29 results on '"Ashley, Wachsman"'
Search Results
2. Segmentation of Pancreatic Subregions in Computed Tomography Images
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Sehrish Javed, Touseef Ahmad Qureshi, Zengtian Deng, Ashley Wachsman, Yaniv Raphael, Srinivas Gaddam, Yibin Xie, Stephen Jacob Pandol, and Debiao Li
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pancreatic subregions segmentation ,pancreas segmentation ,CT abdominal scans ,Photography ,TR1-1050 ,Computer applications to medicine. Medical informatics ,R858-859.7 ,Electronic computers. Computer science ,QA75.5-76.95 - Abstract
The accurate segmentation of pancreatic subregions (head, body, and tail) in CT images provides an opportunity to examine the local morphological and textural changes in the pancreas. Quantifying such changes aids in understanding the spatial heterogeneity of the pancreas and assists in the diagnosis and treatment planning of pancreatic cancer. Manual outlining of pancreatic subregions is tedious, time-consuming, and prone to subjective inconsistency. This paper presents a multistage anatomy-guided framework for accurate and automatic 3D segmentation of pancreatic subregions in CT images. Using the delineated pancreas, two soft-label maps were estimated for subregional segmentation—one by training a fully supervised naïve Bayes model that considers the length and volumetric proportions of each subregional structure based on their anatomical arrangement, and the other by using the conventional deep learning U-Net architecture for 3D segmentation. The U-Net model then estimates the joint probability of the two maps and performs optimal segmentation of subregions. Model performance was assessed using three datasets of contrast-enhanced abdominal CT scans: one public NIH dataset of the healthy pancreas, and two datasets D1 and D2 (one for each of pre-cancerous and cancerous pancreas). The model demonstrated excellent performance during the multifold cross-validation using the NIH dataset, and external validation using D1 and D2. To the best of our knowledge, this is the first automated model for the segmentation of pancreatic subregions in CT images. A dataset consisting of reference anatomical labels for subregions in all images of the NIH dataset is also established.
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- 2022
- Full Text
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3. Feasibility and safety study of 22-gauge endoscopic ultrasound (EUS) needles for portal vein sampling in a swine model
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Kenneth Park, Daniel Lew, Christopher Chapman, Ashley Wachsman, Matthew Bloom, Liiana Bancila, Rachel Perry, Qiang Wang, Laith Jamil, Stephen Pandol, and Simon Lo
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Diseases of the digestive system. Gastroenterology ,RC799-869 - Abstract
Background and study aims Endoscopic ultrasound (EUS) has been used for portal vein sampling in patients with pancreaticobiliary cancers for enumerating circulating tumor cells but is not yet a standard procedure. Further evaluation is needed to refine the methodology. Therefore, we evaluated the feasibility and safety of 19-gauge (19G) versus a 22-gauge (22 G) EUS fine-needle aspiration needles for portal vein sampling in a swine model. Methods Celiotomy was performed on two farm pigs. Portal vein sampling occurred transhepatically. We compared 19 G and 22 G needles coated interiorly with saline, heparin or ethylenediaminetetraacetic acid (EDTA). Small- (10 mL) and large- (25 mL) volume blood collections were evaluated. Two different collection methods were tested: direct-to-vial and suction syringe. A bleeding risk trial for saline-coated 19 G and 22 G needles was performed by puncturing the portal vein 20 times. Persistent bleeding after 3 minutes was considered significant. Results All small-volume collection trials were successful except for 22 G saline-coated needles with direct-to-vial method. All large-volume collection trials were successful when using suction syringe; direct-to-vial method for both 19 G and 22 G needles were unsuccessful. Collection times were shorter for 19 G vs. 22 G needles for both small and large-volume collections (P
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- 2020
- Full Text
- View/download PDF
4. Quantitative MRI of chronic pancreatitis: results from a multi-institutional prospective study, magnetic resonance imaging as a non-invasive method for assessment of pancreatic fibrosis (MINIMAP)
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Temel, Tirkes, Dhiraj, Yadav, Darwin L, Conwell, Paul R, Territo, Xuandong, Zhao, Scott A, Persohn, Anil K, Dasyam, Zarine K, Shah, Sudhakar K, Venkatesh, Naoki, Takahashi, Ashley, Wachsman, Liang, Li, Yan, Li, Stephen J, Pandol, Walter G, Park, Santhi S, Vege, Phil A, Hart, Mark, Topazian, Dana K, Andersen, and Evan L, Fogel
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Pancreatitis, Chronic ,Acute Disease ,Humans ,Prospective Studies ,Digestive System Abnormalities ,Fibrosis ,Magnetic Resonance Imaging - Abstract
To determine if quantitative MRI techniques can be helpful to evaluate chronic pancreatitis (CP) in a setting of multi-institutional study.This study included a subgroup of participants (n = 101) enrolled in the Prospective Evaluation of Chronic Pancreatitis for Epidemiologic and Translational Studies (PROCEED) study (NCT03099850) from February 2019 to May 2021. MRI was performed on 1.5 T using Siemens and GE scanners at seven clinical centers across the USA. Quantitative MRI parameters of the pancreas included T1 relaxation time, extracellular volume (ECV) fraction, apparent diffusion coefficient (ADC), and fat signal fraction. We report the diagnostic performance and mean values within the control (n = 50) and CP (n = 51) groups. The T1, ECV and fat signal fraction were combined to generate the quantitative MRI score (Q-MRI).There was significantly higher T1 relaxation time; mean 669 ms (± 171) vs. 593 ms (± 82) (p = 0.006), ECV fraction; 40.2% (± 14.7) vs. 30.3% (± 11.9) (p 0.001), and pancreatic fat signal fraction; 12.2% (± 5.5) vs. 8.2% (± 4.4) (p 0.001) in the CP group compared to controls. The ADC was similar between groups (p = 0.45). The AUCs for the T1, ECV, and pancreatic fat signal fraction were 0.62, 0.72, and 0.73, respectively. The composite Q-MRI score improved the diagnostic performance (cross-validated AUC: 0.76).Quantitative MR parameters evaluating the pancreatic parenchyma (T1, ECV fraction, and fat signal fraction) are helpful in the diagnosis of CP. A Q-MRI score that combines these three MR parameters improves diagnostic performance. Further studies are warranted with larger study populations including patients with acute and recurrent acute pancreatitis and longitudinal follow-ups.
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- 2022
5. T1 signal intensity ratio of the pancreas as an imaging biomarker for the staging of chronic pancreatitis
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Temel, Tirkes, Anil K, Dasyam, Zarine K, Shah, Evan L, Fogel, Santhi Swaroop, Vege, Liang, Li, Shuang, Li, Stephanie T, Chang, Carlos A, Farinas, Joseph R, Grajo, Kareem, Mawad, Naoki, Takahashi, Sudhakar K, Venkatesh, Ashley, Wachsman, William E, Fisher, Christopher E, Forsmark, Phil A, Hart, Stephen J, Pandol, Walter G, Park, Stephen K, Van Den Eeden, Yunlong, Yang, Mark, Topazian, Dana K, Andersen, Jose, Serrano, Darwin L, Conwell, and Dhiraj, Yadav
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Pancreatitis, Chronic ,Acute Disease ,Humans ,Prospective Studies ,Magnetic Resonance Imaging ,Pancreas ,Biomarkers - Abstract
Our purpose was to validate the T1 SIR (T1 score) as an imaging biomarker for the staging of CP in a large, multi-institutional, prospective study.The prospective study population included 820 participants enrolled in the PROCEED study from nine clinical centers between June 2017 and December 2021. A radiologist at each institution used a standardized method to measure the T1 signal intensity of the pancreas and the reference organs (spleen, paraspinal muscle, liver), which was used to derive respective T1 scores. Participants were stratified according to the seven mechanistic stages of chronic pancreatitis (MSCP 0-6) based on their clinical history, MRCP, and CT findings.The mean pancreas-to-spleen T1 score was 1.30 in participants with chronic abdominal pain, 1.22 in those with acute or recurrent acute pancreatitis, and 1.03 in definite CP. After adjusting for covariates, we observed a linear, progressive decline in the pancreas-to-spleen T1 score with increasing MSCP from 0 to 6. The mean pancreas-to-spleen T1 scores were 1.34 (MSCP 0), 1.27 (MSCP 1), 1.21 (MSCP 2), 1.16 (MSCP 3), 1.18 (MSCP 4), 1.12 (MSCP 5), and 1.05 (MSCP 6) (p 0.0001). The pancreas-to-liver and pancreas-to-muscle T1 scores showed less linear trends and wider confidence intervals.The T1 score calculated by SIR of the pancreas-to-spleen shows a negative linear correlation with the progression of chronic pancreatitis. It holds promise as a practical imaging biomarker in evaluating disease severity in clinical research and practice.
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- 2022
6. Venous bullet embolism to the right ventricle: Case report and review of management
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Ashley Wachsman, Fardad Esmailian, Joanna Chikwe, and Luke Henderson
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medicine.medical_specialty ,general surgery ,cardiothoracic surgery ,medicine.medical_treatment ,lcsh:Medicine ,Case Report ,Case Reports ,030204 cardiovascular system & hematology ,vascular surgery ,03 medical and health sciences ,0302 clinical medicine ,medicine ,cardiovascular diseases ,lcsh:R5-920 ,Surgical complication ,business.industry ,lcsh:R ,General Medicine ,Vascular surgery ,medicine.disease ,Surgery ,medicine.anatomical_structure ,Embolism ,Cardiothoracic surgery ,Ventricle ,030220 oncology & carcinogenesis ,Right heart ,cardiovascular system ,lcsh:Medicine (General) ,business ,Cardiotomy - Abstract
Intravascular missile emboli to the right heart should be retrieved surgically if the risk of surgical complication due to sternotomy and cardiotomy is low. Endovascular retrieval is another possible method of extraction to be considered.
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- 2020
7. Abstract A037: Predicting pancreatic cancer using artificial intelligence analysis of pancreatic subregions using computed tomography images
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Sehrish Javed, Touseef Ahmad Qureshi, Srinivas Gaddam, Ashley Wachsman, Linda Azab, Vahid Asadpour, Wansu Chen, Bechien Wu, Yibin Xie, Stephen Pandol, and Debiao Li
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Cancer Research ,Oncology - Abstract
Study background: Early detection of pancreatic ductal adenocarcinoma (PDAC) can elevate the current ~10% five-years survival rate of PDAC up to 50%. Accurate stratification of high-risk individuals for PDAC can improve early detection as follow-up screening may assist diagnosis at an early stage. Studies show that the pancreas adopts changes prior to or during the development of cancer due to the underlying biological variations. This study aimed to examine the precancerous changes that occurred within and across pancreatic subregions to help stratify individuals at high risk of developing PDAC. Dataset: In a multi-institute retrospective study, 108 contrast-enhanced CT abdominal scans were collected, consisting of 36 diagnostic scans with established PDAC and observable tumor, 36 pre-diagnostic scans of the same subjects as in the diagnostic group but were obtained up to 3 years before PDAC diagnosis and were deemed ‘normal’ by radiologists, and 36 healthy scans reported with no PDAC signs. Trained radiologists outlined 3 subregions (head, body, tail) in all scans. Also, the subregions in pre-diagnostic scans were classified into high-risk (with cancer underdevelopment) and low-risk (no cancer development) groups by exploring the tumor signs in their corresponding subregions in the diagnostic scans. Experiments and results: Radiomic analysis was performed on all 324 subregions by extracting and analyzing hundreds of morphological and textural features. In a pairwise feature analysis (i.e. between corresponding subregions), the texture of the high-risk subregions in pre-diagnostic scans was found significantly unique and statistically different than that of the low-risk subregions, supporting the study hypothesis. Such textural features are usually too minute and remain obscured when the pancreas is observed as a single structure. The analysis showed that AI can efficiently identify and quantify such predictors. A Naïve Bayes model was then trained using the same data to automatically predict PDAC using the textural features of the pancreatic subregions. In four-fold cross-validation, the model obtained prediction accuracy by correctly classifying pre-diagnostic and healthy CT scans by 88.2% on average, with sensitivity (true positive rate) and specificity (true negative rate) reaching 82.5% and 94.0%, respectively. The results of this preliminary study are promising and encouraging to further validate the model on a larger dataset. The model showed improved results over those produced in our recent study [1] in which the pancreas as a single structure was examined. The prediction based on the proposed model can potentially assist clinicians to undertake specialized screening, diagnosis, and treatment planning accordingly as the tumor structure, symptoms, and drug response for each pancreatic subregion differs a lot. 1. Qureshi et. al, Predicting pancreatic ductal adenocarcinoma using artificial intelligence analysis of pre-diagnostic computed tomography images. Cancer Biomarkers, 33(2), pp.211-217, 2022. Citation Format: Sehrish Javed, Touseef Ahmad Qureshi, Srinivas Gaddam, Ashley Wachsman, Linda Azab, Vahid Asadpour, Wansu Chen, Bechien Wu, Yibin Xie, Stephen Pandol, Debiao Li. Predicting pancreatic cancer using artificial intelligence analysis of pancreatic subregions using computed tomography images [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer; 2022 Sep 13-16; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2022;82(22 Suppl):Abstract nr A037.
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- 2022
8. A phase 1 study of veliparib, a PARP-1/2 inhibitor, with gemcitabine and radiotherapy in locally advanced pancreatic cancer
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Laith H. Jamil, Richard Tuli, Miranda Bryant, Kevin Scher, Simon S. Lo, Stephen L. Shiao, Lindsey Ristow, David M. J. Hoffman, Samuel J. Klempner, Paul Noe, Nicholas N. Nissen, Ashley Wachsman, Howard M. Sandler, Veronica Placencio-Hickok, Sepehr Rokhsar, Sungjin Kim, Mourad Tighiouart, M.J. Davis, Arsen Osipov, Andrew Eugene Hendifar, and Steven Piantadosi
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Male ,0301 basic medicine ,Oncology ,Research paper ,medicine.medical_treatment ,Poly (ADP-Ribose) Polymerase-1 ,Phases of clinical research ,Deoxycytidine ,chemistry.chemical_compound ,0302 clinical medicine ,Antineoplastic Combined Chemotherapy Protocols ,Clinical endpoint ,Medicine ,Neoplasm Metastasis ,Pancreas cancer ,Cancer ,Radiation ,General Medicine ,Middle Aged ,Prognosis ,Combined Modality Therapy ,6.5 Radiotherapy and other non-invasive therapies ,3. Good health ,Treatment Outcome ,6.1 Pharmaceuticals ,030220 oncology & carcinogenesis ,PARP inhibitor ,Public Health and Health Services ,Female ,Microsatellite Instability ,Poly(ADP-ribose) Polymerases ,Parp inhibitor ,medicine.drug ,medicine.medical_specialty ,Veliparib ,Clinical Trials and Supportive Activities ,Clinical Sciences ,Poly(ADP-ribose) Polymerase Inhibitors ,General Biochemistry, Genetics and Molecular Biology ,Pancreatic Cancer ,03 medical and health sciences ,Rare Diseases ,Clinical Research ,Internal medicine ,Genetics ,Humans ,Neoplasm Staging ,Aged ,Chemotherapy ,Radiotherapy ,business.industry ,Evaluation of treatments and therapeutic interventions ,Gemcitabine ,Pancreatic Neoplasms ,Radiation therapy ,Regimen ,Good Health and Well Being ,030104 developmental biology ,chemistry ,Mutation ,Benzimidazoles ,Digestive Diseases ,business - Abstract
Background Locally advanced pancreatic cancer (LAPC) has a dismal prognosis with current treatment modalities and one-third of patients die from local progression of disease. Preclinical studies with orthotopic PC demonstrated dramatic synergy between radiotherapy (RT) and the poly(ADP-ribose) polymerase-1/2 inhibitor (PARPi), veliparib. We conducted a phase I trial of gemcitabine, radiotherapy and dose-escalated veliparib in LAPC. Methods This was a single institution investigator-initiated open-label, single-arm phase 1 clinical trial (NCT01908478). Weekly gemcitabine with daily IMRT and veliparib dose escalated using a Bayesian adaptive design were administered in treatment naive LA or borderline resectable PC. The primary end point was identification of the MTD. Secondary endpoints included efficacy, characterization of PAR levels using ELISA, DDR alterations with targeted next generation sequencing and transcriptome analysis, tumor mutation burden (TMB) and microsatellite instability (MSI) status. Findings Thirty patients were enrolled. The MTD of veliparib was 40 mg BID with gemcitabine 400 mg/m2 and RT (36 Gy/15 fractions). Sixteen DLTs were identified in 12 patients. Grade ≥ 3 adverse events included lymphopenia (96%) and anemia (36%). Median OS for all patients was 15 months. Median OS for DDR pathway gene altered and intact cases was 19 months (95% CI: 6.2–27.2) and 14 months (95% CI: 10.0–21.8), respectively. There were no significant associations between levels of PAR, TMB, or MSI with outcomes. The DDR transcripts PARP3 and RBX1 significantly correlated with OS. Interpretation This is the first report of a PARPi-chemoradiotherapy combination in PC. The regimen was safe, tolerable at the RP2D, and clinically active as an upfront treatment strategy in patients biologically unselected by upfront chemotherapy. Expression of the DDR transcripts, PARP3 and RBX1, were associated with OS suggesting validation in a follow up phase 2 study. Fund Phase One Foundation; National Institutes of Health [1R01CA188480-01A1, P01 CA098912]. Veliparib was provided by Abbvie.
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- 2019
9. Percutaneous Cholecystostomy Tube for Acute Cholecystitis: Quantifying Outcomes and Prognosis
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Edward H. Phillips, Raymond Huang, Deven C. Patel, Joseph Ralph Kallini, Richard J. Van Allan, Daniel R. Margulies, Ashley Wachsman, and Galinos Barmparas
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Male ,medicine.medical_specialty ,Demographics ,business.industry ,General surgery ,medicine.medical_treatment ,Cholecystitis, Acute ,Prognosis ,Intensive care unit ,law.invention ,Acs nsqip ,Treatment Outcome ,law ,Acute cholecystitis ,medicine ,Percutaneous cholecystostomy ,Humans ,Surgery ,In patient ,Cholecystectomy ,Complication ,business ,Cholecystostomy ,Retrospective Studies - Abstract
Percutaneous cholecystostomy tubes (PCT) are utilized in the management of acute cholecystitis in patients deemed unsuitable for surgery. However, the drive for these decisions and the outcomes remain understudied. We sought to characterize the practices and utilization of PCT and evaluate associated outcomes at an urban medical center.Patients undergoing PCT placement over a 12-y study period ending May 2019 were reviewed. Demographics, clinical presentation, labs, imaging studies, and outcomes were abstracted. The primary and secondary outcomes were 30-d mortality and interval cholecystectomy, respectively.Two hundred and four patients met inclusion criteria: 59.3% were male with a median age of 67.5 y and a National Surgical Quality Improvement Program (NSQIP) risk of serious complication of 8.0%. Overall, 57.8% of patients were located in an intensive care unit setting. The majority (80.9%) had an ultrasound and 48.5% had a hepatobiliary iminodiacetic acid scan. The overall 30-d mortality was 31.9%: 41.5% for intensive care unit and 18.6% for ward patients (P0.01). Of patients surviving beyond 30 d (n = 139), the PCT was removed from 106 (76.3%), and a cholecystectomy was performed in 55 (39.6%) at a median interval of 58.0 d. A forward logistic regression identified total bilirubin (Adjusted Odds Ratio: 1.12, adjusted P0.01) and NSQIP risk of serious complication (Adjusted Odds Ratio: 1.16, adjusted P0.01) as the only predictors for 30-d mortality.Patients selected for PCT placement have a high mortality risk. Despite subsequent removal of the PCT, the majority of surviving patients did not undergo an interval cholecystectomy. Total bilirubin and NSQIP risk of serious complication are useful adjuncts in predicting 30-d mortality in these patients.
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- 2021
10. Feasibility and safety study of 22-gauge endoscopic ultrasound (EUS) needles for portal vein sampling in a swine model
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Qiang Wang, Kenneth H. Park, Stephen J. Pandol, Rachel Perry, Matthew B. Bloom, Christopher G. Chapman, Daniel Lew, Laith H. Jamil, Simon S. Lo, Liiana Bancila, and Ashley Wachsman
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Suction (medicine) ,Endoscopic ultrasound ,medicine.medical_specialty ,Original article ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Ultrasound ,Portal vein ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,medicine ,030211 gastroenterology & hepatology ,Pharmacology (medical) ,Sampling (medicine) ,lcsh:Diseases of the digestive system. Gastroenterology ,Radiology ,lcsh:RC799-869 ,business ,Saline ,Fine-needle aspirate ,Syringe - Abstract
Background and study aims Endoscopic ultrasound (EUS) has been used for portal vein sampling in patients with pancreaticobiliary cancers for enumerating circulating tumor cells but is not yet a standard procedure. Further evaluation is needed to refine the methodology. Therefore, we evaluated the feasibility and safety of 19-gauge (19G) versus a 22-gauge (22 G) EUS fine-needle aspiration needles for portal vein sampling in a swine model. Methods Celiotomy was performed on two farm pigs. Portal vein sampling occurred transhepatically. We compared 19 G and 22 G needles coated interiorly with saline, heparin or ethylenediaminetetraacetic acid (EDTA). Small- (10 mL) and large- (25 mL) volume blood collections were evaluated. Two different collection methods were tested: direct-to-vial and suction syringe. A bleeding risk trial for saline-coated 19 G and 22 G needles was performed by puncturing the portal vein 20 times. Persistent bleeding after 3 minutes was considered significant. Results All small-volume collection trials were successful except for 22 G saline-coated needles with direct-to-vial method. All large-volume collection trials were successful when using suction syringe; direct-to-vial method for both 19 G and 22 G needles were unsuccessful. Collection times were shorter for 19 G vs. 22 G needles for both small and large-volume collections (P Conclusion The results of this animal study demonstrate the feasibility and the safety of using 22 G needles for portal vein sampling and can form the basis for a pilot study in patients.
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- 2020
11. Inter-observer variability of radiologists for Cambridge classification of chronic pancreatitis using CT and MRCP: results from a large multi-center study
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Kareem Mawad, Ashley Wachsman, Darwin L. Conwell, Liang Li, Naoki Takahashi, Joseph R. Grajo, Carlos A. Farinas, Savitri Appana, Anil K. Dasyam, Temel Tirkes, Stephanie T. Chang, Zarine K. Shah, and Dhiraj Yadav
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Adult ,Male ,Cholangiopancreatography, Magnetic Resonance ,Urology ,Concordance ,Contrast Media ,Severity of Illness Index ,Article ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Cohen's kappa ,Pancreatitis, Chronic ,Radiologists ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Aged ,Observer Variation ,Magnetic resonance cholangiopancreatography ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Magnetic resonance imaging ,Middle Aged ,medicine.disease ,030220 oncology & carcinogenesis ,Cohort ,Pancreatitis ,Female ,Nuclear medicine ,business ,Observer variation ,Tomography, X-Ray Computed ,Kappa - Abstract
PURPOSE: Determine inter-observer variability among radiologists in assigning Cambridge Classification (CC) of chronic pancreatitis (CP) based on magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) and contrast-enhanced CT (CECT). METHODS: Among 422 eligible subjects enrolled into the PROCEED study between 6/2017 and 8/2018, 39 were selected randomly for this study (chronic abdominal pain (n=8; CC of 0), suspected CP (n=22; CC of 0, 1 or 2) or definite CP (n=9; CC of 3 or 4). Each imaging was scored by the local radiologist (LRs) and three of five central radiologists (CRs) at other consortium sites. The CRs were blinded to clinical data and site information of the participants. We compared the CC score assigned by the LR with the consensus CC score assigned by the CRs. The weighted kappa statistic (K) was used to estimate the inter-observer agreement. RESULTS: For the majority of subjects (34/39), the group assignment by LR agreed with the consensus composite CT/MRCP score by the CRs (concordance ranging from 75% to 89% depending on cohort group). There was moderate agreement (63% and 67% agreed, respectively) between CRs and LRs in both the CT score (weighted Kappa [95% CI] = 0.56 [0.34, 0.78]; p-value = 0.57) and the MR score (weighted Kappa [95% CI] = 0.68 [0.49, 0.86]; p-value = 0.72). The composite CT/MR score showed moderate agreement (weighted Kappa [95% CI] = 0.62 [0.43, 0.81]; p-value = 0.80). CONCLUSION: There is a high degree of concordance among radiologists for assignment of CC using MRI and CT.
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- 2020
12. Colonic Diverticulitis Complicated by Liver Abscess: Case Series and Review of Literature
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Ashley Wachsman, Meka Adi Uffenheimer, Alagappan Annamalai, Yosef Nasseri, Paul A. Kohanteb, and Cynthia Liu
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medicine.medical_specialty ,business.industry ,medicine ,Radiology ,Diverticulitis ,business ,medicine.disease ,Liver abscess - Abstract
Aim: Evaluate patients with colonic diverticulitis complicated by liver abscesses at a single center and provide review of literature.Methods: Patients with colonic diverticulitis and liver abscess were identified via an administrative database and imaging search engine at Cedars Sinai Medical Center (CSMC). Clinical manifestations, laboratory and imaging findings and treatment strategies were assessed.Results: We identified 10 patients with a median age of 59 and a 7:3 male: female ratio. The top presenting signs and symptoms were: fever (90%), malaise (70%), anorexia (60%), nausea (40%), and right upper quadrant abdominal pain (30%). Mean white blood cell count was 22.4 1000/UL, total bilirubin 2.59 mg/DL, and alkaline phosphatase 206.6 IU/L. Of the reported liver abscess cultures, 5 patients grew a single organism and 2 had multiple organisms. Most common bacteria genus was Streptococcus (n=4). Five patients had right hepatic abscesses, 3 had bilobar, and 2 had left hepatic abscesses. Four patients had locally complicated diverticulitis: 2 with paracolonic abscess and 2 with purulent peritonitis. Nine patients had CT-guided drainage of liver abscess, while 2 needed surgical drainage of liver abscess (one required both). Five patients had colectomy: 1 emergently and 4 electively. Two patients who did not have colectomy had recurrent diverticulitis, and underwent colectomy following recurrence.Conclusion: Majority of patients with diverticulitis with liver abscess were males presenting with fever, and leukocytosis. Most had right liver lobe abscesses and most underwent colectomies. Diverticulitis with liver abscess is likely best treated as locally complicated disease and should undergo colectomy.
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- 2018
13. Imaging of Neuroendocrine Tumors
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Run Yu and Ashley Wachsman
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medicine.medical_specialty ,Modalities ,medicine.diagnostic_test ,business.industry ,Endocrinology, Diabetes and Metabolism ,Octreotide scan ,Tumor burden ,Computed tomography ,Neuroendocrine tumors ,medicine.disease ,030218 nuclear medicine & medical imaging ,Functional imaging ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,medicine ,Abdomen ,Radiology ,Somatostatin analog ,Nuclear medicine ,business - Abstract
Imaging is critical in the diagnosis, prognosis, and management of neuroendocrine tumors (NETs). NETs share common imaging features, but each type exhibits unique features. Computed tomography scans or MRI of the abdomen is used to assess tumor burden routinely. Functional imaging with octreotide scan or gallium-68 somatostatin analog PET is used selectively to confirm diagnosis and guide therapy. Clinicians and radiologists should be familiar with the indications and interpretations of imaging modalities. Novel functional imaging modalities likely will be developed to detect small NETs, predict prognosis, guide therapeutic choices, and design novel therapies.
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- 2017
14. Su1335 FEASIBILITY AND SAFETY OF USING A 22-GAUGE ENDOSCOPIC ULTRASOUND NEEDLE FOR PORTAL VEIN SAMPLING IN A SWINE MODEL
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Simon K. Lo, Kenneth H. Park, Liliana Bancila, Ashley Wachsman, Rachel Perry, Matthew B. Bloom, Christopher G. Chapman, and Daniel Lew
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Endoscopic ultrasound ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Gauge (instrument) ,Gastroenterology ,medicine ,Portal vein ,Sampling (statistics) ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Published
- 2020
15. The role of pre-operative imaging and double balloon enteroscopy in the surgical management of small bowel neuroendocrine tumors: Is it necessary?
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Andrew Eugene Hendifar, Ashley Wachsman, Nicholas N. Nissen, Laith H. Jamil, Attiya Harit, Nicholas Manguso, Farin Amersi, Simon S. Lo, Jeffrey Johnson, and Alexandra Gangi
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Enteroscopy ,Adult ,Male ,medicine.medical_specialty ,Extent of disease ,Neuroendocrine tumors ,Imaging modalities ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Double-balloon enteroscopy ,Intestinal Neoplasms ,Intestine, Small ,medicine ,Humans ,Pain Management ,Watchful Waiting ,Aged ,Retrospective Studies ,Aged, 80 and over ,Double-Balloon Enteroscopy ,medicine.diagnostic_test ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Primary tumor ,Pre operative ,Endoscopy ,Neuroendocrine Tumors ,Oncology ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,Radiology ,business ,Follow-Up Studies - Abstract
Background and Objectives Pre-operative localization of small bowel neuroendocrine tumors (SBNET) is important for operative planning. The aim was to determine the effectiveness of pre-operative imaging and double-balloon enteroscopy (DBE) in identifying extent of disease. Methods Database review identified 85 patients with primary SBNET between 2006 and 2013. Analysis included patients who underwent imaging, endoscopy, and surgery at our institution. Results Average age was 60.7 years. Sixty-six (77.1%) patients had a primary NET in the ileum. Seventy-two patients (67.3%) underwent CT, 47 (46.7%) had MRI, 44 (46.7%) had somatostatin receptor imaging (SRI), and 41 (39.3%) underwent DBE. The sensitivity of each in identifying the NET was 59.7% for CT, 54% for MRI, 56% for SRI, and 88.1% for DBE. Eighteen (21.2%) patients had primary tumors not identified on imaging. Of these 18, 13 underwent DBE, and 12 of 13 (92.3%) DBEs identified the primary lesion. DBE was significantly better at identifying the primary NET than CT, MRI or SRI (P = 0.004, 0.007, and 0.012). Conclusions Most SBNETs are identified with a combination of imaging modalities. In those with unidentified primary tumors after imaging, DBE should be considered as it may provide valuable information as to the location of the primary tumor.
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- 2017
16. The role of embolization in reducing the complications of cryoablation in renal cell carcinoma
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Marc L. Friedman, Joseph M. Miller, R.J. Van Allan, Ashley Wachsman, and P. Julien
- Subjects
Male ,medicine.medical_specialty ,viruses ,medicine.medical_treatment ,Renal function ,Cryosurgery ,environment and public health ,Lesion ,Postoperative Complications ,Renal cell carcinoma ,Biopsy ,medicine ,Carcinoma ,Humans ,Radiology, Nuclear Medicine and imaging ,Embolization ,Carcinoma, Renal Cell ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Cryoablation ,General Medicine ,medicine.disease ,Embolization, Therapeutic ,Kidney Neoplasms ,Surgery ,Treatment Outcome ,Feasibility Studies ,Female ,Radiology ,medicine.symptom ,business ,Complication - Abstract
Aim To investigate whether embolization prior to cryoablation would decrease morbidity without negative effects on tissue pathology, renal function, or recurrence. Material and methods The electronic medical records of all patients undergoing cryoablation for renal cell carcinomas were reviewed for lesion size, pre-ablative renal function, post-ablative renal function, post-ablative complications, recurrence, and quality of biopsy specimen. Comparisons were made between patients who underwent cryoablation (the Cryo-Only group) and those who underwent cryoablation after same-day coil embolization of their lesion (the Cryo-Embo group). Further comparison was made between the Cryo-Embo lesions and the subset of larger Cryo-Only lesions (≥3 cm), which were expected to have a higher natural complication rate. Results A total of 21 lesions in 19 patients were treated by percutaneous cryoablation (17 Cryo-Only, four Cryo-Embo). Complications were seen in 83% of the large Cryo-Only lesions (average size 3.6 cm), whereas no complication was seen amongst Cryo-Embo lesions (average size 4 cm). Embolization significantly decreased complications between size-matched lesions ( p = 0.048) without impacting renal function ( p = 1), biopsy quality ( p = 1), or recurrence ( p = 1). Conclusion Performance of trans-arterial embolization prior to cryoablation of large renal cell carcinomas significantly decreases complications, such as haemorrhage, without a discernible effect on biopsy quality, renal function, or recurrence rate.
- Published
- 2014
17. Fulminant Clostridium difficile Colitis: Comparing Computed Tomography with Histopathology: Are They Concordant?
- Author
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Katherine Haker, Phillip Fleshner, Bonnie Balzer, Brent K. Larson, Ashley Wachsman, Daniel R. Margulies, Seth Felder, and Alagappan Annamalai
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pancolitis ,medicine.medical_treatment ,Concordance ,Fulminant ,Clostridium Difficile Colitis ,Preoperative Care ,medicine ,Humans ,Colitis ,Colectomy ,Aged ,Retrospective Studies ,Aged, 80 and over ,Clostridioides difficile ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Clostridium Infections ,Female ,Histopathology ,Radiology ,medicine.symptom ,Segmental resection ,Tomography, X-Ray Computed ,business - Abstract
A Total abdominal colectomy (TAC) is recommended for fulminant Clostridium difficile colitis (FCDC) because intraoperative assessment of diseased segments is inaccurate. To determine whether computerized tomography (CT) provides an accurate assessment of disease, we examined the concordance between CT and histopathologic colitis distribution in patients undergoing TAC for FCDC. The ileocolon was divided into seven distinct segments. Of 20 patients meeting criteria, the median interval between preoperative CT and TAC was 1.5 days (range, 0 to 23 days), and mortality was 65 per cent. The CT distribution of colitis was pancolitis in 12 patients and segmental in eight. Nine of the 12 patients with CT pancolitis had histologic pancolitis (75% concordance). Four of the eight patients with CT-diagnosed segmental disease had histologic segmental disease (50% concordance). For patients with FCDC, the distribution of colitis on CT agrees with the histopathologic extent of disease in the majority of patients. However, discordance between CT and histologic extent of disease was present in 25 to 50 per cent of patients. Therefore, the recommendation for TAC rather than segmental resection for FCDC remains justified.
- Published
- 2014
18. The effects of everolimus on tuberous sclerosis-associated lesions can be dramatic but may be impermanent
- Author
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Ashley Wachsman, Katherine Haker, Joseph M. Miller, Dechu Puliyanda, Fataneh Majlessipour, and Moise Danielpour
- Subjects
Male ,Sirolimus ,Nephrology ,medicine.medical_specialty ,Pathology ,Angiomyolipoma ,Everolimus ,Adolescent ,business.industry ,mTORC1 ,medicine.disease ,Tuberous sclerosis ,Maintenance therapy ,Tuberous Sclerosis ,Giant cell ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Subependymal zone ,Humans ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Tuberous sclerosis complex (TSC) predisposes to the development of benign lesions within multiple organ systems, including the brain, kidneys, heart, lungs, and skin. Disease mortality is due to space-occupying subependymal giant cell astrocytomas and hemorrhage-prone renal angiomyolipomas. The recent use of mTORC1 inhibitors, such as everolimus, has allowed for direct targeting of TSC-associated mass lesions without apparent effect on surrounding tissues. Because of the mechanism of these drugs, there is reason to believe that these effects are not durable and that there may be need for continued long-term maintenance therapy.We present a case of TSC-associated mass lesions that were ill-suited for definitive surgical therapy. The patient was started on everolimus, however due to a complex social situation treatment was discontinued and ultimately resumed many months later. Radiologic studies acquired before and after each period of therapeutic onset/cessation reveal the dramatic but impermanent effects of mTORC1 inhibition.While everolimus provides a non-invasive way to treat TSC-associated lesions, patients may require lifelong therapy. When termination of therapy is considered, the patient should be made aware of the expectation of potentially dramatic increases in lesion size. If consideration is to be given to definitive surgical therapy, it should be pursued while the patient is still on the medication, or at least soon after treatment is halted.
- Published
- 2014
19. Visual Vignette
- Author
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Run Yu, Ashley Wachsman, and Nicholas N. Nissen
- Subjects
Fatty Liver ,Pancreatic Neoplasms ,Endocrinology ,Endocrinology, Diabetes and Metabolism ,Humans ,Female ,Insulinoma ,General Medicine ,Magnetic Resonance Imaging ,Aged - Published
- 2015
20. Pancreatic Fistula or Leak after Distal Pancreatectomy: Has Anything Changed? 13-Year Single Surgeon Experienc
- Author
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Laith H. Jamil, Pratik Mehta, Braden N. Miller, Nicholas N. Nissen, Alagappan Annamalai, Ashley Wachsman, Anthony Morada, Srinivas Gaddam, and Simon K. Lo
- Subjects
Leak ,medicine.medical_specialty ,Hepatology ,business.industry ,Pancreatic fistula ,General surgery ,Gastroenterology ,Medicine ,business ,Distal pancreatectomy ,medicine.disease ,Single surgeon ,Surgery - Published
- 2017
21. Hyperphosphatemia
- Author
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John J. Orrego, Michael Sheehan, Melpomeni Peppa, Maria Dracopoulou-Vabouli, Sotirios A. Raptis, Anna Milanesi, Edward Wolin, Ashley Wachsman, and Run Yu
- Subjects
medicine.medical_specialty ,biology ,business.industry ,Endocrinology, Diabetes and Metabolism ,Adrenalectomy ,medicine.medical_treatment ,21-Hydroxylase ,MEDLINE ,General Medicine ,Bioinformatics ,Endocrinology ,Text mining ,Internal medicine ,medicine ,biology.protein ,business - Published
- 2010
22. Pancreatic Neuroendocrine Tumors: Presentation, Management, and Outcomes
- Author
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Edward M. Wolin, Simon K. Lo, Steven D. Colquhoun, Amanda S. Kim, Nicholas N. Nissen, Run Yu, Ashley Wachsman, and Marc L. Friedman
- Subjects
medicine.medical_specialty ,Abdominal pain ,Pancreatic disease ,business.industry ,Multimodal therapy ,General Medicine ,Neuroendocrine tumors ,Hypoglycemia ,Single Center ,medicine.disease ,Gastroenterology ,Surgery ,Median follow-up ,Pancreatic tumor ,Internal medicine ,medicine ,medicine.symptom ,business - Abstract
Pancreatic neuroendocrine tumors (pNETs) are an uncommon pancreatic neoplasm. We reviewed the presentation, management, and outcome of patients with pNETs treated at a single center by a multidisciplinary approach between 2004 and 2008. Over this time period, 154 patients with carcinoid and neuroendocrine tumors were treated, which included 46 patients (30% of total) with pNETs. The most common presentations included abdominal pain (20 of 46 [43%]), systemic symptoms such as hypoglycemia (15 of 46 [33%]), and incidental mass (7 of 46 [15%]). Fourteen patients had functional tumors. At the time of diagnosis, 22 patients (48%) presented without metastases and 24 (52%) had metastatic disease. Median follow up for the entire group was 42 months. All patients with nonmetastatic pNET underwent pancreatic resection with 95 per cent postoperative survival. Overall survival in this group at 3 years was 86 per cent and disease-free survival was 81 per cent. In patients presenting with metastatic pNET, multiple treatment modalities were used, including liver resection or ablation (n = 15), hepatic chemoembolization (n = 17), pancreatic resection (n = 12), and systemic treatments (n = 7). Three-year survival was 70 per cent. Pancreatic resection results in greater than 80 per cent 3-year survival in nonmetastatic pNET. In patients presenting with metastatic pNET, excellent survival rates are also achievable using a multidisciplinary multimodal approach.
- Published
- 2009
23. Four-dimensional Magnetic Resonance Imaging with 3D Radial Sampling and Self-gating based K-space Sorting: Early Clinical Experience on Pancreatic Cancer Patients
- Author
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Zixin Deng, Debiao Li, Richard Tuli, Zhaoyang Fan, Benedick A. Fraass, Robert Reznik, Jianing Pang, Ashley Wachsman, Wensha Yang, and Howard M. Sandler
- Subjects
Adult ,Male ,Cancer Research ,Movement ,Magnetic Resonance Imaging, Cine ,Article ,Image stitching ,Pancreatic tumor ,Pancreatic cancer ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,Four-Dimensional Computed Tomography ,Projection (set theory) ,Aged ,Radiation ,medicine.diagnostic_test ,business.industry ,Respiration ,Magnetic resonance imaging ,k-space ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,Tumor Burden ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Oncology ,Female ,Nuclear medicine ,business ,Pancreas ,Artifacts - Abstract
Purpose To apply a novel self-gating k-space sorted 4-dimensional MRI (SG-KS-4D-MRI) method to overcome limitations due to anisotropic resolution and rebinning artifacts and to monitor pancreatic tumor motion. Methods and Materials Ten patients were imaged using 4D-CT, cine 2-dimensional MRI (2D-MRI), and the SG-KS-4D-MRI, which is a spoiled gradient recalled echo sequence with 3-dimensional radial-sampling k-space projections and 1-dimensional projection-based self-gating. Tumor volumes were defined on all phases in both 4D-MRI and 4D-CT and then compared. Results An isotropic resolution of 1.56 mm was achieved in the SG-KS-4D-MRI images, which showed superior soft-tissue contrast to 4D-CT and appeared to be free of stitching artifacts. The tumor motion trajectory cross-correlations (mean ± SD) between SG-KS-4D-MRI and cine 2D-MRI in superior–inferior, anterior–posterior, and medial–lateral directions were 0.93 ± 0.03, 0.83 ± 0.10, and 0.74 ± 0.18, respectively. The tumor motion trajectories cross-correlations between SG-KS-4D-MRI and 4D-CT in superior–inferior, anterior–posterior, and medial–lateral directions were 0.91 ± 0.06, 0.72 ± 0.16, and 0.44 ± 0.24, respectively. The average standard deviation of gross tumor volume calculated from the 10 breathing phases was 0.81 cm 3 and 1.02 cm 3 for SG-KS-4D-MRI and 4D-CT, respectively ( P =.012). Conclusions A novel SG-KS-4D-MRI acquisition method capable of reconstructing rebinning artifact–free, high-resolution 4D-MRI images was used to quantify pancreas tumor motion. The resultant pancreatic tumor motion trajectories agreed well with 2D-cine-MRI and 4D-CT. The pancreatic tumor volumes shown in the different phases for the SG-KS-4D-MRI were statistically significantly more consistent than those in the 4D-CT.
- Published
- 2015
24. Parenchymal-Preserving Resection for Pancreatic Neuroendocrine Tumors: are the Outcomes Justified?
- Author
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Anthony Morada, Gwendolyn Garnett, Nicholas N. Nissen, Braden N. Miller, Simon K. Lo, Ashley Wachsman, Deepti Dhall, Alagappan Annamalai, and Andrew Eugene Hendifar
- Subjects
Pathology ,medicine.medical_specialty ,Hepatology ,business.industry ,Parenchyma ,Gastroenterology ,medicine ,Neuroendocrine tumors ,medicine.disease ,business ,Resection - Published
- 2017
25. TH-CD-204-01: FEATURED PRESENTATION and BEST IN PHYSICS (JOINT IMAGING-THERAPY): Novel SG-KS-4D-MRI Sequence Reduces 4D Rebinning Artifacts and Improves GTV Contouring Consistency for Pancreatic Cancer Patients
- Author
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Zixin Deng, Richard Tuli, Benedick A. Fraass, Ashley Wachsman, Jianing Pang, Zhaoyang Fan, H.M. Sandler, Wensha Yang, Debiao Li, and Robert Reznik
- Subjects
Physics ,Contouring ,medicine.diagnostic_test ,Correlation coefficient ,business.industry ,Magnetic resonance imaging ,General Medicine ,Kinematics ,Iterative reconstruction ,medicine.disease ,Organ Motion ,Pancreatic tumor ,medicine ,Projection (set theory) ,Nuclear medicine ,business - Abstract
Purpose: Dynamic magnetic resonance imaging (MRI) has been used to characterize tumor motion but real time acquisition has been limited to 2-dimensions. Methods have been developed to reconstruct four-dimensional MRI (4D-MRI) based on time-stamped 2D images or 2D K-space data. These methods suffer from anisotropic resolution and rebinning artifacts. We have developed a self-gating based K-space sorted 4D-MRI (SG-KS-4D-MRI) method to overcome these limitations and in this study apply it to monitoring organ motion of pancreatic cancer patients. Methods: Ten patients were imaged using 4D-CT, cine 2D-MRI and the SG-KS-4D-MRI method, which is a spoiled gradient recalled echo (GRE) sequence with 3D radial-sampling K-space projections and 1D projection-based self-gating. Tumor volumes were drawn at the end of exhalation phases in the 4D-MRI and 4D-CT, and mapped to the other phases using deformable registration. The tumor volumes and motion trajectories were compared. Results: An isotropic resolution of 1.6 mm was achieved in the SG-KS-4D-MRI images, which showed superior soft tissue contrast to 4D-CT and appeared to be free of rebinning artifacts. SG-KS-4D-MRI was able to detect out-of-plane tumor motion and showed good correlation with 4D-CT and cine 2D-MRI in superior-inferior direction with a correlation coefficient of 0.91±0.06 and 0.93±0.03, respectively. The average standard deviation of GTV (GTV_σ) calculated from ten breathing phases were 0.81 cc and 1.02 cc for SG-KS-4D-MRI and 4D-CT (p=0.004) respectively. Conclusion: A novel SG-KS-4D-MRI acquisition method capable of reconstructing rebinning-artifact-free high resolution 4D-MRI images was used to quantify pancreas tumor motion. The resultant pancreatic tumor motion trajectories better agreed with 2D-cine-MRI and 4D-CT in the SI direction than the other 2 directions due to smaller motions in those directions. The pancreatic tumor volumes derived using SG-KS-4D-MRI were significantly more consistent than those from the 4D-CT.This work is supported in part by NIH grant 1R03CA173273-01. This study is supported in part by NIH 1R03CA173273
- Published
- 2015
26. Recurrence of pancreatic ductal adenocarcinoma after pancreaticoduodenectomy: Is there a role for locoregional treatment?
- Author
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Marwan Sheckley, Andrew Eugene Hendifar, Richard Tuli, Alexandra Gangi, Ashley Wachsman, Vijay G. Menon, and Nicholas N. Nissen
- Subjects
Cancer Research ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,business.industry ,General surgery ,medicine.medical_treatment ,Pancreaticoduodenectomy ,Margin status ,Single surgeon ,Surgery ,Academic institution ,Oncology ,medicine ,Curative surgery ,business ,Median survival - Abstract
329 Background: The majority of patients undergoing potentially curative surgery for pancreatic ductal adenocarcinoma (PDA) will face recurrence. While other types of metastatic tumors are often treated with loco-regional therapy, this approach is rarely applied to metastatic PDA. We examined recurrence patterns of PDA and the potential application of loco-regional treatment. Methods: Evaluation of a prospective database of patients undergoing pancreaticoduodenctomy at an academic institution by a single surgeon. Patients: Pancreaticoduodenectomy for PDA was performed in 95 patients between 2002 and 2012. Margin status was R0 in 88 (93%) and R1 in the remainder. Results: Overall median survival was 27 months and 1 and 3 year survival was 68% and 41%. Known recurrence occurred in 44 of 64 patients (69%) at a median of 20.9 months, while the status of 31 patients was unknown. The most common site of initial recurrence was liver (n=19, median 9.2 months post-surgery), followed by local recurrence (n=15; median 18.7 months) and lung (n=5; median 5.2 months). Patients with R0 margin vs R1 recurred at a median 21 vs 5 months. In our series, 6 patients (5/6 treated in the last 2 years) underwent loco-regional treatment of recurrent disease, including liver resection (n=2), stereotactic radiotherapy (n=2), hepatic ablation (n=1) or radioembolization (n=1). All 6 patients treated with loco-regional therapy are alive at a median of 15.6 months after recurrence and a median of 25.3 months since initial surgery. Conclusions: The initial site of recurrent PDA after pancreaticoduodenectomy is usually liver, and the major risk factor for recurrence is the margin status at resection. Loco-regional modalities for the treatment of recurrent PDA hold promise in select patients. The tendency to utilize loco-regional therapy for recurrent PDA is increasing and warrants continued consideration.
- Published
- 2014
27. 449 Simultaneous Surgical Resection of Primary and Metastatic Carcinoid and Neuroendocrine Tumors Is Both Safe and Effective
- Author
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Deepti Dhall, James Mirocha, Steven D. Colquhoun, Nicholas N. Nissen, Ashley Wachsman, Run Yu, Edward M. Wolin, Alagappan Annamalai, Marc L. Friedman, and Vijay G. Menon
- Subjects
Surgical resection ,medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Metastatic carcinoid ,Gastroenterology ,Medicine ,Radiology ,Neuroendocrine tumors ,business ,medicine.disease - Published
- 2013
28. Su1116 Small Bowel Ultrasound Accurately Predicts Post-Operative Endoscopic Recurrence in Crohn's Disease
- Author
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Gil Y. Melmed, Eric A. Vasiliauskas, Avetis Azizyan, Kelly Haas, Marla Dubinsky, Ashley Wachsman, James Mirocha, Phillip Fleshner, Casey J. Rosenthal, Shervin Rabizadeh, and Manreet Kaur
- Subjects
medicine.medical_specialty ,Crohn's disease ,Hepatology ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Gastroenterology ,Colonoscopy ,medicine.disease ,Ulcerative colitis ,Chromoendoscopy ,Clinical trial ,Intestinal inflammation ,Internal medicine ,medicine ,Radiology ,Post operative ,business - Abstract
Background & Aim: Recently, mucosal healing assessed by endoscopic findings appears to predict long-term remission in patients with ulcerative colitis (UC), although there is no agreement on clinical, endoscopic or histological scoring system. In most of clinical trial, endoscopic score of Mayo 0 or 1 is defined as mucosal healing in UC patients. However, assessment of endoscopic score of Mayo 0 or 1 is quite different depending on endoscopists. Therefore, to develop the objectively quantitative scoring system that will help to improve patient outcome is required. Emerging endoscopic imaging modalities, including both, vital and virtual chromoendoscopy and magnification endoscopy, enabled endoscopists to visualize and interpret mucosal details. Among them, i-scan is the newly developed imageenhanced endoscopic technology from HOYA/PENTAX (Tokyo, Japan). i-scan TE-c is one of digital transmission method among HOYA/PENTAX EPK-i system in conjunction with EC38-i10M. The aim of study is to assess the significance of new endoscopic imaging system with i-scan TE-c for quantitative evaluation of colonic inflammation in patients with UC. Method: From January 2011 to Aug 2012, a total of 76 UC patients with endoscopic score of Mayo 0 or 1 by standard white light endoscopy were reassessed by i-scan TE-c. We performed white light (WL) colonoscopy in conjunction with i-scan TE-c in UC patients with endoscopic score of Mayo 0 or 1, and the difference of the tone of color between normal and inflamed colonic mucosa was given with a numeric conversion. The intensity and width of inflammatory lesion identified by modified color phase and saturation was given with a numeric conversion and visualized. Results: In 29 of 76 UC patients, endoscopic score of Mayo was estimated as 0. In the remaining 47 patients, that was estimated as 1. The mean i-scan TE-c score of UC patients with endoscopic score of Mayo 0 and with Mayo 1 was 576.1±437.3 and 1172.7±668.6, respectively. A significant difference of i-scan TE-c score was observed between UC patients with endoscopic score of Mayo 0 and those with Mayo 1 (p,0.001). There was a considerable variation in i-scan TE-c score of UC patients with endoscopic score of Mayo 1 by WL colonoscopy, suggesting that UC patients diagnosed with endoscopic score of Mayo 1 had intestinal inflammation with objectively varying degrees. Conclusion: In UC patients with endoscopic score of Mayo 0 or 1, this new imaging system with i-scan TE-c can make the inflammatory lesion visualized more clearly in comparison with WL colonoscopy, and their intensity and width digitized. Application with this new system is easy and useful for objective and quantitative evaluation of colonic inflammation in UC patients with endoscopic score of Mayo 0 or 1. Further clinical trial with a new imaging system will be required for clinically quiescent UC patients.
- Published
- 2013
29. Recurrence of pancreatic ductal adenocarcinoma after pancreaticoduodenectomy: Is there a role for loco-regional treatment?
- Author
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Richard Tuli, Nicholas N. Nissen, Vijay G. Menon, Catherine Bresee, Marc L. Friedman, and Ashley Wachsman
- Subjects
medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,Hepatology ,business.industry ,Endocrinology, Diabetes and Metabolism ,General surgery ,medicine.medical_treatment ,Gastroenterology ,medicine ,Radiology ,Pancreaticoduodenectomy ,business - Published
- 2013
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