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

Assistant Professor in the Department of 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

Publications:

Correction

MLA Citation
Correction.” American Journal of Roentgenology, vol. 210, no. 1, American Roentgen Ray Society, Jan. 2018, pp. 235–235. Crossref, doi:10.2214/ajr.17.19352.
URI
https://scholars.duke.edu/individual/pub1445203
Source
crossref
Published In
Ajr. American Journal of Roentgenology
Volume
210
Published Date
Start Page
235
End Page
235
DOI
10.2214/ajr.17.19352

Prospects of a Fellowship Match for Abdominal Imaging: A National Survey by the Society of Abdominal Radiology.

PURPOSE: After the Society of Chairs of Academic Radiology Departments timeline and guidelines were released for the 2021 through 2022 fellowship application cycle, the Society of Abdominal Radiology conducted a survey of residents, fellows, and abdominal imaging fellowship program directors (PDs) to assess stakeholders' perceptions of changes in the fellowship application process. METHODS: Eligible study participants included fellowship PDs of all US abdominal imaging programs and Society of Abdominal Radiology members-in-training. A questionnaire was developed by content and survey experts, pilot-tested, and administered from August to October 2019. RESULTS: Survey response rates were 51.4% among PDs (54 of 103) and 24.2% among trainees (67 of 279), with an overall response rate of 31.8%. Attitudes regarding the abdominal imaging fellowship application process were overall similar between PDs and trainees, including expressed support for a common application. Although trainees and PDs agreed that the Society of Chairs of Academic Radiology Departments 2021 through 2022 cycle timeline is preferable to the prior unstructured system, only 42.4% of PDs and 40.7% of trainees supported moving to a formal match, with a significant number of respondents undecided. Both PDs and trainees favored timing fellowship interviews during the fall of the third year of residency (R3 year), with a 1- to 2-month buffer between the start of interviews and offers. CONCLUSIONS: PDs and trainees demonstrate similar attitudes in support of the Society of Chairs of Academic Radiology Departments 2021 through 2022 cycle timeline and a common abdominal imaging fellowship application. Shifting the interview season from winter to fall of R3 year could be considered to meet the preferences of PDs and trainees alike. Moving to a formal match remains controversial.
Authors
Magudia, K; Sugi, MD; Balthazar, P; Donelan, K; Bay, CP; Gupta, R; Maturen, K
MLA Citation
Magudia, Kirti, et al. “Prospects of a Fellowship Match for Abdominal Imaging: A National Survey by the Society of Abdominal Radiology.J Am Coll Radiol, vol. 17, no. 6, June 2020, pp. 804–11. Pubmed, doi:10.1016/j.jacr.2020.02.003.
URI
https://scholars.duke.edu/individual/pub1451273
PMID
32105644
Source
pubmed
Published In
Journal of the American College of Radiology : Jacr
Volume
17
Published Date
Start Page
804
End Page
811
DOI
10.1016/j.jacr.2020.02.003

Proliferative potential and response to nivolumab in clear cell renal cell carcinoma patients

© 2020, © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC. Background: Biomarkers predicting immunotherapy response in metastatic renal cell cancer (mRCC) are lacking. PD-L1 immunohistochemistry is a complementary diagnostic for immune checkpoint inhibitors (ICIs) in mRCC, but has shown minimal clinical utility and is not used in routine clinical practice. Methods: Tumor specimens from 56 patients with mRCC who received nivolumab were evaluated for PD-L1, cell proliferation (targeted RNA-seq), and outcome. Results: For 56 patients treated with nivolumab as a standard of care, there were 2 complete responses and 8 partial responses for a response rate of 17.9%. Dividing cell proliferation into tertiles, derived from the mean expression of 10 proliferation-associated genes in a reference set of tumors, poorly proliferative tumors (62.5%) were more common than moderately (30.4%) or highly proliferative (8.9%) counterparts. Moderately proliferative tumors were enriched for PD-L1 positive (41.2%), compared to poorly proliferative counterparts (11.4%). Objective response for moderately proliferative (29.4%) tumors was higher than that of poorly (11.4%) proliferative counterparts, but not statistically significant (p = .11). When cell proliferation and negative PD-L1 tumor proportion scores were combined statistically significant results were achieved (p = .048), showing that patients with poorly proliferative and PD-L1 negative tumors have a very low response rate (6.5%) compared to moderately proliferative PD-L1 negative tumors (30%). Conclusions: Cell proliferation has value in predicting response to nivolumab in clear cell mRCC patients, especially when combined with PD-L1 expression. Further studies which include the addition of progression-free survival (PFS) along with sufficiently powered subgroups are required to further support these findings.
Authors
Zhang, T; Pabla, S; Lenzo, FL; Conroy, JM; Nesline, MK; Glenn, ST; Papanicolau-Sengos, A; Burgher, B; Giamo, V; Andreas, J; Wang, Y; Bshara, W; Madden, KG; Shirai, K; Dragnev, K; Tafe, LJ; Gupta, R; Zhu, J; Labriola, M; McCall, S; George, DJ; Ghatalia, P; Dayyani, F; Edwards, R; Park, MS; Singh, R; Jacob, R; George, S; Xu, B; Zibelman, M; Kurzrock, R; Morrison, C
MLA Citation
Zhang, T., et al. “Proliferative potential and response to nivolumab in clear cell renal cell carcinoma patients.” Oncoimmunology, vol. 9, no. 1, Jan. 2020. Scopus, doi:10.1080/2162402X.2020.1773200.
URI
https://scholars.duke.edu/individual/pub1449567
Source
scopus
Published In
Oncoimmunology
Volume
9
Published Date
DOI
10.1080/2162402X.2020.1773200

Assessments of frailty in bladder cancer.

BACKGROUND AND AIMS: The incidence of frailty is increasing as the population ages, which has important clinical implications given the associations between frailty and poor outcomes in the bladder cancer population. Due to a multi-organ system decline and decreased physiologic reserve, frail patients are vulnerable to stressors of disease and have poorer mortality and morbidity rates than their nonfrail peers. The association between frailty and poor outcomes has been documented across multiple populations, including radical cystectomy, creating a need for frailty assessments to be used preoperatively for risk stratification. We aim to provide a review of the common frailty assessments and their relevance to radical cystectomy patients. FINDINGS: A variety of assessments for frailty exist, from short screening items to comprehensive geriatric assessments. The syndrome spans multiple organ systems, as do the potential diagnostic instruments. Some instruments are less practical for use in clinical practice by urologists, such as the Canadian Study of Health and Aging Frailty Index and Comprehensive Geriatric Assessment. The tool most studied in radical cystectomy is the modified Frailty Index, associated with high grade complications and 30-days mortality. Frailty often coexists with malnutrition and sarcopenia, stressing the importance of screening for and addressing these syndromes to improve patient's perioperative outcomes. CONCLUSIONS: There is no universally agreed upon frailty assessment, but the most studied in radical cystectomy is the modified Frailty Index, providing valuable data with which to counsel patients preoperatively. Alterations in immune phenotypes provide potential future diagnostic biomarkers for frailty.
Authors
Grimberg, DC; Shah, A; Molinger, J; Whittle, J; Gupta, RT; Wischmeyer, PE; McDonald, SR; Inman, BA
MLA Citation
Grimberg, Dominic C., et al. “Assessments of frailty in bladder cancer.Urol Oncol, vol. 38, no. 9, Sept. 2020, pp. 698–705. Pubmed, doi:10.1016/j.urolonc.2020.04.036.
URI
https://scholars.duke.edu/individual/pub1442035
PMID
32451229
Source
pubmed
Published In
Urol Oncol
Volume
38
Published Date
Start Page
698
End Page
705
DOI
10.1016/j.urolonc.2020.04.036

MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2.

OBJECTIVE: To evaluate the efficacy of multiparametric magnetic resonance/transrectal ultrasound fusion (MRI/TRUS fusion) biopsy versus systematic biopsy and its association with PI-RADS v2 categories in patients with suspected prostate cancer. MATERIALS AND METHODS: 122 patients undergoing both MRI/TRUS fusion and systematic biopsy, with suspicion of prostate cancer, with suspicious findings on MRI based on PI-RADS v2, were included between April 2016 and March 2017. Comparison of tumor detection rates using each technique and combined techniques was performed for all lesions as well as those that are traditionally difficult to access (i.e., anterior lesions). RESULTS: Prostate cancer was detected in 83/122 patients (68%) with 74.6% clinically significant lesions (Gleason 3 + 4 or greater). There was a statistically significant difference in presence of clinically significant prostate cancer in PI-RADS v2 categories of 3, 4, and 5 (20%, 52% and 77%, respectively, p < 0.001). Fusion biopsy was positive in a significantly higher percentage of patients versus systematic biopsy (56% versus 48%, respectively, p < 0.05). The fusion biopsy alone was positive in 20%. Of 34 patients with anterior lesions on MRI, 44% were detected only by fusion biopsy, with a joint yield of 71%. In patients with previous negative systematic biopsies, 48.7% lesions were found by fusion biopsy with 20.5% being exclusively positive by this method. The percentage of positive cores for fusion biopsies was significantly higher than for systematic biopsies (26% vs. 12.3%, p < 0.001). CONCLUSION: The incorporation of MRI/TRUS fusion biopsy significantly improves the detection rate of prostate cancer versus systematic biopsy, particularly for anterior lesions.
Authors
Labra, A; González, F; Silva, C; Franz, G; Pinochet, R; Gupta, RT
MLA Citation
Labra, Andrés, et al. “MRI/TRUS fusion vs. systematic biopsy: intra-patient comparison of diagnostic accuracy for prostate cancer using PI-RADS v2.Abdom Radiol (Ny), vol. 45, no. 7, July 2020, pp. 2235–43. Pubmed, doi:10.1007/s00261-020-02481-y.
URI
https://scholars.duke.edu/individual/pub1437037
PMID
32249349
Source
pubmed
Published In
Abdom Radiol (Ny)
Volume
45
Published Date
Start Page
2235
End Page
2243
DOI
10.1007/s00261-020-02481-y