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Simeone, Frank

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Simeone

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Frank

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Simeone, Frank
Author's Publications: search.filters.isAuthorOfPublication.7f522672-d85e-4b44-a88d-81bfe0768b03

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    Quantitative contrast-enhanced CT attenuation evaluation of osseous metastases following chemotherapy
    (Springer Nature, 2017) Chang, Connie; Simeone, Frank; Torriani, Martin; Bredella, Miriam
    Purpose: Osseous metastases often undergo an osteoblastic response following chemotherapy also known as the “flare” phenomenon. The purpose of our study was to demonstrate the quantitative CT changes in density of osseous metastases before and after chemotherapy. Materials and Methods: Our study was IRB approved and HIPAA compliant. Our cohort consisted of 48 consecutive cancer patients with studies both before chemotherapy/at the time of diagnosis of osseous metastases and 14 ± 3 (12-20) months after the initiation of treatment 60 ±10 (range: 37-80) years, 26 F, 22 M). CT density of all lesions was measured by two fellowship trained MSK radiologists. The largest possible region of interest was selected to measure the average and maximum densities in Hounsfield Units (HU). If multiple lesions were present, the largest lesion was evaluated. Treatment effects were assessed using paired t-tests, using P < 0.05 as statistically significant. Intraclass correlation coefficient (ICC) was calculated for the two readers. Results: The distribution of primary tumors was as follows: breast (20/48, 42%), lung (10/48, 21%), prostate (5/48, 10%), pancreatic (5/48, 10%), renal (2/48, 4%), and other (6/48, 13%). The measured lesions were in the following locations: spine/sacrum (35/48, 73%), pelvis (10/48, 21%), sternum (3/48, 6%). The distribution of lesion types were as follows: lytic (14/48, 29%), blastic (25/48, 52%), and mixed lytic-blastic (9/48, 19%). Mean and maximum CT densities (Reader 1) of all metastases before chemotherapy treatment were 328 ± 206 HU and 580 ± 391 HU, respectively and after chemotherapy treatment were 511 ± 263 HU and 789 ± 439 HU, respectively. There was a significant increase in mean and maximum CT densities of metastases following chemotherapy for all lesions collectively but also when separated into lytic, blastic, and mixed lytic-blastic lesions (P < 0.05). ICC was almost perfect for average density and moderate to substantial for maximum density. Conclusion: Quantitative assessment of osseous metastatic disease using CT density measurements confirms a statistically significant increase in density 12-20 months after initiation of chemotherapy. Clinical Application: Measuring changes in CT density of osseous metastases may have a significant role in evaluating chemotherapy effect.
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    Percutaneous CT-guided sacroiliac joint sampling for infection: aspiration, biopsy, and technique
    (Springer Science and Business Media LLC, 2017-11-15) Knipp, David; Simeone, Frank; Nelson, Sandra; Huang, Ambrose; Chang, Connie
    Objective: To elucidate the management algorithm for sacroiliac joint sampling by percutaneous CT-guided sacroiliac joint sampling for suspected infection patients. Materials and Methods: All CT-guided sacroiliac joint sampling procedures for suspected infection were reviewed for sampling type (aspiration lavage aspiration, biopsy), microbiology results, and clinical and imaging follow-up. The gold standard was pathology. If pathology was not available, then positive blood culture with same organism as SIJ sampling, imaging and clinical follow-up, or clinical follow-up only were used. Anterior and posterior joint distention was evaluated by MRI within seven days of the procedure.
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    Distinguishing Untreated Osteoblastic Metastases From Enostoses Using CT Attenuation Measurements
    (American Roentgen Ray Society, 2016) Ulano, Adam; Bredella, Miriam; Burke, Patrick J; Chebib, Ivan; Simeone, Frank; Huang, Ambrose; Torriani, Martin; Chang, Connie
    Purpose: To determine if CT density thresholds of osteoblastic bone lesions can be used to distinguish untreated osteoblastic metastases from enostoses. Materials and Methods: The study group comprised 62 patients (37 enostoses, 25 untreated osteoblastic metastases) with sclerotic bone lesions found on CT. Etiology of sclerotic lesions was assessed histologically or by clinical and imaging follow-up. None of the patients had prior treatment for metastases. The average and maximum densities in Hounsfield Units (HU) were measured. Receiver operating curve (ROC) analysis was performed to determine sensitivity, specificity, area under the ROC curve (AUC), confidence intervals (CI), and cutoff values of CT densities to differentiate metastases from enostoses. Interreader reproducibility was assessed using intraclass correlation coefficient (ICC) with 95% CI. Results: Mean and maximum CT densities of enostoses were 1190 ± 239 and 1323 ± 234 HU and of osteoblastic metastases were 654 ± 176 and 787 ± 194 HU, respectively. Using a cut-off of 885 HU for average density, AUC was 0.982, sensitivity was 95%, and specificity was 96%. Using a cut-off of 1058 HU for maximum CT density, AUC was 0.976, sensitivity was 95%, and specificity was 96%. Mean density ICC was 0.987 for enostoses and 0.81 for metastases. Maximum density ICC was 0.814 for enostoses and 0.980 for metastases. Conclusion: CT density measurements can be used to distinguish untreated osteoblastic metastases from enostoses. An average density of 885 HU and a maximum density of 1058 HU provide reliable thresholds below which a metastatic lesion is the favored diagnosis.