CME Radiology Grand Rounds

When: 

No Grand Rounds in June, July, & August.

Usually 2nd & 4th Fridays, 12:00pm - 1:00pm, for exceptions see below.

Where: 

Rooms TBA for in-person Grand Rounds. Zoom will be available for all Grand Round events in 2022-23.

Join from PC, Mac, Linux, iOS or Android: https://stanford.zoom.us/j/600003703?pwd=RjcwS2MvOG1qVkxyL3U0RmNtUDVWdz09  Password: 566048

Or iPhone one-tap (US Toll): +18333021536,,600003703# or +16507249799,,600003703#

Or Telephone:  Dial: +1 650 724 9799 (US, Canada, Caribbean Toll) or +1 833 302 1536 (US, Canada, Caribbean Toll Free)


2022 - 2023 Schedule

January

Friday, January 13, 2023

12:00-1:00PM | CAM Grand Rounds Room at 453 Quarry Rd., Palo Alto; Zoom also available

Juergen K. Willmann Lectureship

Claude B. Sirlin, MD

Professor of Radiology
Co-Director, Liver Imaging Group
UC San Diego School of Medicine
UC San Diego Health

Point-of-care Ultrasound and MR-based Diagnostics for Fatty Liver Disease

Fatty liver disease has become the most common cause of chronic liver disease in children and adults worldwide, affecting over one billion human beings. Fatty liver disease is associated with obesity, metabolic syndrome, alcohol consumption, and other factors, and it can progress to cirrhosis, liver cancer, and end-stage liver failure. It is also associated with and may contribute to the development of diabetes, cardiovascular disease, and cancer originating outside the liver. Early diagnosis and intervention can reverse the disease and prevent its downstream complications. The gold standard method for diagnosis of fatty liver disease is percutaneous biopsy with histology analysis. To avoid the risks and other shortcomings of invasive biopsy, noninvasive imaging-based diagnostics for fatty liver disease have been developed, chief among them ultrasound- and MR-based methods. These methods have improved considerably over recent years and are now available on clinical ultrasound scanners and MR systems. Despite these technical advances, however, clinical ultrasound scanners and MR systems do not have enough capacity to screen, diagnose, and monitor a disease that afflicts about one quarter of the earth’s population. Emerging point-of-care ultrasound and MR-based diagnostics may be part of the solution.

Friday, January 27, 2023

12:00-1:00PM | LKSC 101/102; Zoom also available

Sanna Herwald, MD, PhD

Resident in Radiology, Stanford University

Quantitative Viscosity of Abscess Fluid

Image-guided percutaneous drainage of intra-abdominal abscesses is critical to modern medicine, reducing mortality, morbidity, length of hospital stay, and hospital costs. At the time of abscess drain placement, however, it is difficult to confidently predict whether a particular abscess will resolve soon after drain placement or will be challenging to drain and require multiple drain exchanges. Although the presumed or qualitative viscosity of abscess fluid regularly guides drain management, such as the choice of drain size, there are minimal published quantitative measurements of abscess fluid viscosity. Due to the challenges of quantitatively measuring abscess fluid viscosity with commercially-available methods, our research group has explored novel measurement methods with the potential to smoothly integrate into the clinical workflow. We will present our preliminary findings examining the quantitative physical properties of clinical abscess fluid samples and the possible implications of these results for both the initial selection and management of abscess drains.

Ophir Vermesh, MD, PhD, MSC

Resident in Radiology, Stanford University

Synthetic Cancer Reporters

[18F]Fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) has high sensitivity for lung nodule detection but low specificity in distinguishing malignant from benign nodules, and cross-sectional imaging for routine lung cancer screening is expensive. An ideal cancer screening test would be sensitive and specific as well as inexpensive, such that only those individuals who test positive would then undergo expensive cross-sectional imaging for accurate tumor localization. Breath analysis holds enormous promise for inexpensive, rapid, and noninvasive early lung cancer detection and surveillance; however, clinical implementation has been limited by low signal from cancer cells and high background noise from nonmalignant tissue. To address this issue, we are developing a novel breath-based “synthetic” reporter system in which cancer cells are induced to express D-limonene, a volatile organic compound (VOC) from citrus fruit that is not produced in humans and thus has low background signal. In vivo gene delivery and tumor-specific expression of limonene could enable sensitive, specific, and inexpensive cancer screening via exhaled breath, but tumor localization would still be needed in the event of a positive test. This could be achieved via a dual-reporter system encoding a volatile reporter along with a PET imaging reporter, both driven by a tumor- activatable promoter and delivered in vivo within DNA minicircles (MC). PET imaging could also be performed using an emerging radiotracer, (4S)-4-(3-[18F]fluoropropyl)-L- glutamate [18F]FSPG, a glutamate analog which has shown greater sensitivity than [18F] FDG in detecting lung cancer based on preliminary results of our phase II clinical trial in patients with solitary pulmonary nodules. These strategies could permit a two-step screening process in which individuals who test positive for cancer via an inexpensive limonene breath test would then be triaged to PET imaging for tumor localization.

Wenhui Zhou, MD, PhD

Resident in Radiology, Stanford University

Real-world Utilization, Practice Patterns and Efficacy of Off-label 90Y Radioembolization in Liver Metastases

Liver-directed embolization therapy is increasingly utilized for liver tumors in patients ineligible for surgical resection or transplantation. Early and prominent use of 90Y radioembolization therapy for liver tumors include inoperable HCC and mCRC, which resulted in FDA approvals. As the liver is one of the most common sites of metastatic disease, the concept of using the tumor vasculature for anatomically targeted 90Y internal radiation holds promise for treating a broader range of tumors. Here we present the utilization and efficacy data of 90Y radioembolization from 1600 patients in a multicenter, observational, registry-based study. The results of our study demonstrate that 90Y radioembolization is frequently utilized as a palliative treatment of liver metastases of non- colorectal cancer origin. We will discuss potential candidate tumor types that have promising treatment responses to 90Y radioembolization, which may incentivize future randomized trials to expand the current indications of this treatment.