Rajan Gupta

Overview:

Abdominal Imaging; Multiparametric MR imaging of prostate cancer; MR imaging of the hepatobiliary system; Applications of dual energy CT in the abdomen and pelvis

Positions:

Associate Professor of Radiology

Radiology, Abdominal Imaging
School of Medicine

Associate Professor in Surgery

Surgery, Urology
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.D. 2003

Northwestern University

Grants:

Quantitative Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE-MRI) of Bone Marrow In Acute Myeloid Leukemia

Administered By
Radiology, Abdominal Imaging
Awarded By
Bayer Healthcare Pharmaceuticals Inc
Role
Principal Investigator
Start Date
End Date

Philips' IntelliSpace Precision Medicine (ISPM) platform and its prostate cancer application(s)

Administered By
Radiology, Abdominal Imaging
Awarded By
Philips Healthcare
Role
Principal Investigator
Start Date
End Date

Publications:

Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience.

PURPOSE: To report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters. MATERIALS AND METHODS: In this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed. RESULTS: Intravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique. CONCLUSIONS: Intravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.
Authors
Swenson, C; Martin, JG; Jaffe, T; Gupta, RT; Sag, AA; Befera, NT; Pabon-Ramos, WM; Suhocki, PV; Smith, TP; Kim, CY; Ronald, J
MLA Citation
Swenson, Christopher, et al. “Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience.J Vasc Interv Radiol, vol. 32, no. 9, Sept. 2021, pp. 1310-1318.e2. Pubmed, doi:10.1016/j.jvir.2021.04.029.
URI
https://scholars.duke.edu/individual/pub1484211
PMID
34058351
Source
pubmed
Published In
J Vasc Interv Radiol
Volume
32
Published Date
Start Page
1310
End Page
1318.e2
DOI
10.1016/j.jvir.2021.04.029

ACR Appropriateness Criteria® Renal Failure.

Renal failure can be divided into acute kidney injury and chronic kidney disease. Both are common and result in increased patient morbidity and mortality. The etiology is multifactorial and differentiation of acute kidney injury from chronic kidney disease includes clinical evaluation, laboratory tests, and imaging. The main role of imaging is to detect treatable causes of renal failure such as ureteral obstruction or renovascular disease and to evaluate renal size and morphology. Ultrasound is the modality of choice for initial imaging, with duplex Doppler reserved for suspected renal artery stenosis or thrombosis. CT and MRI may be appropriate, particularly for urinary tract obstruction. However, the use of iodinated and gadolinium-based contrast should be evaluated critically depending on specific patient factors and cost-benefit ratio. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
Authors
Expert Panel on Urologic Imaging,; Wong-You-Cheong, JJ; Nikolaidis, P; Khatri, G; Dogra, VS; Ganeshan, D; Goldfarb, S; Gore, JL; Gupta, RT; Heilbrun, ME; Lyshchik, A; Metter, DF; Purysko, AS; Savage, SJ; Smith, AD; Wang, ZJ; Wolfman, DJ; Lockhart, ME
MLA Citation
Expert Panel on Urologic Imaging, Mark E., et al. “ACR Appropriateness Criteria® Renal Failure.J Am Coll Radiol, vol. 18, no. 5S, May 2021, pp. S174–88. Pubmed, doi:10.1016/j.jacr.2021.02.019.
URI
https://scholars.duke.edu/individual/pub1481855
PMID
33958111
Source
pubmed
Published In
Journal of the American College of Radiology : Jacr
Volume
18
Published Date
Start Page
S174
End Page
S188
DOI
10.1016/j.jacr.2021.02.019

Can procedure time for paracentesis be optimized based on bottle selection?

PURPOSE: The purpose of our study was to assess if plastic containers could decrease the overall procedure time for paracentesis relative to more commonly used glass containers. METHODS: In this IRB exempt study, initial pilot data comparing filling time of glass and plastic containers in an ex vivo setting under identical conditions revealed power calculations that n = 37 patients per group would be needed to achieve standard deviation (SD) = 60 s, difference (diff) = 40 s, two-tailed alpha-level 0.05, and power 80%. Total of 43 patients (93 containers) were enrolled and randomized to glass or plastic bottles at enrollment. Timing of bottle filling was assessed using standardized sonographic screen captures. RESULTS: An interim look at statistics at n = 20 patients indicated that original conjectures from pilot data were conservative and smaller sample size was sufficient to stop the study and conduct the analyses. Specifically, SD = 54 s, diff = 49 s, two-tailed alpha-level 0.05, and power 80% required n = 21 patients per group. Plastic containers had a statistically significantly lower average filling time per bottle (162.7 ± 53.3 s) compared to glass (212.2 ± 50.4 s) (p = 0.003). Viscosity was calculated for each specimen and did not affect the statistical significance of the results (p = 0.32). CONCLUSION: Plastic containers have 50 s time savings of per bottle filling time as compared to glass bottles as theorized based on their faster flow rate. This holds true in both an ex vivo setting and in patients and can have important downstream impacts on patient throughput, provider efficiency and system wide cost savings.
Authors
Perry, WP; Barrett, JJ; Secic, M; Ehieli, WL; Leder, RA; Marin, D; Nelson, RC; Gupta, RT
MLA Citation
Perry, William P., et al. “Can procedure time for paracentesis be optimized based on bottle selection?Abdom Radiol (Ny), vol. 46, no. 8, Aug. 2021, pp. 4062–67. Pubmed, doi:10.1007/s00261-021-03033-8.
URI
https://scholars.duke.edu/individual/pub1477407
PMID
33783568
Source
pubmed
Published In
Abdom Radiol (Ny)
Volume
46
Published Date
Start Page
4062
End Page
4067
DOI
10.1007/s00261-021-03033-8

Editorial Comment on "Prevalence of Prostate Cancer in PI-RADS Version 2.1 Transition Zone Atypical Nodules Upgraded by Abnormal DWI: Correlation With MRI-Directed TRUS-Guided Targeted Biopsy".

Authors
URI
https://scholars.duke.edu/individual/pub1459994
PMID
32876484
Source
pubmed
Published In
Ajr. American Journal of Roentgenology
Volume
216
Published Date
Start Page
690
DOI
10.2214/AJR.20.24501

How frequently does hepatocellular carcinoma develop in at-risk patients with a negative liver MRI examination with intravenous Gadobenate dimeglumine?

OBJECTIVE: To determine the rate of development of clinically significant liver nodules (LR-4, LR-5, LR-M) after a negative MRI in an HCC screening population. METHODS: This retrospective study included patients at risk of developing HCC requiring imaging surveillance who had undergone multiphase Gadobenate dimeglumine-enhanced MRI that was negative and had follow up LI-RADS compliant multiphase CTs or MRIs for at least 12 months or positive follow-up within 12 months. Follow-up examinations were classified as negative (no nodules or only LR-1 nodules) or positive (nodule other than LR-1). Time-to-first positive examination, types of nodules, and cumulative incidence of nodule development were recorded. RESULTS: 204 patients (mean age 58.9 ± 10.2 years, 128 women), including 172 with cirrhosis, were included. Based CT/MRI follow-up (median 35 months, range 12-80 months), the overall cumulative incidence of developing a nodule was 10.5%. Cumulative incidence of nodule development was: 0.5% at 6-9 months and 2.1% at 12 ± 3 months, including one LR-4 nodule, one LR-M nodule, and two LR-3 nodules. The cumulative incidence of clinically significant nodule development was 1.1% at 9-15 months. 70% (143/204) of patients also underwent at least one US follow-up, and no patient developed a positive US examination following index negative MRI. CONCLUSION: Clinically significant liver nodules develop in 1.1% of at-risk patients in the first year following negative MRI. While ongoing surveillance is necessary for at-risk patients, our study suggests than longer surveillance intervals after a negative MRI may be reasonable and that further research is needed to explore this possibility.
Authors
Zaki, IH; Shropshire, E; Zhang, S; Xiao, D; Wildman-Tobriner, B; Marin, D; Gupta, RT; Erkanli, A; Nelson, RC; Bashir, MR
MLA Citation
Zaki, Islam H., et al. “How frequently does hepatocellular carcinoma develop in at-risk patients with a negative liver MRI examination with intravenous Gadobenate dimeglumine?Abdom Radiol (Ny), vol. 46, no. 3, Mar. 2021, pp. 969–78. Pubmed, doi:10.1007/s00261-020-02771-5.
URI
https://scholars.duke.edu/individual/pub1461101
PMID
32951065
Source
pubmed
Published In
Abdom Radiol (Ny)
Volume
46
Published Date
Start Page
969
End Page
978
DOI
10.1007/s00261-020-02771-5