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Atul B. Shinagare,Ramin Khorasani 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.1
With the advances in the field of oncology, imaging is increasingly used in the follow-up of cancer patients, leading to concerns about over-utilization. Therefore, it has become imperative to make imaging more evidence-based, efficient, cost-effective and equitable. This review explores the strategies and tools to make diagnostic imaging more evidence-based, mainly in the context of follow-up of cancer patients.
김경원,Atul B. Shinagare,Katherine M. Krajewski,Junhee Pyo,Sree Harsha Tirumani,Jyothi P. Jagannathan,Nikhil H. Ramaiya 대한영상의학회 2015 Korean Journal of Radiology Vol.16 No.2
We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management. In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores. The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement aftermanagement, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3–4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction. Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.
Kim, Kyung Won,Shinagare, Atul B.,Krajewski, Katherine M.,Pyo, Junhee,Tirumani, Sree Harsha,Jagannathan, Jyothi P.,Ramaiya, Nikhil H. The Korean Society of Radiology 2015 KOREAN JOURNAL OF RADIOLOGY Vol.16 No.2
<P><B>Objective</B></P><P>We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management.</P><P><B>Materials and Methods</B></P><P>In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores.</P><P><B>Results</B></P><P>The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, <I>p</I> = 0.002), and often required drug-cessation/dose-reduction.</P><P><B>Conclusion</B></P><P>Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.</P>
Sree Harsha Tirumani,Pamela Deaver,Atul B. Shinagare,Harika Tirumani,Jason L. Hornick,Suzanne George,Nikhil H. Ramaiya 대한부인종양학회 2014 Journal of Gynecologic Oncology Vol.25 No.4
Objective: To describe metastatic pattern of uterine leiomyosarcomas (ULMS) and correlate it with clinical and histopathologic parameters. Methods: we included 113 women (mean age, 53 years; range, 29 to 72 years) with histopathology-confirmed ULMS from 2000 to 2012. Distribution of metastases was noted from imaging by two radiologists in consensus. Predictors of development of metastases were analyzed with univariate and multivariate analysis. Impact of various clinical and histopathologic parameters on survival was compared using Log-rank test and Cox proportional hazard regression model. Results: Distant metastases were seen in 81.4% (92/113) of the patients after median interval of 7 months (interquartile range, 1 to 21). Lung was most common site of metastases (74%) followed by peritoneum (41%), bones (33%), and liver (27%). Local tumor recurrence was noted in 57 patients (50%), 51 of whom had distant metastases. Statistically significant correlation was noted between local recurrence and peritoneal metastases (p<0.001) and between lung and other common sites of hematogeneous metastases (p<0.05). Age, serosal involvement, local recurrence, and the International Federation of Gynecology and Obstetrics (FIGO) stage were predictive factors for metastases. At the time of reporting, 65% (74/113) of the patients have died; median survival was 45 months. Stage, local recurrence, and age were poor prognostic factors. Conclusion: ULMS metastasizes most frequently to lung, peritoneum, bone, and liver. Local recurrence was associated with peritoneal spread and lung metastases with other sites of hematogeneous metastases. Age, FIGO stage and local recurrence predicted metastatic disease and advanced stage, older age and local recurrence predicted poor outcome.
박혜선,Lacey McIntosh,Marta Braschi-Amirfarzan,Atul B. Shinagare,Katherine M. Krajewski 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.1
T-cell non-Hodgkin lymphomas (NHLs) are biologically diverse, uncommon malignancies characterized by a spectrum of imaging findings according to subtype. The purpose of this review is to describe the common subtypes of T-cell NHL, highlight important differences between cutaneous, various peripheral and precursor subtypes, and summarize imaging features and the role of imaging in the management of this diverse set of diseases.
허지미,Jisuk Park,Kyung Won Kim,김형중,이종석,이종화,정융기,Atul B. Shinagare,Nikhil H. Ramaiya 대한영상의학회 2018 Korean Journal of Radiology Vol.19 No.6
Objective: The reliability of size measurements of liver metastases from neuroendocrine tumors (NETs) on contrast-enhanced computed tomography (CT) phases made by different readers may be hampered due to transient, variable rim enhancement in arterial phase (AP) or portal venous phase (PVP) images. We aimed to assess the reliability of tumor size measurements in pre- and post-contrast scans. Materials and Methods: The study coordinator selected target lesions according to Response Evaluation Criteria in Solid Tumors 1.1 guidelines in 44 consecutive patients with pathologically confirmed NET liver metastases. Two blinded readers measured the longest diameters of target lesions on pre-contrast, AP, and PVP images twice with a 4-week interval. Interand intra-observer agreements were evaluated using Bland-Altman plots and 95% limit of agreement (LOA) calculations. Results: Of the 79 target lesions (approximate mean size of 3 cm), 45 showed rim enhancement. Inter-observer agreement assessed based on LOA was highest in pre-contrast CT images (-6.1–5.7 mm), followed by PVP (-7.9–7.1 mm) and AP (-8.5– 7.4 mm) images. Intra-observer agreement showed the same trend: -2.8–2.9 mm and -2.9–2.9 mm for readers 1 and 2, respectively, on pre-contrast CT, -2.8–2.9 mm and -3.0–3.2 mm, respectively, on PVP, and -3.2–4.2 mm and -3.4–3.2 mm, respectively, on AP images. Mean tumor diameters differed significantly among the phases in the following increasing order: pre-contrast CT, PVP, and AP images. Conclusion: There was better inter- and intra-observer agreement in size measurements of NET liver metastases on precontrast scans than on AP and PVP scans. Pre-contrast CT may be the optimal for measuring NET liver metastases if its accuracy is proven.
Katherine M. Krajewski,Marta Braschi-Amirfarzan,Pamela J. DiPiro,Jyothi P. Jagannathan,Atul B. Shinagare 대한영상의학회 2017 Korean Journal of Radiology Vol.18 No.1
Oncology is a rapidly evolving field with a shift toward personalized cancer treatment. The use of therapies targeted to the molecular features of individual tumors and the tumor microenvironment has become much more common. In this review, anti-angiogenic and other molecular targeted therapies are discussed, with a focus on typical and atypical response patterns and imaging manifestations of drug toxicities.
Suh, C. H.,Kim, K. W.,Park, S. H.,Shin, S.,Ahn, J.,Pyo, J.,Shinagare, A. B.,Krajewski, K. M.,Ramaiya, N. H. Springer Science + Business Media 2018 EUROPEAN RADIOLOGY Vol.28 No.1
<P>aEuro cent EOB-MRI strategy is the most cost-effective for differentiating FNH from HCA.</P>