25 research outputs found
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Multiparametric MRI texture analysis in prediction of glioma biomarker status: added value of MR diffusion.
BackgroundEarly identification of glioma molecular phenotypes can lead to understanding of patient prognosis and treatment guidance. We aimed to develop a multiparametric MRI texture analysis model using a combination of conventional and diffusion MRI to predict a wide range of biomarkers in patients with glioma.MethodsIn this retrospective study, patients were included if they (1) had diagnosis of gliomas with known IDH1, EGFR, MGMT, ATRX, TP53, and PTEN status from surgical pathology and (2) had preoperative MRI including FLAIR, T1c+ and diffusion for radiomic texture analysis. Statistical analysis included logistic regression and receiver-operating characteristic (ROC) curve analysis to determine the optimal model for predicting glioma biomarkers. A comparative analysis between ROCs (conventional only vs conventional + diffusion) was performed.ResultsFrom a total of 111 patients included, 91 (82%) were categorized to training and 20 (18%) to test datasets. Constructed cross-validated model using a combination of texture features from conventional and diffusion MRI resulted in overall AUC/accuracy of 1/79% for IDH1, 0.99/80% for ATRX, 0.79/67% for MGMT, and 0.77/66% for EGFR. The addition of diffusion data to conventional MRI features significantly (P < .05) increased predictive performance for IDH1, MGMT, and ATRX. The overall accuracy of the final model in predicting biomarkers in the test group was 80% (IDH1), 70% (ATRX), 70% (MGMT), and 75% (EGFR).ConclusionAddition of MR diffusion to conventional MRI features provides added diagnostic value in preoperative determination of IDH1, MGMT, and ATRX in patients with glioma
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Multiparametric MRI texture analysis in prediction of glioma biomarker status: added value of MR diffusion.
BackgroundEarly identification of glioma molecular phenotypes can lead to understanding of patient prognosis and treatment guidance. We aimed to develop a multiparametric MRI texture analysis model using a combination of conventional and diffusion MRI to predict a wide range of biomarkers in patients with glioma.MethodsIn this retrospective study, patients were included if they (1) had diagnosis of gliomas with known IDH1, EGFR, MGMT, ATRX, TP53, and PTEN status from surgical pathology and (2) had preoperative MRI including FLAIR, T1c+ and diffusion for radiomic texture analysis. Statistical analysis included logistic regression and receiver-operating characteristic (ROC) curve analysis to determine the optimal model for predicting glioma biomarkers. A comparative analysis between ROCs (conventional only vs conventional + diffusion) was performed.ResultsFrom a total of 111 patients included, 91 (82%) were categorized to training and 20 (18%) to test datasets. Constructed cross-validated model using a combination of texture features from conventional and diffusion MRI resulted in overall AUC/accuracy of 1/79% for IDH1, 0.99/80% for ATRX, 0.79/67% for MGMT, and 0.77/66% for EGFR. The addition of diffusion data to conventional MRI features significantly (P < .05) increased predictive performance for IDH1, MGMT, and ATRX. The overall accuracy of the final model in predicting biomarkers in the test group was 80% (IDH1), 70% (ATRX), 70% (MGMT), and 75% (EGFR).ConclusionAddition of MR diffusion to conventional MRI features provides added diagnostic value in preoperative determination of IDH1, MGMT, and ATRX in patients with glioma
sj-docx-7-hss-10.1177_15563316221134244 – Supplemental material for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study
Supplemental material, sj-docx-7-hss-10.1177_15563316221134244 for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study by Sara N. Kiani, Samuel Z. Maron, Manasa G. Rao, Nicole Zubizarreta, Madhu Mazumdar, Leesa M. Galatz, Jashvant Poeran and Paul J. Cagle in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p
sj-docx-2-hss-10.1177_15563316221134244 – Supplemental material for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study
Supplemental material, sj-docx-2-hss-10.1177_15563316221134244 for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study by Sara N. Kiani, Samuel Z. Maron, Manasa G. Rao, Nicole Zubizarreta, Madhu Mazumdar, Leesa M. Galatz, Jashvant Poeran and Paul J. Cagle in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p
sj-docx-8-hss-10.1177_15563316221134244 – Supplemental material for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study
Supplemental material, sj-docx-8-hss-10.1177_15563316221134244 for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study by Sara N. Kiani, Samuel Z. Maron, Manasa G. Rao, Nicole Zubizarreta, Madhu Mazumdar, Leesa M. Galatz, Jashvant Poeran and Paul J. Cagle in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p
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Effect of Clinical Decision Support on Appropriateness of Advanced Imaging Use Among Physicians-in-Training
Clinical decision support (CDS) tools have been shown to reduce inappropriate imaging orders. We hypothesized that CDS may be especially effective for house staff physicians who are prone to overuse of resources.
Our hospital implemented CDS for CT and MRI orders in the emergency department with scores based on the American College of Radiology's Appropriateness Criteria (range, 1-9; higher scores represent more-appropriate orders). Data on CT and MRI orders from April 2013 through June 2016 were categorized as pre-CDS or baseline, post-CDS period 1 (i.e., intervention with active feedback for scores of ≤ 4), and post-CDS period 2 (i.e., intervention with active feedback for scores of ≤ 6). Segmented regression analysis with interrupted time series data estimated changes in scores stratified by house staff and non-house staff. Generalized linear models further estimated the modifying effect of the house staff variable.
Mean scores were 6.2, 6.2, and 6.7 in the pre-CDS, post-CDS 1, and post-CDS 2 periods, respectively (p < 0.05). In the segmented regression analysis, mean scores significantly (p < 0.05) increased when comparing pre-CDS versus post-CDS 2 periods for both house staff (baseline increase, 0.41; 95% CI, 0.17-0.64) and non-house staff (baseline increase, 0.58; 95% CI, 0.34-0.81), showing no differences in effect between the cohorts. The generalized linear model showed significantly higher scores, particularly in the post-CDS 2 period compared with the pre-CDS period (0.44 increase in scores; p < 0.05). The house staff variable did not significantly change estimates in the post-CDS 2 period.
Implementation of active CDS increased overall scores of CT and MRI orders. However, there was no significant difference in effect on scores between house staff and non-house staff
sj-docx-9-hss-10.1177_15563316221134244 – Supplemental material for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study
Supplemental material, sj-docx-9-hss-10.1177_15563316221134244 for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study by Sara N. Kiani, Samuel Z. Maron, Manasa G. Rao, Nicole Zubizarreta, Madhu Mazumdar, Leesa M. Galatz, Jashvant Poeran and Paul J. Cagle in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p
sj-docx-4-hss-10.1177_15563316221134244 – Supplemental material for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study
Supplemental material, sj-docx-4-hss-10.1177_15563316221134244 for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study by Sara N. Kiani, Samuel Z. Maron, Manasa G. Rao, Nicole Zubizarreta, Madhu Mazumdar, Leesa M. Galatz, Jashvant Poeran and Paul J. Cagle in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p
sj-docx-1-hss-10.1177_15563316221134244 – Supplemental material for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study
Supplemental material, sj-docx-1-hss-10.1177_15563316221134244 for The Burden of Postoperative Delirium After Shoulder Arthroplasty and Modifiable Pharmacological Perioperative Risk Factors: A Retrospective Nationwide Cohort Study by Sara N. Kiani, Samuel Z. Maron, Manasa G. Rao, Nicole Zubizarreta, Madhu Mazumdar, Leesa M. Galatz, Jashvant Poeran and Paul J. Cagle in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery</p