Xiaochun Li

Purpose The aim of this study is to evaluate the treatment response of patients with osteoid osteoma (OO) following radiofrequency ablation (RFA) and identify factors influencing the time to complete pain relief post-treatment. Materials and methods This is a retrospective cohort study of patients who underwent RFA for OO between 2010 and 2023. Demographic, clinical data, and time between symptoms onset to diagnosis and RFA were recorded. CTs were reviewed for OO location (upper extremity, lower extremity, spine/pelvis), intra-articular versus extra-articular lesions, nidus size, degree of peripheral bone formation, and presence of vessel sign. Procedural related information included needle approach, RFA active tip length, and number of RFA cycles. Statistical analysis was made on factors and their correlation to complete pain relief. Results Out of 63 patients included in our study (mean age 19.3 ± 10.6), OO were located in the upper extremity (n = 7, 11%), lower extremity (n = 48, 76%), and pelvis/spine (n = 8, 13%). OO in the pelvis/spine achieved the quickest complete pain relief (14 days) compared to those in lower (25 days, 11 days longer) and upper extremity (54 days, 40 days longer) respectively (p = 0.04). Vessel sign had significant association with shorter time to complete pain relief (p = 0.03). Longer duration of symptoms until diagnosis or RFA, larger nidus, more bone formation, and extra-articular OO responded slower to RFA, though statistical significance was not reached. Conclusions Anatomical location and certain imaging characteristics of OO may have association with time to complete pain relief following RFA. The findings can potentially help optimizing patient counseling with more realistic expectations and symptom management strategies prior to and following RFA.

PURPOSE: Women occupy a minority of academic leadership positions despite increasing representation in the physician workforce. Similarly, women remain underrepresented as academic conference presenters, an important factor for career advancement. We examined whether there were gender disparities in opportunities to present original research at the ASCO Annual Meeting. METHODS: We retrospectively reviewed oral original research, educational, and discussant presentations at the ASCO Annual Meetings from 2018 to 2021. Presenters were identified as first author, senior author, or ASCO-appointed (chair, discussant, or speaker). Presenter-identified gender was unavailable; binary gender was determined by presenter name, pronouns, video files, and institutional websites. Presenter gender distributions were summarized descriptively by nominal levels for each third variable with corresponding odds ratios (ORs) for each nominal level. Common ORs were estimated for each third variable if the Breslow-Day test was not significant, with no adjustments for P values. RESULTS: We reviewed 4,267 video presentations, divided into original research (n = 2,079) and ASCO-appointed (n = 2,188). Women represented 37% of first authors (OR, 0.68 [95% CI, 0.60 to 0.76]) and 28% of senior authors (OR, 0.44 [95% CI, 0.39 to 0.50]), compared with 47% of ASCO-appointed presenters. Women were significantly more likely to have an ASCO-appointed role than a first or senior author role, even after adjusting for conference year, session type, session area, academic rank, and geographic region. CONCLUSION: Gender disparities persist in opportunities to present original research at the ASCO Annual Meeting. Women were less likely to present research as first or senior author and were more likely to have an educational or discussant role. As high-profile original research can elevate careers, examining factors contributing to this disparity may suggest approaches to address gender leadership gaps in oncology.

The development of noninvasive MRI biomarkers as surrogates of histopathological features in kidney tissue requires detailed explorations of contrast. Therefore, we studied kidney diffusion kurtosis imaging (DKI) with a wide array of encodings, including flow compensation, variable directional sampling, and cardiac gating regimes. Twelve healthy volunteers underwent DKI at 5–10 diffusion weightings ( b ‐values) ranging from 0 to 1200 smm ⁻² with 12 or 30 directional samplings, bipolar or flow‐compensated diffusion gradient waveforms, and at systolic or diastolic cardiac phases. DKI biomarkers, mean diffusivity (MD) and kurtosis (MK), were interrogated using a directionally robust fitting algorithm compared to conventional fits. The combination of flow compensation and cardiac triggering at the diastolic phase in the kidneys reduced flow effects on DKI. In systole, flow‐compensated waveforms significantly reduced MD and MK for both cortex and medulla: cortex MD: 3.00 versus 2.55 μm ² ms ⁻¹ , medulla MD: 2.80 versus 2.39 μm ² ms ⁻¹ , cortex MK: 0.58 versus 0.45, and medulla MK: 0.60 versus 0.47 (all p < 0.05). Flow suppression alleviated requirements for processing the DKI at higher minimum b ‐values, as neither MD nor MK significantly differed at the diastolic phase for minimum b ‐values of 0 versus 200 smm ⁻² : cortex MD: 2.30 versus 2.28 μm ² ms ⁻¹ , p = 0.278; medulla MD: 2.29 versus 2.28 μm ² ms ⁻¹ , p = 0.437; cortex MK: 0.37 versus 0.36, p = 0.308; and medulla MK: 0.40 versus 0.40, p = 0.904. Flow‐compensated waveforms mitigate cardiac and respiratory motion‐related artifacts at higher diffusion encodings in addition to microcirculation effects. The robust fitting initially developed for brain DKI is highly applicable to the kidneys because it disentangles tissue‐specific directional diffusion information from artifacts.

Intravoxel incoherent motion MRI parameters derived from two software packages demonstrated diagnostic value for breast cancer, with multivariable combinations of histogram metrics achieving high diagnostic accuracy.

Purpose As the pancreas is a low contrast visibility organ, pancreatic ductal adenocarcinoma detection is challenging due to subtle attenuation differences between tumor and pancreatic parenchyma. Photon counting CT (PCCT) has superior iodine contrast-to-noise ratio than conventional CT and also affords the creation of low keV virtual monoenergetic images, both of which increase adenocarcinoma conspicuity. The purpose therefore was to identify the optimal virtual monoenergy for visualizing PDAC during the pancreatic parenchymal phase of enhancement at PCCT using both quantitative and qualitative analyses. Methods Consecutive patients with pancreatic parenchymal phase PCCT source data were retrospectively identified by PACS search. For the quantitative analysis, region of interest (ROI) measurements were drawn in the pancreatic head, body, tail, pancreatic adenocarcinoma (if present), and psoas muscles on 40-120 keV virtual monoenergetic images in 10 keV increments. Based on the quantitative analysis results and vendor recommendations, four virtual monoenergies(40 keV, 55 keV, 70 keV, and 85 keV) were selected for additional qualitative analysis. Three radiologists blinded to four virtual monoenergies assessed overall image quality, image noise, pancreatic enhancement, and pancreatic mass conspicuity on 5-point Likert scales. Results 54 patients (28/54 male, mean[SD] age: 62 [13] years) were included. Quantitatively, 40 keV had the highest pancreatic parenchymal CNR and attenuation difference between the adenocarcinoma and parenchyma, but also the highest noise (HUsd). Qualitatively, 70 keV had the best overall image quality (Mean [SE]: 3.7[0.1]) and lower noise than 40 and 55 keV (3.6[0.08] vs. 1.8[0.07] and 2.7[0.05], respectively, p < .001). 40 keV had the greatest pancreatic enhancement (mean[SE] 4.6[0.11]). Adenocarcinoma conspicuity ratings were greatest at 40 keV and 55 keV, and not significantly different from each other (mean[SE] 4.4[0.13] and 4.3[0.14], respectively, Tukey adj-p =.20). 55 keV had greater overall image quality and lower noise than 40 keV (mean[SE] 3.4[0.08] vs. 2.5[0.08], Tukey adj-p < .001 and 2.7[0.05] vs. 1.8[0.07], Tukey adj-p < .001 respectively). Conclusion 55 keV pancreatic parenchymal phase virtual monoenergetic images afford optimal pancreatic assessment at PCCT for the visualization of pancreatic adenocarcinoma. Routinely viewing 55 keV virtual monoenergetic images at PCCT may improve PDAC detection.

Background Few reports explore the frequency and factors associated with diagnostic ultrasound (US) for midgut volvulus. Objective To evaluate predictive factors for diagnostic US for midgut volvulus and clinical outcomes of patients with non-diagnostic US. Materials and methods This retrospective study included infants imaged for midgut volvulus with US. Exams were rated as diagnostic (midgut volvulus present or absent) or non-diagnostic by a pediatric radiologist, and in cases of disagreement with the original report, an additional pediatric radiologist was the tie-breaker. For each exam, the following were recorded: age, weight, respiratory support, exam indication, sonographer experience, and gaseous dilated bowel loops on radiography. Logistic regression models with “stepwise” variable selection were used to investigate the association of diagnostic US for midgut volvulus with each of the independent variables. Results One hundred nineteen patients were imaged. US was diagnostic in 74% (88/119) of patients. In subsets of patients presenting with bilious emesis or age P=0.02). Out of 26 patients with available radiographs, US was diagnostic in 92% (12/13) of patients without bowel dilation on radiographs compared to 62% (8/13) of patients with bowel dilation (P=0.16). Weight, respiratory support, and sonographer experience did not differ between groups. Two sick neonates, ages 2 days and 30 days, in whom the primary clinical concern was dropping hematocrit and sepsis, respectively, had non-diagnostic ultrasounds in the setting of bowel dilation on radiography. Both were found to have midgut volvulus at surgery and both expired. Conclusion US was most frequently diagnostic in patients with bilious emesis or age less than 28 days. Non-diagnostic US for midgut volvulus must prompt a predetermined follow-up strategy, such as an additional imaging study (e.g., upper GI series), particularly in a sick child, as non-diagnostic US may miss midgut volvulus. Graphical abstract

Purpose To compare dual-source dual-energy CT enterography (dsDECTE) obtained iodine density (I) (mg/mL) and I normalized to the aorta (I%) with Crohn’s disease (CD) phenotypes defined by the SAR-AGA small bowel CD consensus statement. Methods Fifty CD patients (31 male, 19 female; mean [SD] age: 50.4 [15.2] years) who underwent dsDECTE were retrospectively identified. Two abdominal radiologists assigned CD phenotypes: no active inflammation (group-2), active inflammation without (group-3) or with luminal narrowing (group-4), stricture with active inflammation (group-5), stricture without active inflammation (group-1), and penetrating disease (group-6). Semiautomatic prototype software was used to determine the median I and I% of CD-affected small bowel mucosa for each patient. The means of the I and I% medians were compared among 4 groups (“1 + 2”, “3 + 4”, “5”, “6”) using one-way ANOVA (significance level 0.05 for each outcome) for each outcome individually followed by Tukey’s range test for pairwise comparisons with adjusted p-values (overall alpha = 0.05). Results Mean [SD] I was 2.14 [1.07] mg/mL for groups 1 + 2 (n = 16), 3.54 [1.71] mg/mL for groups 3 + 4 (n = 15), 5.5 [3.27] mg/mL for group- “5” (n = 9), and 3.36 [1.43] mg/mL for group-“6” (n = 10) (ANOVA p = .001; group “1 + 2” versus “5” adj-p = .0005). Mean [SD] I% was 21.2 [6.13]% for groups 1 + 2, 39.47 [9.71]% for groups 3 + 4, 40.98 [11.76]% for group-5, and 35.01 [7.58]% for group-6 (ANOVA p < .0001; groups “1 + 2” versus “3 + 4” adj-p < .0001, group “1 + 2” versus “5” adj-p < .0001, and groups “1 + 2” versus “6” adj-p = .002). Conclusion Iodine density obtained from dsDECTE significantly differed among CD phenotypes defined by SAR-AGA, with I (mg/mL) increasing with phenotype severity and decreasing for penetrating disease. I and I% can be used to phenotype CD. Graphical abstract