overall survival (OS), calculated from the date of reference CT to death or censoring at last follow-up. For survival analysis, patients with ≥3 years follow-up were included. Clinical and imaging variables were analyzed using univariate Cox proportional hazard model and statistically significant variables (P < 0.05) were entered into multivariable analysis to identify independent predictors of mortality. All statistical analyses were performed using Python (pandas, seaborn, lifelines).Sex-specific PA diameter thresholds (90th percentile: 29 mm men, 27 mm women) were applied. PA dilation was present in 179 patients (23%). On univariate analysis, age, underweight BMI, smoking status, diabetes, hypertension, coronary artery disease, PA dilation (absolute and PA:AA ratio), and emphysema severity (Goddard score) were associated with decreased survival. On multivariate analysis, PA dilation remained independently associated with increased mortality (HR = 1.83; 95% CI: 1.20-2.79; P = 0.005), along with age, underweight BMI, smoking status, hypertension, and higher Goddard scores.PA enlargement on low-dose CT independently predicts worse survival and may help risk-stratify asymptomatic patients undergoing lung cancer screening.

  View details for DOI 10.1016/j.clinimag.2026.110806

  View details for PubMedID 41990692

• Deep reinforcement learning for automatic anatomic CT landmark localization in Stanford Type B aortic dissection. Radiology advances Bäumler, K., Codari, M., Mastrodicasa, D., Mistelbauer, G., Willemink, M. J., Walters, S., Hinostroza, V., Turner, V., Chepelev, L., Sriprachyakul, A., Madani, M. H., Ewane, A., Chen, E. P., Marsden, A. L., Desjardins, B., Fleischmann, D. 2026; 3 (2): umag006

  Abstract

  Long-term aortic dissection monitoring requires consistent, landmark-based measurements over time.To evaluate the performance of deep reinforcement learning (DRL) agents for the detection of anatomic landmarks in patients with Stanford Type B aortic dissection (TBAD).This is an international retrospective study of 396 CT angiography scans of patients with TBAD from 9 participating sites (mean age 57.6 years ± 13.7/[SD]; 236 male, 160 female). Aortic landmarks, including the aortic annulus and 8 aortic branch vessels, were manually labeled. Additionally, interobserver variability data were collected between 2 observers for 30 scans. DRL agents were trained independently for each landmark with the manual labels serving as the reference standard. Unique landmark locations were obtained from (1) single agents' predictions and (2) clusters of landmark predictions using the DBSCAN clustering algorithm. The performance was analyzed based on distance metrics (mean, median, quantiles) and failure rates, defined as a distance error of more than 10 mm. Interobserver variability data were analyzed with a pairwise Wilcoxon test.On the internal test set, DRL single agents predicted landmark locations with median errors of 2.7 (95% CI, 2.2-3.3) mm and 4.8% failure rate. Cluster-based predictions resulted in a median error of 2.5 (95% CI, 2.4-2.7) mm and 4.0% failure rate. Pooled over all landmarks, cluster-based predictions outperformed single-agent predictions (P < 1e-5). In the external test set, cluster-based DRL models demonstrated significantly lower localization errors and fewer failures compared to single-agent DRL models (P < .01), and were either not significantly different (single agents) from or significantly better (cluster-based, P < .05) than human interobserver variability. The median processing time for a single agent's prediction was 1.0 second (IQR, 0.7-1.4 seconds).Single-agent and cluster-based DRL predict aortic landmarks in patients with TBAD with high accuracy and precision, comparable to the variability between human observers.

  View details for DOI 10.1093/radadv/umag006

  View details for PubMedID 41782811

  View details for PubMedCentralID PMC12956048

• Reproducibility of the 2020 Society for Vascular Surgery/Society of Thoracic Surgeons Reporting Standards for Uncomplicated Type B Aortic Dissection. Radiology. Cardiothoracic imaging Sriprachyakul, A., Mastrodicasa, D., Willemink, M. J., Mistelbauer, G., Shen, J., Yang, I., Hallett, R. L., Malik, S. B., Madani, M. H., Lai, K. M., Hinostroza, V., Stern, J. R., Tran, K., Lee, J. T., Watkins, A. C., MacArthur, J. W., Mitchell, R. S., Miller, D. C., Fleischmann, D. 2025; 7 (6): e240325

  Abstract

  Purpose To assess the inter- and intrareader agreement of the 2020 Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) reporting standards in patients with acute uncomplicated type B aortic dissection (uTBAD). Materials and Methods CT angiograms, obtained between January 2001 and December 2013, from 37 patients (mean age ± SD, 48.5 years ± 15.6; 24 male) with uTBAD were retrospectively reviewed by 14 cardiovascular radiologists and surgeons. The entry tear and proximal and distal extent of each dissection were allocated to aortic zones according to the 2020 SVS/STS reporting standards. Inter- and intrareader agreement was assessed using Cohen κ. Causes of discrepant classifications were analyzed. Results Interreader agreement among all 14 readers (eight radiologists, four cardiothoracic surgeons, and two vascular surgeons) were fair for the entry tear (к = 0.33, 0.40, 0.22, and 0.40), poor to moderate for the proximal extent (к = 0.30, 0.37, 0.20, and 0.41), and moderate to substantial for the distal dissection extent (к = 0.65, 0.80, 0.41, and 0.77). Interreader agreement between individuals was poor to substantial for the entry tear (к = 0.04-0.71; 78% discrepancy) and proximal extent (к = 0.00-0.62; 68% discrepancy), and fair to excellent for the distal extent (к = 0.33-0.92; 35% discrepancy). The causes for discrepancies were unclear definitions of aortic zones, anatomic complexity of lesions, and poor image quality. Intrareader agreement was moderate for the entry tear (к = 0.41-0.57), fair to moderate for the proximal extent (к = 0.37-0.58), and substantial to excellent for the distal extent (к = 0.66-0.92). Conclusion The 2020 SVS/STS reporting standards for acute uTBAD were poorly reproducible among experienced cardiovascular radiologists and surgeons. Keywords: Vascular, Aorta, Dissection, Aortic Dissection, SVS/STS Reporting Standards, CT Angiography, Interobserver Study, Intraobserver Study Supplemental material is available for this article. © RSNA, 2025.

  View details for DOI 10.1148/ryct.240325

  View details for PubMedID 41231129

• Iatrogenic chest tube placement within the heart following a large pneumothorax. Radiology case reports Zoghi, S., Brock, C. L., Atsina, K., Abdelhafez, Y. G., Sen, F., Nardo, L., Madani, M. H. 2025; 20 (8): 3875-3878

  Abstract

  This case report describes an uncommon occurrence of cardiac injury and perforation resulting from chest tube placement. The patient, a 44-year-old female, presented to the ED with severe blunt force trauma following a pedestrian motor vehicle collision. Imaging revealed a large pneumothorax and multiple fractures. Pulsatile bleeding was observed during chest tube placement, and the tube's tip was later found on CT of the thorax to be located within the heart. Although the patient recovered by postoperative day 13 and was subsequently discharged, this case highlights the importance of performing this procedure under image-guidance, along with elucidating the critical role of serial thorough clinical evaluations and prompt imaging for early detection and management of complications.

  View details for DOI 10.1016/j.radcr.2025.04.089

  View details for PubMedID 40492159

  View details for PubMedCentralID PMC12148379

• A multireader, multicase study comparing ultra-high-resolution and conventional-resolution computed tomography for lung nodule characterization. Journal of clinical imaging science Hernandez, A. M., Chen, A. F., Sen, F., Mitchell, A. S., McKenney, S. E., Nardo, L., Abbey, C. K., Madani, M. H. 2025; 15: 25

  Abstract

  The objective of the study was to evaluate the efficacy of ultra-high-resolution computed tomography (UHRCT) in comparison to conventional resolution computed tomography (CT) for the characterization of lung nodules.104 non-contrast chest UHRCT scans (mean age of 66 years, 57 females) with pulmonary nodules were retrospectively collected (February-November 2022), and corresponding normal-resolution (NR) reconstructions were synthesized using a validated algorithm. Five blinded radiologists scored the following for each localized nodule in the ultra-high-resolution (UHR) and NR datasets: Margin clarity (5-point Likert scale), image quality "IQ" (3-point), density confidence (0-100%), and size (long/short axes). Image noise (voxel standard deviation) was calculated within the trachea. Differences between UHR and NR were tested using the Wilcoxon signed-rank test. Intrareader agreement was quantified with intraclass correlation coefficient (ICC), and ordinal association between margin clarity and IQ was quantified with Kendall's τ coefficient.Margin clarity, IQ, and density confidence were significantly higher for UHR (P < 0.001). No significant differences between UHR and NR were observed in the variability (standard deviation across readers) for measuring long and short axes (P > 0.100). Intrareader agreement for UHR and NR was poor for margin clarity, IQ, and density confidences (ICC < 0.250) but moderate for short axes (ICC = 0.731) and good for long axes (ICC = 0.807). Ordinal association between margin clarity and IQ was moderate for UHR (τ = 0.566) and good for IQ (τ = 0.637). Image noise was significantly higher (P < 0.001) for UHR compared to NR.UHRCT offers significant improvements in the visualization of lung nodules compared to conventional resolution CT, albeit with an increase in image noise.

  View details for DOI 10.25259/JCIS_17_2025

  View details for PubMedID 40837596

  View details for PubMedCentralID PMC12361665

• Diagnostic accuracy in NSCLC lymph node staging with Total-Body and conventional PET/CT. European journal of nuclear medicine and molecular imaging Mingels, C., Madani, M. H., Sen, F., Nalbant, H., Riess, J. W., Abdelhafez, Y. G., Ghasemiesfe, A., Rominger, A., Guindani, M., Badawi, R. D., Spencer, B. A., Nardo, L. 2025; 52 (9): 3190-3198

  Abstract

  Our aim was to characterize the diagnostic accuracy indices for nodal (N)-staging with [18F]FDG Total-Body (TB) and short-axial field-of-view (SAFOV) PET/CT in non-small cell lung cancer (NSCLC) patients referred for staging or restaging.In this prospective single center cross-over head-to-head comparative study 48 patients underwent [18F]FDG TB and SAFOV PET/CT on the same day. In total 700 lymph node levels (1R/L, 2R/L, 3a/p, 4R/L, 5, 6, 7, 8R/L, 9R/L, 10-14R/L) of 28 patients could be correlated to a composite reference standard (histopathological correlation, imaging after localized or systemic treatment), which allowed determination of true positive (TP), false positive (FP), true negative (TN) and false negative (FN) lesions. Lymph nodes were characterized semi-quantitatively by maximum standardized uptake value (SUVmax), tumor-to-background ratio (TBR), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) leading to threshold for each scanner.TB and SAFOV PET/CT showed high diagnostic accuracy indices for patient-based N-staging. Sensitivity and specificity were 86.0% (CI: 77.0-95.0%) and 98.3% (CI: 97.3-99.3%) for TB; 77.2% (CI: 66.3-88.1%) and 97.4% (CI: 96.1-98.6%) for SAFOV PET. Positive predictive value was higher for TB (81.7%, CI: 71.9-91.5%) compared to SAFOV PET (72.1%, CI: 60.9-83.4%). However, this finding was not statistically significant (p = 0.08). Negative predictive values for TB (98.6%, CI: 97.9-99.6%) and SAFOV PET/CT (98.0%, CI: 96.9-99.1%) were comparable. Overall, NSCLC N-staging was affected in six cases on SAFOV and only in one case on TB PET/CT. Semi-quantitative analysis revealed a threshold of SUVmax 3.0 to detect TP lesions on both scanners. However, TBR, MTV and TLG thresholds were lower on TB compared to SAFOV PET (TBR: 1.2 vs. 1.7, MTV: 0.5 ml vs. 1.0 ml and TLG: 1.0 ml vs. 3.0 ml).TB and SAFOV PET/CT showed high diagnostic accuracy indices for N-staging in NSCLC patients. Sensitivity and PPV on TB PET/CT were slightly higher, compared to SAFOV PET/CT without statistical significance. However, TB PET/CT showed lower rate of incorrect N-staging and lower semi-quantitative thresholds for the detection positive mediastinal lymph nodes. Therefore, TB PET/CT might be advantageous in detecting small and low [18F]FDG-avidity mediastinal lymph node metastases in NSCLC patients.

  View details for DOI 10.1007/s00259-025-07177-3

  View details for PubMedID 40113643

  View details for PubMedCentralID PMC12222388

• Incidental Myocardial Infarction on Routine Non-Gated Thoracic Computed Tomography. Current medical imaging Rokni, M., Abdelhafez, Y. G., Nardo, L., Madani, M. H. 2025; 21: e15734056363863

  Abstract

  The aim of this study is to assess the identification of incidental myocardial infarction on non-electrocardiogram-gated computed tomographic scans of the chest and its prognostic significance.The increased utilization and abundance of thoracic computed tomographic (CT) scans have provided a substrate for potential screening purposes.The objective of this study was to evaluate the detection of incidental myocardial infarction on routine non-gated thoracic CT performed for noncardiac reasons and its associated major cardiovascular events and survival.We retrospectively assessed routine non-gated thoracic CT scans of all consecutive individuals aged 18 or above who underwent thoracic CT scans as outpatients at the University of California Davis from January 2015 to December 2015. We evaluated the presence and location of incidental MI on non-gated thoracic CT and compared major adverse cardiac events (MACE) and overall survival in CT-positive infarct individuals with a CTnegative infarct control group.We reviewed routine thoracic CT scans of 1157 individuals and identified 12 individuals with incidental MI. The mean age of individuals with infarction was 71.4 ± 14.1 years, and 50% were female. All individuals with incidental MI had coronary calcification. Individuals with incidental MI had a higher rate of MACE endpoint (92% vs. 28%, p=0.0001), number of MACE events (1.1 vs. 0.3, p<0.001), and lower overall survival (median survival of 67 months vs. not reached, p=0.023) compared with age and sex-matched controls without incidental MI.Although small in number relative to the total number of individuals evaluated, subjects with incidental MI on routine non-gated thoracic CT scans have worse cardiovascular outcomes and survival compared with controls without infarction. This study highlights the potential opportunistic screening utility of routine thoracic CTs, which could lead to improved risk stratification and intervention.

  View details for DOI 10.2174/0115734056363863250509093505

  View details for PubMedID 40396321

  View details for PubMedCentralID PMC12754824

• Predicting Late Adverse Events in Uncomplicated Stanford Type B Aortic Dissection: Results From the ROADMAP Validation Study. Circulation. Cardiovascular imaging Fleischmann, D., Mastrodicasa, D., Willemink, M. J., Turner, V. L., Hinostroza, V., Burris, N. S., Yang, B., Hanneman, K., Ouzounian, M., Ocazionez Trujillo, D., Afifi, R. O., Estrera, A. L., Lacomis, J. M., Sultan, I., Gleason, T. G., Pacini, D., Folesani, G., Lovato, L., Stillman, A. E., De Cecco, C. N., Chen, E. P., Hinzpeter, R., Alkadhi, H., Hedgire, S., Sundt, T. M., van Kuijk, S. M., Schurink, G. W., Chin, A. S., Codari, M., Sailer, A. M., Mistelbauer, G., Madani, M. H., Bäumler, K., Shen, J., Lai, K. M., Fischbein, M. P., Miller, D. C. 2025; 18 (2): e016766

  Abstract

  Risk stratification is highly desirable in patients with uncomplicated Stanford type B aortic dissection but inadequately supported by evidence. We sought to validate externally a published prediction model for late adverse events (LAEs), consisting of 1 clinical (connective tissue disease) and 4 imaging variables: maximum aortic diameter, false lumen circumferential angle, false lumen outflow, and number of identifiable intercostal arteries.We assembled a retrospective multicenter cohort (ROADMAP [Registry of Aortic Diseases to Model Adverse Events and Progression]) of 401 patients with uncomplicated Stanford type B aortic dissection presenting to 1 of 8 aortic centers between 2001 and 2013, followed until 2020. LAEs were defined as fatal or nonfatal aortic rupture, new refractory hypertension or pain, organ or limb ischemia, aortic aneurysm formation (≥6 cm), or rapid growth (≥1 cm per year). We applied the original model parameters to the validation cohort and examined the effect on risk categorization using LAE end points.One hundred and seventy-six patients (44%) with incomplete imaging or clinical data were excluded. Of 225 patients in the final cohort, 90 (40%) developed LAEs, predominantly driven by aneurysm formation. Baseline maximum aortic diameter was significantly larger in patients with (42.6 [95% CI, 39.1-45.8] mm) compared with patients without LAEs (39.9 [95% CI, 36.3-44.2] mm; P=0.001). A multivariable Cox regression model indicated that only maximum diameter was associated with LAEs (hazard ratio, 1.07 [95% CI, 1.03-1.11] per mm; P<0.001), while the other parameters were not (P>0.05). Applying the original prediction model to the validation cohort resulted in a poor 5-year sensitivity (38%) and specificity (69%).A clinical and imaging-based prediction model performed poorly in the ROADMAP cohort. Maximum aortic diameter remains the strongest predictor of LAEs in uncomplicated Stanford type B aortic dissection.

  View details for DOI 10.1161/CIRCIMAGING.124.016766

  View details for PubMedID 39965039

  View details for PubMedCentralID PMC11839160

• Traumatic injury of the left anterior descending coronary artery with fistula to the right ventricular outflow tract postgunshot wound. Radiology case reports Zeidan, S., Atsina, K., Jimenez, S., Madani, M. H. 2024; 19 (12): 6465-6469

  Abstract

  Coronary artery fistulas (CAF) are rare abnormalities involving a connection between a coronary artery and an adjacent vessel or heart chamber. Here we discuss the case of a 47-year-old male patient who had multiple gunshot wounds (GSWs) to the chest and abdomen, suffering a through and through bullet wound to the heart from the left ventricle (LV) through the left anterior descending (LAD) coronary artery and exiting from the right ventricle (RV). At the time of his hospitalization, he underwent a non-ECG gated trauma CT scan and subsequent cardiac catheterization that showed patient has a CAF between the LAD and RVOT. Roughly 3 years after his injury, the patient had an ECG-gated coronary CT scan showing the CAF is still present. The patient is now experiencing symptoms of heart failure with suspected worsening of shunt flow from the fistula. This case sheds light on CAFs, their presentation and potential complications to raise awareness for clinicians and radiologists.

  View details for DOI 10.1016/j.radcr.2024.09.117

  View details for PubMedID 39380824

  View details for PubMedCentralID PMC11460361

• Evaluation of responses to cardiac imaging questions by the artificial intelligence large language model ChatGPT. Clinical imaging Monroe, C. L., Abdelhafez, Y. G., Atsina, K., Aman, E., Nardo, L., Madani, M. H. 2024; 112: 110193

  Abstract

  To assess ChatGPT's ability as a resource for educating patients on various aspects of cardiac imaging, including diagnosis, imaging modalities, indications, interpretation of radiology reports, and management.30 questions were posed to ChatGPT-3.5 and ChatGPT-4 three times in three separate chat sessions. Responses were scored as correct, incorrect, or clinically misleading categories by three observers-two board certified cardiologists and one board certified radiologist with cardiac imaging subspecialization. Consistency of responses across the three sessions was also evaluated. Final categorization was based on majority vote between at least two of the three observers.ChatGPT-3.5 answered seventeen of twenty eight questions correctly (61 %) by majority vote. Twenty one of twenty eight questions were answered correctly (75 %) by ChatGPT-4 by majority vote. Majority vote for correctness was not achieved for two questions. Twenty six of thirty questions were answered consistently by ChatGPT-3.5 (87 %). Twenty nine of thirty questions were answered consistently by ChatGPT-4 (97 %). ChatGPT-3.5 had both consistent and correct responses to seventeen of twenty eight questions (61 %). ChatGPT-4 had both consistent and correct responses to twenty of twenty eight questions (71 %).ChatGPT-4 had overall better performance than ChatGTP-3.5 when answering cardiac imaging questions with regard to correctness and consistency of responses. While both ChatGPT-3.5 and ChatGPT-4 answers over half of cardiac imaging questions correctly, inaccurate, clinically misleading and inconsistent responses suggest the need for further refinement before its application for educating patients about cardiac imaging.

  View details for DOI 10.1016/j.clinimag.2024.110193

  View details for PubMedID 38820977

• Volumetric Analysis: Effect on Diagnosis and Management of Indeterminate Solid Pulmonary Nodules in Routine Clinical Practice. Journal of computer assisted tomography Lim, R. S., Rosenberg, J., Willemink, M. J., Cheng, S. N., Guo, H. H., Hollett, P. D., Lin, M. C., Madani, M. H., Martin, L., Pogatchnik, B. P., Pohlen, M., Shen, J., Tsai, E. B., Berry, G. J., Scott, G., Leung, A. N. 2024

  Abstract

  To evaluate the effect of volumetric analysis on the diagnosis and management of indeterminate solid pulmonary nodules in routine clinical practice.This was a retrospective study with 107 computed tomography (CT) cases of solid pulmonary nodules (range, 6-15 mm), 57 pathology-proven malignancies (lung cancer, n = 34; metastasis, n = 23), and 50 benign nodules. Nodules were evaluated on a total of 309 CT scans (average number of CTs/nodule, 2.9 [range, 2-7]). CT scans were from multiple institutions with variable technique. Nine radiologists (attendings, n = 3; fellows, n = 3; residents, n = 3) were asked their level of suspicion for malignancy (low/moderate or high) and management recommendation (no follow-up, CT follow-up, or care escalation) for baseline and follow-up studies first without and then with volumetric analysis data. Effect of volumetry on diagnosis and management was assessed by generalized linear and logistic regression models.Volumetric analysis improved sensitivity (P = 0.009) and allowed earlier recognition (P < 0.05) of malignant nodules. Attending radiologists showed higher sensitivity in recognition of malignant nodules (P = 0.03) and recommendation of care escalation (P < 0.001) compared with trainees. Volumetric analysis altered management of high suspicion nodules only in the fellow group (P = 0.008). κ Statistics for suspicion for malignancy and recommended management were fair to substantial (0.38-0.66) and fair to moderate (0.33-0.50). Volumetric analysis improved interobserver variability for identification of nodule malignancy from 0.52 to 0.66 (P = 0.004) only on the second follow-up study.Volumetric analysis of indeterminate solid pulmonary nodules in routine clinical practice can result in improved sensitivity and earlier identification of malignant nodules. The effect of volumetric analysis on management recommendations is variable and influenced by reader experience.

  View details for DOI 10.1097/RCT.0000000000001630

  View details for PubMedID 38968327

• Natural History of Lung Hernias. Respiration; international review of thoracic diseases Madani, M. H., Abdelhafez, Y. G., Nardo, L. 2023; 102 (9): 843-851

  Abstract

  Lung herniation has been described in case reports or series. There are scare data in the form of original research studies to systematically evaluate this condition.Our aim was to evaluate lung hernias with a focus on their natural history.This is a retrospective study at our institution of patients who were found to have lung herniation on imaging between September 2010 and November 2022. Electronic medical record review was performed to extract clinical information regarding patients. Computed tomographic imaging was used to evaluate hernia size and size progression over time with a median follow-up time of 3.8 years.Thirty-eight patients were eligible for analysis. Majority of patients were overweight or obese (31/38), smokers (31/38), had prior thoracic surgery (30/38), and were asymptomatic (33/38). Twenty of 38 patients had stability in hernia size, 12 of 38 patients had hernia size progression, and 6 of 38 patients showed hernia size regression. Younger age was found to be predictive of hernia size progression with age of 60 years being the cut-off for its prediction.Lung hernias typically either remain stable in size or show size progression. Younger age (60 years cut-off) was found to be predictive of size progression. This is the largest systematic investigation at a medical institution to the best of our knowledge of lung hernias which used computed tomographic imaging to follow up lung hernias. Further information could be given to patients with this condition and to clinicians for potential management guidance.

  View details for DOI 10.1159/000533196

  View details for PubMedID 37669638

• Imaging of lung cancer. Current problems in cancer Madani, M. H., Riess, J. W., Brown, L. M., Cooke, D. T., Guo, H. H. 2023: 100966

  Abstract

  Lung cancer is the leading cause of cancer-related mortality globally. Imaging is essential in the screening, diagnosis, staging, response assessment, and surveillance of patients with lung cancer. Subtypes of lung cancer can have distinguishing imaging appearances. The most frequently used imaging modalities include chest radiography, computed tomography, magnetic resonance imaging, and positron emission tomography. Artificial intelligence algorithms and radiomics are emerging technologies with potential applications in lung cancer imaging.

  View details for DOI 10.1016/j.currproblcancer.2023.100966

  View details for PubMedID 37316337

• Nonsurgical Therapy for Early-Stage Lung Cancer. Hematology/oncology clinics of North America Daly, M. E., Beagen, P., Madani, M. H. 2023; 37 (3): 499-512

  Abstract

  Treatment options for medically inoperable, early-stage non-small cell lung cancer (NSCLC) include stereotactic ablative radiotherapy (SABR) and percutaneous image guided thermal ablation. SABR is delivered over 1-5 sessions of highly conformal ablative radiation with excellent tumor control. Toxicity is depending on tumor location and anatomy but is typically mild. Studies evaluating SABR in operable NSCLC are ongoing. Thermal ablation can be delivered via radiofrequency, microwave, or cryoablation, with promising results and modest toxicity. We review the data and outcomes for these approaches and discuss ongoing studies.

  View details for DOI 10.1016/j.hoc.2023.02.002

  View details for PubMedID 37024386

• Osimertinib in NSCLC With Atypical EGFR-Activating Mutations: A Retrospective Multicenter Study. JTO clinical and research reports Ji, J., Aredo, J. V., Piper-Vallillo, A., Huppert, L., Rotow, J. K., Husain, H., Stewart, S., Cobb, R., Wakelee, H. A., Blakely, C. M., Wong, M. L., Gubens, M. A., Madani, M. H., Digumarthy, S. R., McCoach, C., Piotrowska, Z., Neal, J. W., Riess, J. W. 2023; 4 (3): 100459

  Abstract

  Introduction: EGFR mutations drive a subset of NSCLC. Patients harboring the common EGFR mutations, deletion ofexon 19 and L858R, respond well to osimertinib, a third-generation tyrosine kinase inhibitor. Nevertheless, the effect of osimertinib on NSCLC with atypical EGFR mutations is not well described. This multicenter retrospective study evaluates the efficacy of osimertinib among patients with NSCLC harboring atypical EGFR mutations.Methods: Patients with metastatic NSCLC treated with osimertinib, harboring at least one atypical EGFR mutation, excluding concurrent deletion of exon 19, L858R, or T790M mutations, from six U.S. academic cancer centers were included. Baseline clinical characteristics were collected. The primary end point was the time to treatment discontinuation (TTD) of osimertinib. Objective response rate by the Response Evaluation Criteria in Solid Tumors version 1.1 was also assessed.Results: A total of 50 patients with NSCLC with uncommon EGFR mutations were identified. The most frequent EGFR mutations were L861Q (40%, n= 18), G719X (28%, n= 14), and exon 20 insertion (14%, n= 7). The median TTD of osimertinib was 9.7 months (95% confidence interval [CI]: 6.5-12.9 mo) overall and 10.7 months (95% CI: 3.2-18.1 mo) in the first-line setting (n= 20). The objective response rate was 31.7% (95% CI: 18.1%-48.1%) overall and 41.2% (95% CI: 18.4%-67.1%) in the first-line setting. The median TTD varied among patients with L861Q (17.2 mo), G719X (7.8 mo), and exon 20 insertion (1.5 mo) mutations.Conclusions: Osimertinib has activity in patients with NSCLC harboring atypical EGFR mutations. Osimertinib activity differs by the type of atypical EGFR-activating mutation.

  View details for DOI 10.1016/j.jtocrr.2022.100459

  View details for PubMedID 36879929

• Limited Aortic Intimal Tears: CT Imaging Features and Clinical Characteristics. Radiology. Cardiothoracic imaging Madani, M. H., Turner, V. L., Hallett, R. L., Willemink, M. J., Murillo, H., Chin, A. S., Berry, G. J., Fleischmann, D. 2022; 4 (6): e220155

  Abstract

  Limited aortic intimal tear is an uncommon lesion of the dissection spectrum. The lesion has several imaging features that are not well known, including asymmetric aortic contour abnormalities, filling defects, and various morphologic patterns, such as linear, L-shaped, T-shaped, and stellate configurations. Hemorrhage of the aortic wall may also be present in patients with this rare entity. This imaging essay reviews the CT imaging findings and clinical characteristics of patients with limited intimal tears. Keywords: Aorta, CT © RSNA, 2022.

  View details for DOI 10.1148/ryct.220155

  View details for PubMedID 36601454

  View details for PubMedCentralID PMC9806729

• 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

  Abstract

  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

• Pericardial computed tomography imaging findings in the setting of coccidioidomycosis. BMC infectious diseases Madani, M. H., Ghasemiesfe, A., Abdelhafez, Y. G., Nardo, L. 2022; 22 (1): 623

  Abstract

  Pericardial disease can be a manifestation of infection and imaging can have a role in its diagnosis. coccidioidomycosis endemic fungal infection has been more frequently reported over the past few decades. Other than case reports or series, there has been no systemic study evaluating pericardial imaging findings in patients with coccidioidomycosis to the best of our knowledge. The purpose of this study was to evaluate intrathoracic computed tomographic (CT) imaging abnormalities in patients with coccidioidal infection with specific emphasis on the pericardium.Retrospective review of radiology reports and clinical chart review was performed to identify patients with coccidioidomycosis between January 2000 and September 2021 at our medical center. Diagnosis of infection was confirmed predominately with serology. Patients were excluded if a CT was not performed within 3 months of confirmed diagnosis date and if there was concomitant additional granulomatous or fungal infection. Chest CT was reviewed for pericardial and additional intrathoracic findings.The final retrospective cohort consisted of 37 patients. Imaging findings included lung nodules (N = 33/37), consolidation (N = 25/37), mediastinal or hilar lymphadenopathy (N = 20/37) and pleural effusions (N = 13/37). Eleven of 37 patients (30%) had either trace pericardial fluid (N = 3/37) or small pericardial effusions (N = 8/37). One patient had pericardial enhancement/thickening and history of pericardial tamponade. No other patient had clinical pericarditis or pericardial tamponade. Pericardial calcifications were not seen in any patient. Pericardial effusion was statistically associated with presence of pleural effusion as 9/13 patients with pleural effusion had pericardial effusion versus 2/26 patients without pleural effusion had pericardial effusion (p < 0.001). Otherwise patients with and without pericardial imaging findings were similar in terms of demographics, comorbidities and other imaging findings.Pulmonary parenchymal pathology is a common manifestation of coccidioidal infection. Most patients with coccidioidomycosis do not have pericardial imaging abnormalities on CT.

  View details for DOI 10.1186/s12879-022-07601-1

  View details for PubMedID 35843935

  View details for PubMedCentralID PMC9290292

• Aorto-iliac/right leg arterial thrombosis necessitating limb amputation, pulmonary arterial, intracardiac, and ilio-caval venous thrombosis in a 40-year-old with COVID-19. Clinical imaging Madani, M. H., Leung, A. N., Becker, H. C., Chan, F. P., Fleischmann, D. n. 2021; 75: 1–4

  Abstract

  We describe a 40-year-old man with severe COVID-19 requiring mechanical ventilation who developed aorto-bi-iliac arterial, right lower extremity arterial, intracardiac, pulmonary arterial and ilio-caval venous thromboses and required right lower extremity amputation for acute limb ischemia. This unique case illustrates COVID-19-associated thrombotic complications occurring at multiple, different sites in the cardiovascular system of a single infected patient.

  View details for DOI 10.1016/j.clinimag.2020.12.036

  View details for PubMedID 33477081

• Traumatic Pneumothorax Presenting as a Subcutaneous "Airball". American journal of respiratory and critical care medicine Madhok, J. n., Madani, M. H., Leung, A. N., Mihm, F. n. 2020

  View details for DOI 10.1164/rccm.202006-2515IM

  View details for PubMedID 33197203

• 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

  Abstract

  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

• Could contrast-enhanced cardiovascular MRI potentially be used to screen pediatric cardiac transplant patients for transplant coronary artery disease? Expert review of cardiovascular therapy Caruthers, S. D., Madani, M. H., Wickline, S. A., Canter, C. E. 2012; 10 (12): 1459-61

  View details for DOI 10.1586/erc.12.149

  View details for PubMedID 23253269

• Noninvasive detection of transplant coronary artery disease with contrast-enhanced cardiac MRI in pediatric cardiac transplants. The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation Madani, M. H., Canter, C. E., Balzer, D. T., Watkins, M. P., Wickline, S. A. 2012; 31 (11): 1234-5

  View details for DOI 10.1016/j.healun.2012.06.001

  View details for PubMedID 22749830

  View details for PubMedCentralID PMC3665003