Publications by authors named "Patrick Navin"

In patients with renal masses, when intervention is warranted, partial nephrectomy is preferred when feasible, especially for T1 renal masses. Thermal ablation, however, has become an accepted alternative treatment of small renal neoplasms with excellent oncologic outcomes. The National Comprehensive Cancer Network guidelines include thermal ablation as a treatment strategy for managing T1a and select T1b masses.

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Incidental adrenal nodules provide a diagnostic conundrum. Current imaging techniques have demonstrated success in identifying lipid-rich adenomas, however, are limited in detecting malignancy and assessing for functionality. Imaging biomarkers are objective characteristics derived from imaging that may measure normal or pathological processes or assess response to therapy.

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Radioligand therapies such as [Lu] Lu-PSMA-617 have gained significant momentum in cancer treatment after clinical trials and multicenter studies demonstrated their safety and efficacy. As these innovative treatments become more widespread, rare and unique clinical manifestations are expected to be observed. In this report, we describe a case with metastatic castration-resistant prostate cancer (mCRPC) and peripancreatic lymph node metastases who developed acute pancreatitis following [Lu] Lu-PSMA-617 therapy.

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Hepatic sinusoids are highly specialized microcirculatory conduits within the hepatic lobules that facilitate liver functions. The sinusoids can be affected by various disorders, including sinusoidal dilatation, sinusoidal obstruction syndrome (SOS), sinusoidal cellular infiltration, perisinusoidal infiltration, and endothelial neoplasms, such as hemangioendothelioma and angiosarcoma. While these disorders, particularly SOS and neoplasms, can be life threatening, their clinical manifestation is often nonspecific.

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Purpose: In the milieu of emergency medicine, pelvic and lower abdominal pain present recurrently, with ovarian torsion posing a formidable diagnostic quandary amid multifarious etiologies. Given the burgeoning reliance on CT in acute care settings, it invariably assumes primacy as the principal imaging modality. This study endeavors to elucidate the CT imaging manifestations encountered by surgically confirmed ovarian torsion patients and utilizing CT to differentiate necrosis.

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  • The study aimed to create an automated system to extract important prostate cancer information from clinical notes, focusing on patients who had prostate MRIs.
  • Researchers analyzed data from over 23,000 patients between 2017 and 2022, using advanced machine learning techniques (like BERT models) to classify data from sentences in the notes.
  • The results indicated that the automated pipeline was highly effective at identifying cancer risk factors, outperforming radiologists in sensitivity, though it was slightly less accurate in classifying other clinical information.*
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  • Presacral neuroendocrine neoplasms (PNENs) are rare tumors, with a study reviewing 12 cases from 2008 to 2022, primarily affecting middle-aged women who often presented with symptoms like back pain and constipation.* -
  • Half of the patients exhibited metastatic disease at diagnosis, with treatments varying in surgical techniques, and complications occurring in about 25% of cases; most tumors were well-differentiated grade 2.* -
  • The findings highlight the challenges in managing PNENs, showing a notable local recurrence rate of 23.8% and a need for further multicenter research to improve treatment strategies and outcomes for patients.*
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Chronic liver disease is highly prevalent and often leads to fibrosis or cirrhosis and complications such as liver failure and hepatocellular carcinoma. The diagnosis and staging of liver fibrosis is crucial to determine management and mitigate complications. Liver biopsy for histologic assessment has limitations such as sampling bias and high interreader variability that reduce precision, which is particularly challenging in longitudinal monitoring.

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CT with adrenal-washout protocol (hereafter, adrenal-protocol CT) is commonly performed to distinguish adrenal adenomas from other adrenal tumors. However, the technique's utility among heterogeneous nodules is not well established, and the optimal method for placing ROIs in heterogeneous nodules is not clearly defined. The purpose of our study was to determine the diagnostic performance of adrenal-protocol CT to distinguish adenomas from nonadenomas among heterogeneous adrenal nodules and to compare this performance among different methods for ROI placement.

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Metabolic syndrome comprises a set of risk factors that include abdominal obesity, impaired glucose tolerance, hypertriglyceridemia, low high-density lipoprotein levels, and high blood pressure, at least three of which must be fulfilled for diagnosis. Metabolic syndrome has been linked to an increased risk of cardiovascular disease and type 2 diabetes mellitus. Multimodality imaging plays an important role in metabolic syndrome, including diagnosis, risk stratification, and assessment of complications.

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Estrogen-secreting adrenocortical carcinoma (ACC) is exceedingly rare, representing 1% to 2% of all ACCs. We present a case of a 65-year-old man diagnosed with an estrogen-secreting, 4.3-cm right adrenal mass discovered during work-up for bilateral gynecomastia.

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Background And Objectives: We assessed the accuracy of preoperative gallium-68 DOTA-Tyr3-octreotate (DOTATATE) positron emission tomography (PET) imaging in estimating multifocality and nodal metastases of small bowel neuroendocrine tumors (sbNETs).

Methods: A multicenter analysis was performed on patients with sbNETs who underwent preoperative DOTATATE PET imaging and surgical resection, with manual palpation of the entire length of the small bowel, between January 2016 and August 2022. Preoperative imaging reports and blinded secondary imaging reviews were compared to the final postoperative pathology reports.

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  • Castleman disease (CD) is classified into two main forms: unicentric CD (UCD), which presents as a single mass, and multicentric CD (MCD), characterized by systemic symptoms like fever and weight loss.
  • UCD is often diagnosed incidentally and is typically treated with complete surgical excision, while MCD generally requires systemic therapy due to its more complex presentation.
  • Imaging studies like CT, MRI, and PET are vital for diagnosing CD, assessing its extent, and guiding biopsies, but definitive diagnosis usually relies on pathological confirmation through biopsy.
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The radiologic diagnosis of adrenal disease can be challenging in settings of atypical presentations, mimics of benign and malignant adrenal masses, and rare adrenal anomalies. Misdiagnosis may lead to suboptimal management and adverse outcomes. Adrenal adenoma is the most common benign adrenal tumor that arises from the cortex, whereas adrenocortical carcinoma (ACC) is a rare malignant tumor of the cortex.

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PET/MRI is a relatively new imaging modality with several advantages over PET/CT that promise to improve imaging of the abdomen and pelvis for specific diagnostic tasks by combining the superior soft tissue characterization of MRI with the functional information acquired from PET. PET/MRI has an established role in staging and response assessment of multiple abdominopelvic malignancies, but the modality is not yet established for non-oncologic conditions of the abdomen and pelvis. In this review, potential applications of PET/MRI for non-oncologic conditions of abdomen and pelvis are outlined, and the available literature is reviewed to highlight promising areas for further research and translation into clinical practice.

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Neuroendocrine neoplasms (NENs) of the small bowel are typically slow-growing lesions that remain asymptomatic until reaching an advanced stage. Imaging modalities for lesion detection, staging, and follow-up in patients with known or suspected NEN include CT enterography, MR enterography, and PET/CT using a somatostatin receptor analog. FDG PET/CT may have a role in the evaluation of poorly differentiated NENs.

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Historically, radiation therapy was not considered in treatment of liver tumors owing to the risk of radiation-induced liver disease. However, development of highly conformed radiation treatments such as stereotactic body radiation therapy (SBRT) has increased use of radiation therapy in the liver. SBRT is indicated in treatment of primary and metastatic liver tumors with outcomes comparable to those of other local therapies, especially in treatment of hepatocellular carcinoma.

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  • Thyroid nodule treatment now focuses on personalizing care based on the nodule's cause and the patient's health, with increasing interest in radiofrequency ablation (RFA) as a less invasive alternative to surgery.
  • RFA involves heating the thyroid nodule to cause tissue destruction and is recognized by various medical guidelines as an effective option for benign nodules and certain cases where surgery is not feasible.
  • While RFA is effective and safe for many patients, its use for treating small thyroid cancers remains debated, highlighting the importance of careful patient selection and procedural technique to minimize risks.
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Primary hepatic neuroendocrine tumors and primary hepatic neuroendocrine carcinomas are rare and pose challenges for both diagnosis and for determining whether the tumor is primary to the liver versus metastatic disease. The lack of a uniform definition for primary hepatic neuroendocrine neoplasms is also a limitation to understanding and treating these rare tumors. Recently, there have been significant histological advances in the diagnosis and classification of neuroendocrine tumors in general, as well as significant advances in imaging for neuroendocrine neoplasms, all of which are important for their treatment.

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Purpose Of Review: Adrenal imaging forms an important role in the workup of adrenal masses. The purpose of this review is to briefly review the traditional role of imaging in adrenal diseases and highlight the most recent research and new applications aimed to improve diagnostic accuracy.

Recent Findings: The current review will focus on new applications of computed tomography (CT), MRI and PET/CT imaging, addressing the implications of artificial intelligence and radiomics in progressing diagnostic accuracy.

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  • Primary sclerosing cholangitis (PSC) is a serious liver disease that causes inflammation and hardening of bile ducts, which can lead to liver failure and the need for a transplant.
  • There is no good medical treatment for PSC right now, so doctors focus on monitoring liver health, especially liver stiffness, which indicates how much the liver is damaged.
  • MR Elastography (MRE) is a special imaging technique that helps doctors see how stiff the liver is, making it a helpful tool for predicting how well a patient with PSC will do.
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Objective: Cystic adrenal mass is a rare imaging presentation of pheochromocytoma. We aimed to describe the clinical, biochemical and imaging characteristics of patients with cystic pheochromocytoma.

Design: Single-centre, retrospective study, 2000-2020.

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Objective: To retrospectively evaluate the safety and efficacy of percutaneous image-guided mediastinal mass core-needle biopsy.

Patients And Methods: Retrospective review of an institutionally maintained biopsy registry identified 337 computed tomography- or ultrasound-guided percutaneous mediastinal mass core needle biopsies between October 2002 and August 2017 in a single quaternary referral center. Mean patient age was 51 (range, 18 to 93) years.

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COVID-19 vaccination may trigger reactive lymphadenopathy, confounding imaging interpretation. There has been limited systematic analysis of PET findings after COVID-19 vaccination. The purpose of this study was to evaluate the frequency and characteristics of abnormal FDG and C-choline uptake on PET performed after COVID-19 vaccination.

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