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  1. Article ; Online: Beyond the

    Krishnamurthy, Rajesh / Krishnamurthy, Ramkumar

    AJR. American journal of roentgenology

    2020  Volume 216, Issue 6, Page(s) 1437

    MeSH term(s) Child ; Diagnostic Imaging ; Emergency Service, Hospital ; Humans
    Language English
    Publishing date 2020-12-23
    Publishing country United States
    Document type Journal Article ; Comment
    ZDB-ID 82076-3
    ISSN 1546-3141 ; 0361-803X ; 0092-5381
    ISSN (online) 1546-3141
    ISSN 0361-803X ; 0092-5381
    DOI 10.2214/AJR.20.25294
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  2. Article: 2D BLADE Turbo Gradient- and Spin-Echo versus 2D Spin-Echo Echo-Planar Diffusion-Weighted Brain MRI in Children

    McAllister, Aaron S / Krishnamurthy, Ramkumar

    Magnetom flash

    2022  Volume -, Issue 2 = Nr. 81, Page(s) 30

    Language English
    Document type Article
    ZDB-ID 2465783-9
    Database Current Contents Medicine

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  3. Article ; Online: Brand ferumoxytol vs. generic ferumoxytol comparison across two dosing regimens: a cardiac MRI image quality study.

    Dasi, Anoushka / Kring, Donna N / Selvaraj, Bhavani / Morgan, Patricia / Gerity, Christopher / Morgan, Eric E / Krishnamurthy, Ramkumar / Krishnamurthy, Rajesh

    Pediatric radiology

    2023  Volume 53, Issue 13, Page(s) 2622–2632

    Abstract: Background: Ferumoxytol is becoming more widely used as an off-label blood-pool contrast agent for MR angiography (MRA) and four-dimensional (4D) flow imaging in pediatric cardiovascular disease. Brand and generic versions of ferumoxytol are available ... ...

    Abstract Background: Ferumoxytol is becoming more widely used as an off-label blood-pool contrast agent for MR angiography (MRA) and four-dimensional (4D) flow imaging in pediatric cardiovascular disease. Brand and generic versions of ferumoxytol are available with no information on relative efficacy as a contrast agent and safety profiles.
    Objective: This study evaluates patient safety and image quality of comparable dosages of generic ferumoxytol (GF) versus brand ferumoxytol (BF) with the following hypotheses: (1) Reducing the contrast dosage from 3 to 2 mg/kg will not affect imaging quality and diagnostic accuracy of MRA and four-dimensional 4D flow. (2) GF and BF have similar image quality. (3) GF and BF have similar patient safety profiles.
    Materials and methods: In an IRB-approved retrospective study, changes in vitals/clinical status between baseline, during infusion, and 30 min post-infusion were analyzed in 3 groups: group 1 (3 mg/kg BF, 216 patients, age: 19.29 ± 11.71 years ranging from 2 months to 62 years), group 2 (2 mg/kg BF, 47 patients, age: 15.35 ± 8.56 years ranging from 10 days to 41 years), and group 3 (2 mg/kg GF, 127 patients, age: 17.16 ± 12.18 years ranging from 6 days to 58 years). Both pediatric and adult patients with congenital heart disease (CHD) indications were included within the study. Adverse reactions were classified as mild, moderate, or severe. Quantitative analysis of MR image quality was performed with signal-to-noise ratio (SNR) on MRA and velocity-to-noise ratio (VNR) on 4D flow. Qualitative grading of imaging features was performed by 2 experienced observers. Two-way analysis of variance (ANOVA) and chi-square tests were used for comparison with a P value of ≤ 0.05 used for significance.
    Results: No statistical difference was found in clinical status and vital signs (P>0.05). No severe reactions were reported. 7.9% of GF patients experienced an adverse reaction compared to 2.3% with 3 mg/kg BF and 8.4% with 2 mg/kg BF. There was no statistical difference in SNR between the 3 groups (P>0.05). For 4D flow, 2 mg/kg GF demonstrated an increase in VNR compared to 2 mg/kg BF (P = 0.005). The qualitative scores for MRA and 4D flow were high (≥ 3) across all 3 groups.
    Conclusions: No significant difference was identified between 2 mg/kg GF and BF in terms of safety profile and image quality. Given the small sample size of this study, further studies are required to confirm these results.
    MeSH term(s) Adult ; Humans ; Child ; Adolescent ; Young Adult ; Child, Preschool ; Ferrosoferric Oxide ; Contrast Media ; Magnetic Resonance Angiography/methods ; Retrospective Studies ; Magnetic Resonance Imaging/methods
    Chemical Substances Ferrosoferric Oxide (XM0M87F357) ; Contrast Media
    Language English
    Publishing date 2023-10-14
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-023-05778-4
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  4. Article ; Online: Validation of automated bone age analysis from hand radiographs in a North American pediatric population.

    Bowden, Jonathan J / Bowden, Sasigarn A / Ruess, Lynne / Adler, Brent H / Hu, Houchun / Krishnamurthy, Rajesh / Krishnamurthy, Ramkumar

    Pediatric radiology

    2022  Volume 52, Issue 7, Page(s) 1347–1355

    Abstract: Background: Radiographic bone age assessment by automated software is precise and instantaneous.: Objective: The aim of this study was to evaluate the accuracy of an automated tool for bone age assessment.: Materials and methods: We compared a ... ...

    Abstract Background: Radiographic bone age assessment by automated software is precise and instantaneous.
    Objective: The aim of this study was to evaluate the accuracy of an automated tool for bone age assessment.
    Materials and methods: We compared a total of 586 bone age radiographs from 451 patients, which had been assessed by three radiologists from 2013 to 2018, with bone age analysis by BoneXpert, using the Greulich and Pyle method. We made bone age comparisons in different patient groups based on gender, diagnosis and race, and in a subset with repeated bone age studies. We calculated Spearman correlation (r) and accuracy (root mean square error, or R
    Results: Bone age analyses by automated and manual assessments showed a strong correlation (r=0.98; R
    Conclusion: Automated bone age assessment was found to be reliable and accurate in a large cohort of pediatric patients in a clinical practice setting in North America.
    MeSH term(s) Age Determination by Skeleton/methods ; Bone and Bones ; Child ; Growth Disorders ; Hand/diagnostic imaging ; Humans ; Infant ; Radiography ; Software
    Language English
    Publishing date 2022-03-24
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-022-05310-0
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  5. Article ; Online: 3D printing with MRI in pediatric applications.

    Parthasarathy, Jayanthi / Krishnamurthy, Ramkumar / Ostendorf, Adam / Shinoka, Toshiharu / Krishnamurthy, Rajesh

    Journal of magnetic resonance imaging : JMRI

    2019  Volume 51, Issue 6, Page(s) 1641–1658

    Abstract: 3D printing (3DP) applications for clinical evaluation, preoperative planning, patient and trainee education, and simulation has increased in the past decade. Most of the applications are found in cardiovascular, head and neck, orthopedic, neurological, ... ...

    Abstract 3D printing (3DP) applications for clinical evaluation, preoperative planning, patient and trainee education, and simulation has increased in the past decade. Most of the applications are found in cardiovascular, head and neck, orthopedic, neurological, urological, and oncological surgical cases. This review has three parts. The first part discusses the technical pathway to realizing a physical model, 3DP considerations in pediatric MRI image acquisition, data and resolution requirements, and related structural segmentation and postprocessing steps needed to generalize both virtual and physical models. Standard practices and processing software used in these processes will be assessed. The second part discusses complementary examples in pediatric applications, including cases from cardiology, neuroradiology, neurology, and neurosurgery, head and neck, orthopedics, pelvic and urological applications, oncological applications, and fetal imaging. The third part explores other 3D printing applications and considerations such as using 3DP to develop tissue-specific phantoms and devices for testing in the MR environment, to educate patients and their families, to train clinicians and students, and facility requirements for building a 3DP program. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2020;51:1641-1658.
    MeSH term(s) Cardiology ; Child ; Computer Simulation ; Humans ; Magnetic Resonance Imaging ; Printing, Three-Dimensional ; Software
    Language English
    Publishing date 2019-07-22
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1146614-5
    ISSN 1522-2586 ; 1053-1807
    ISSN (online) 1522-2586
    ISSN 1053-1807
    DOI 10.1002/jmri.26870
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  6. Article ; Online: Magnetic resonance elastography demonstrates elevated liver stiffness in cystic fibrosis patients.

    Hayes, Don / Krishnamurthy, Ramkumar / Hu, Houchun Harry

    Journal of cystic fibrosis : official journal of the European Cystic Fibrosis Society

    2018  Volume 17, Issue 6, Page(s) e54–e56

    MeSH term(s) Adolescent ; Cystic Fibrosis/complications ; Elasticity Imaging Techniques/methods ; Female ; Humans ; Liver/diagnostic imaging ; Liver/pathology ; Liver Cirrhosis/diagnosis ; Liver Cirrhosis/etiology ; Male ; Monitoring, Physiologic/methods ; Reproducibility of Results ; Young Adult
    Language English
    Publishing date 2018-09-20
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2091075-7
    ISSN 1873-5010 ; 1569-1993
    ISSN (online) 1873-5010
    ISSN 1569-1993
    DOI 10.1016/j.jcf.2018.08.010
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  7. Article ; Online: Advanced imaging use and payment trends in a large pediatric accountable care organization.

    Krishnamurthy, Ramkumar / Shah, Summit H / Wang, Ling / Gleeson, Sean P / Liu, Gilbert C / Hu, Houchun H / Krishnamurthy, Rajesh

    Pediatric radiology

    2021  Volume 52, Issue 1, Page(s) 22–29

    Abstract: Background: Pediatric imaging use and payment trends in accountable care organizations (ACOs) are seldom studied but are important for health policy decisions and resource allocation.: Objective: To evaluate patterns of advanced imaging use and ... ...

    Abstract Background: Pediatric imaging use and payment trends in accountable care organizations (ACOs) are seldom studied but are important for health policy decisions and resource allocation.
    Objective: To evaluate patterns of advanced imaging use and associated payments over a 7-year period at a large ACO in the USA serving a Medicaid population.
    Materials and methods: We reviewed paid claims data from 2011 through 2017 from an ACO, analyzing the MRI, CT and US use trends and payments from emergency department (ED) and outpatient encounters. We defined "utilization rate" as the number of advanced imaging procedures per 100 enrolled children per calendar year. Average yearly utilization and payments trends were analyzed using Pearson correlation.
    Results: Across 7 years, 186,552 advanced imaging procedures were performed. The average overall utilization rate was 6.99 (95% confidence interval [CI]: 6.9-7.1). In the ED this was 2.7 (95% CI: 2.6-2.8) and in outpatients 4.3 (95% CI: 4.2-4.3). The overall utilization rate grew by 0.7% yearly (P=0.077), with US growing the most at 4.0% annually (P=0.0005), especially in the ED in the US, where it grew 10.8% annually (P=0.000019). The overall payments were stable from 2011 to 2017, with outpatient MRI seeing the largest payment decrease at 1.8% (P=0.24) and ED US showing the most growth at 3.3% (P=0.00016). Head CT and abdominal US were the two most common procedures.
    Conclusion: Over the study period, advanced imaging utilization at this large pediatric ACO serving the Medicaid population increased, especially with US use in the ED. Overall payments related to advanced imaging remained stable over this period.
    MeSH term(s) Accountable Care Organizations ; Child ; Emergency Service, Hospital ; Humans ; Magnetic Resonance Imaging ; Medicaid ; Outpatients ; United States
    Language English
    Publishing date 2021-09-17
    Publishing country Germany
    Document type Journal Article
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-021-05198-2
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  8. Article ; Online: Reducing sedation for pediatric body MRI using accelerated and abbreviated imaging protocols.

    Ahmad, Rizwan / Hu, Houchun Harry / Krishnamurthy, Ramkumar / Krishnamurthy, Rajesh

    Pediatric radiology

    2018  Volume 48, Issue 1, Page(s) 37–49

    Abstract: Magnetic resonance imaging (MRI) is an established diagnostic imaging tool for investigating pediatric disease. MRI allows assessment of structure, function, and morphology in cardiovascular imaging, as well as tissue characterization in body imaging, ... ...

    Abstract Magnetic resonance imaging (MRI) is an established diagnostic imaging tool for investigating pediatric disease. MRI allows assessment of structure, function, and morphology in cardiovascular imaging, as well as tissue characterization in body imaging, without the use of ionizing radiation. For MRI in children, sedation and general anesthesia (GA) are often utilized to suppress patient motion, which can otherwise compromise image quality and diagnostic efficacy. However, evidence is emerging that use of sedation and GA in children might have long-term neurocognitive side effects, in addition to the short-term procedure-related risks. These concerns make risk-benefit assessment of sedation and GA more challenging. Therefore, reducing or eliminating the need for sedation and GA is an important goal of imaging innovation and research in pediatric MRI. In this review, the authors focus on technical and clinical approaches to reducing and eliminating the use of sedation in the pediatric population based on image acquisition acceleration and imaging protocols abbreviation. This paper covers important physiological and technical considerations for pediatric body MR imaging and discusses MRI techniques that offer the potential of recovering diagnostic-quality images from accelerated scans. In this review, the authors also introduce the concept of reporting elements for important indications for pediatric body MRI and use this as a basis for abbreviating the MR protocols. By employing appropriate accelerated and abbreviated approaches based on an understanding of the imaging needs and reporting elements for a given clinical indication, it is possible to reduce sedation and GA for pediatric chest, cardiovascular and abdominal MRI.
    MeSH term(s) Anesthesia, General/adverse effects ; Anesthetics/administration & dosage ; Anesthetics/adverse effects ; Child ; Conscious Sedation/adverse effects ; Humans ; Magnetic Resonance Imaging/methods
    Chemical Substances Anesthetics
    Language English
    Publishing date 2018
    Publishing country Germany
    Document type Journal Article ; Review
    ZDB-ID 124459-0
    ISSN 1432-1998 ; 0301-0449
    ISSN (online) 1432-1998
    ISSN 0301-0449
    DOI 10.1007/s00247-017-3987-6
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  9. Article ; Online: Evaluation of tissue-engineered human acellular vessels as a Blalock-Taussig-Thomas shunt in a juvenile primate model.

    Nash, Kevin M / Boe, Brian A / Carrillo, Sergio A / Harrison, Andrew / Iwaki, Ryuma / Kelly, John / Kirkton, Robert D / Krishnamurthy, Ramkumar / Lawson, Jeffrey H / Matsuzaki, Yuichi / Prichard, Heather L / Shah, Kejal / Shinoka, Toshiharu / Breuer, Christopher K

    JTCVS open

    2023  Volume 15, Page(s) 433–445

    Abstract: Objectives: Palliative treatment of cyanotic congenital heart disease (CCHD) uses systemic-to-pulmonary conduits, often a modified Blalock-Taussig-Thomas shunt (mBTTs). Expanded polytetrafluoroethylene (ePTFE) mBTTs have associated risks for thrombosis ... ...

    Abstract Objectives: Palliative treatment of cyanotic congenital heart disease (CCHD) uses systemic-to-pulmonary conduits, often a modified Blalock-Taussig-Thomas shunt (mBTTs). Expanded polytetrafluoroethylene (ePTFE) mBTTs have associated risks for thrombosis and infection. The Human Acellular Vessel (HAV) (Humacyte, Inc) is a decellularized tissue-engineered blood vessel currently in clinical trials in adults for vascular trauma, peripheral artery disease, and end-stage renal disease requiring hemodialysis. In addition to restoring blood flow, the engineered HAV demonstrates the capacity for host cellular remodeling into native-like vasculature. Here we report preclinical evaluation of a small-diameter (3.5 mm) HAV as a mBTTs in a non-human primate model.
    Methods: We implanted 3.5 mm HAVs as right subclavian artery to pulmonary artery mBTTs in non-immunosuppressed juvenile rhesus macaques (n = 5). HAV patency, structure, and blood flow were assessed by postoperative imaging from 1 week to 6 months. Histology of HAVs and surrounding tissues was performed.
    Results: Surgical procedures were well tolerated, with satisfactory anastomoses, showing feasibility of using the 3.5 mm HAV as a mBTTs. All macaques had some immunological reactivity to the human extracellular matrix, as expected in this xenogeneic model. HAV mBTTs remained patent for up to 6 months in animals, exhibiting mild immunoreactivity. Two macaques displaying more severe immunoreactivity to the human HAV material developed midgraft dilatation without bleeding or rupture. HAV repopulation by host cells expressing smooth muscle and endothelial markers was observed in all animals.
    Conclusions: These findings may support use of 3.5 mm HAVs as mBTTs in CCHD and potentially other pediatric vascular indications.
    Language English
    Publishing date 2023-08-09
    Publishing country Netherlands
    Document type Journal Article
    ISSN 2666-2736
    ISSN (online) 2666-2736
    DOI 10.1016/j.xjon.2023.05.018
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  10. Article ; Online: Immediate functional progression program in adolescent athletes with a spondylolysis.

    Selhorst, Mitchell / MacDonald, James / Martin, Lisa C / Rodenberg, Richard / Krishnamurthy, Ramkumar / Ravindran, Reno / Fischer, Anastasia

    Physical therapy in sport : official journal of the Association of Chartered Physiotherapists in Sports Medicine

    2021  Volume 52, Page(s) 140–146

    Abstract: Objective: To assess the preliminary evidence for the efficacy and safety of an immediate functional progression program to treat adolescent athletes with an active spondylolysis.: Design: Prospective single-arm trial.: Setting: Hospital-based ... ...

    Abstract Objective: To assess the preliminary evidence for the efficacy and safety of an immediate functional progression program to treat adolescent athletes with an active spondylolysis.
    Design: Prospective single-arm trial.
    Setting: Hospital-based sports medicine and physical therapy clinic.
    Participants: Twelve adolescent athletes (14.2 ± 2 years, 25% female) with an active spondylolysis.
    Main outcome measures: Clinical outcomes included time out of sport, Micheli Functional Scale (Function and Pain) and adverse reactions. Clinical outcomes were assessed at baseline, 1 month, 3 months and 6 months. Magnetic resonance imaging was performed at baseline and 3 months to confirm diagnosis and assess healing of lesion.
    Results: Eleven participants (92%) fully returned to sport in a median time of 2.5 months (75 days; interquartile range 55 days, 85 days). All participants demonstrated marked improvements in pain and function by the end of the program. One participant (8%) had an adverse reaction during care with a significant recurrence of LBP and had not returned to sport by 6 months. Magnetic resonance imaging demonstrated improvement of the spondylolytic lesion in all but one participant.
    Conclusion: The immediate functional progression program appears a viable method for treating active spondylolysis and warrants future research.
    MeSH term(s) Adolescent ; Athletes ; Child ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Prospective Studies ; Spondylolysis/diagnostic imaging ; Sports
    Language English
    Publishing date 2021-08-23
    Publishing country England
    Document type Journal Article
    ZDB-ID 2008604-0
    ISSN 1873-1600 ; 1466-853X
    ISSN (online) 1873-1600
    ISSN 1466-853X
    DOI 10.1016/j.ptsp.2021.08.009
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