Browsing by Author "Mawad, Kareem"

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    Inter-observer variability of radiologists for Cambridge classification of chronic pancreatitis using CT and MRCP: results from a large multi-center study
    (SpringerLink, 2020-05) Tirkes, Temel; Shah, Zarine K.; Takahashi, Naoki; Grajo, Joseph R.; Chang, Stephanie T.; Wachsman, Ashley M.; Mawad, Kareem; Farinas, Carlos A.; Li, Liang; Appana, Savitri N.; Conwell, Darwin L.; Yadav, Dhiraj; Dasyam, Anil K.; Radiology and Imaging Sciences, School of Medicine
    Purpose: Determine inter-observer variability among radiologists in assigning Cambridge Classification (CC) of chronic pancreatitis (CP) based on magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP) and contrast-enhanced CT (CECT). Methods: Among 422 eligible subjects enrolled into the PROCEED study between 6/2017 and 8/2018, 39 were selected randomly for this study (chronic abdominal pain (n = 8; CC of 0), suspected CP (n = 22; CC of 0, 1 or 2) or definite CP (n = 9; CC of 3 or 4). Each imaging was scored by the local radiologist (LRs) and three of five central radiologists (CRs) at other consortium sites. The CRs were blinded to clinical data and site information of the participants. We compared the CC score assigned by the LR with the consensus CC score assigned by the CRs. The weighted kappa statistic (K) was used to estimate the inter-observer agreement. Results: For the majority of subjects (34/39), the group assignment by LR agreed with the consensus composite CT/MRCP score by the CRs (concordance ranging from 75 to 89% depending on cohort group). There was moderate agreement (63% and 67% agreed, respectively) between CRs and LRs in both the CT score (weighted Kappa [95% CI] = 0.56 [0.34, 0.78]; p-value = 0.57) and the MR score (weighted Kappa [95% CI] = 0.68 [0.49, 0.86]; p-value = 0.72). The composite CT/MR score showed moderate agreement (weighted Kappa [95% CI] = 0.62 [0.43, 0.81]; p-value = 0.80). Conclusion: There is a high degree of concordance among radiologists for assignment of CC using MRI and CT.
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    T1 signal intensity ratio of the pancreas as an imaging biomarker for the staging of chronic pancreatitis
    (Springer, 2022-07-20) Tirkes, Temel; Dasyam, Anil K.; Sham, Zarine K.; Fogel, Evan L.; Vege, Santhi Swaroop; Li, Liang; Li, Shuang; Chang, Stephanie T.; Farinas, Carlos A.; Grajo, Joseph R.; Mawad, Kareem; Takahashi, Naoki; Venkatesh, Sudhakar K.; Wachsman, Ashley; Fisher, William E.; Forsmark , Christopher E.; Hart, Phil A.; Pandol, Stephen J.; Park, Walter G.; Van Den Eeden, Stephen K.; Yang , Yunlong; Topazian, Mark; Andersen, Dana K.; Serrano, Jose; Conwell, Darwin L.; Yadav, Dhiraj; The Consortium for the Study of Chronic Pancreatitis, Diabetes, Pancreatic Cancer (CPDPC); Radiology and Imaging Sciences, School of Medicine
    Purpose Our purpose was to validate the T1 SIR (T1 score) as an imaging biomarker for the staging of CP in a large, multi-institutional, prospective study. Methods The prospective study population included 820 participants enrolled in the PROCEED study from nine clinical centers between June 2017 and December 2021. A radiologist at each institution used a standardized method to measure the T1 signal intensity of the pancreas and the reference organs (spleen, paraspinal muscle, liver), which was used to derive respective T1 scores. Participants were stratified according to the seven mechanistic stages of chronic pancreatitis (MSCP 0–6) based on their clinical history, MRCP, and CT findings. Results The mean pancreas-to-spleen T1 score was 1.30 in participants with chronic abdominal pain, 1.22 in those with acute or recurrent acute pancreatitis, and 1.03 in definite CP. After adjusting for covariates, we observed a linear, progressive decline in the pancreas-to-spleen T1 score with increasing MSCP from 0 to 6. The mean pancreas-to-spleen T1 scores were 1.34 (MSCP 0), 1.27 (MSCP 1), 1.21 (MSCP 2), 1.16 (MSCP 3), 1.18 (MSCP 4), 1.12 (MSCP 5), and 1.05 (MSCP 6) (p < 0.0001). The pancreas-to-liver and pancreas-to-muscle T1 scores showed less linear trends and wider confidence intervals. Conclusion The T1 score calculated by SIR of the pancreas-to-spleen shows a negative linear correlation with the progression of chronic pancreatitis. It holds promise as a practical imaging biomarker in evaluating disease severity in clinical research and practice.