Medical Specialties Commons^™

Cesarean Scar Pregnancy: An Experience Of Three Cases With Review Of Literature, Gulnaz Shafat, Kumail Khandwala, Hina Iqbal, Shaista Afzal Saeed

Department of Radiology

Cesarean scar pregnancy (CSP), often considered the rarest form of ectopic pregnancy, is a result of implantation of the gestational sac into the fibrous tissue scar of a previous cesarean section. With an increase in the rate of cesarean sections, along with better awareness and improvement in sonographic diagnosis, the number and detection of scar pregnancies are on the rise. Because of its early invasion of the myometrium, usually in the first trimester, CSP is considered to be potentially lethal, leading to high risks of uterine rupture. We report a series of three cases of scar pregnancy that presented at …

Percutaneous Management Of Biliary Enteric Anastomotic Strictures: An Institutional Review, Muhammad Azeemuddin, Nauman Turab, Al Qamari, Mustafa Belal Hafeez Chaudhry, Shoaib Hamid, Mohammad Hasan, Raza Sayani

Department of Radiology

Purpose Stricture formation at the biliary enteric anastomotic site is a common complication due to fibrotic healing. Few therapeutic options are available for biliary-enteric anastomotic site stricture (BES) including new surgical reconstruction or percutaneous transhepatic biliary drainage followed by balloon dilation of BES or stent placement. The purpose of this study is to assess the technical success, complications and reintervention rate of percutaneous transhepatic balloon dilatation (PTBD) of BES after iatrogenic bile duct injuries (BDI). Methods A retrospective review of patients who underwent PTBD for benign resistant BES, previously treated for iatrogenic BDI, from December 2004 to January 2016 was …

Mra-Based Evaluation Of Anatomical Variation Of Circle Of Willis In Adult Pakistanis, Rehana Shaikh, Saba Sohail

Department of Radiology

Objective: To determine the frequency and patterns of normal anatomical variation of Circle of Willis on magnetic resonance angiogram in adults without cerebrovascular disease.
Methods: This descriptive cross-sectional study was conducted at the Radiology Department of Dow University of Health Sciences / Civil Hospital, Karachi, from January to December 2016, and comprised patients referred for magnetic resonance imaging of the brain and magnetic resonance angiogram without any clinical or radiological manifestation of cerebrovascular disease, primarily including those with suspected demyelination, infection, epilepsy or metastases. Three-dimensional time-of-flight magnetic resonance angiography was performed. The Circle of Willis was assessed for its completeness …

Multiple Unerupted And Supernumerary Teeth In A Patient With Cleidocranial Dysplasia, Galal Omami

Oral Health Practice Faculty Publications

Cleidocranial dysplasia is an extremely rare familial disorder characterized by partial or complete absence of clavicles, characteristic craniofacial deformities, and the presence of numerous supernumerary and unerupted teeth. Here, the author reviews the striking radiographic findings of cleidocranial dysplasia in a 16-year-old adolescent boy who presented with delayed teeth eruption.

Hepatic, Periportal, Retroperitoneal, And Mesenteric Neurofibromatosis In Von Recklinghausen's Disease, Kumail Khandwala, Zafar Sajjad, Summar-Un-Nisa Abbasi, Muhammad Usman Tariq

Department of Radiology

We present a rare case of histologically proven neurofibromatosis of the liver, hepatic hilum, retroperitoneum, and mesentery. An adult male who had been diagnosed with neurofibromatosis (NF) type 1 underwent a computed tomography (CT) scan for abdominal pain and vomiting. The CT scan showed a large low-attenuating lesion in the region of porta hepatis which was infiltrating along portal tracts into the liver, encasing the major vessels, and extending into the retroperitoneum and mesentery. Based on the radiological findings, a differential diagnosis of plexiform neurofibroma was given, although sarcomatous transformation could not have been entirely excluded from imaging alone. The …

Parp Pet Imaging Agents, Brandon Carney

Dissertations, Theses, and Capstone Projects

The poly (adenosine-diphosphate (ADP) ribose) polymerase (PARP) family of enzymes has been of interest to researchers and clinicians for over fifty years, especially the first member of the family, PARP1. This enzyme has become a target for cancer therapeutics due the reliance of highly proliferating cells on PARP1 for genomic maintenance. In the coming age of individualized medicine, however, highly specific therapeutic agents like PARP inhibitors are in need of similarly highly specific companion diagnostic agents. These kind of agents have been made possible with the quickly progressing field of molecular imaging. Specifically, positron emission tomography (PET) has enabled the …

Multiple System Atrophy - The Cerebellar Type With “Hot Cross Bun Sign” On Mri, Rehana Shaikh, Saba Sohail, Nasreen Naz

Department of Radiology

Multiple system atrophy (MSA) is an adult onset, progressive, idiopathic neurodegenerative disease that clinically manifest as MSA-C with cerebellar signs predominant, MSA-P with Parkinsonian features predominant and MSA-A with autonomic signs and symptoms. MRI has an important role in its diagnosis with a characteristic finding described as "hot cross bun" sign seen in MSA of cerebellar type (MSA-C). We have seen two cases of MSA-C referred to Radiology Department, Civil Hospital Karachi in February 2017 and March 2017 who presented with difficulty in walking and speech and foecal and urinary incontinence. The MRI showed atrophy of pons, cerebellum and middle …

Deep Gaze Velocity Analysis During Mammographic Reading For Biometric Identification Of Radiologists, Hong-Jun Yoon, Folami Alamudun, Kathy Hudson, Garnetta Morin-Ducote, Georgia Tourassi

Journal of Human Performance in Extreme Environments

Several studies have confirmed that the gaze velocity of the human eye can be utilized as a behavioral biometric or personalized biomarker. In this study, we leverage the local feature representation capacity of convolutional neural networks (CNNs) for eye gaze velocity analysis as the basis for biometric identification of radiologists performing breast cancer screening. Using gaze data collected from 10 radiologists reading 100 mammograms of various diagnoses, we compared the performance of a CNN-based classification algorithm with two deep learning classifiers, deep neural network and deep belief network, and a previously presented hidden Markov model classifier. The study showed that …

Mammographic Breast Density And Breast Cancer Molecular Subtypes: The Kenyan-African Aspect, Asim Jamal, Maeve Mullooly, Shahin Sayed, Rose Ndumia, Innocent Abayo, James Orwa, Ronald Wasike, Zahir Moloo, Gretchen L. Gierach

Internal Medicine, East Africa

Introduction: Data examiningmammographic breast density (MBD) among patients in Sub-Saharan Africa are sparse.We evaluated how MBD relates to breast cancer characteristics in Kenyan women undergoing diagnostic mammography.

Methods: This crosssectional study included women with pathologically confirmed breast cancers (𝑛 = 123). Pretreatment mammograms of the unaffectedbreast were assessed to estimate absolute dense area (cm2), nondense area (cm2), and percent density (PD). Relationships between density measurements and clinical characteristics were evaluated using analysis of covariance.

Results: Median PD and dense area were 24.9% and 85.3 cm2. Higher PD and dense area were observed in younger women (𝑃 < 0.01). Higher dense and nondense areas were observed in obese women (𝑃-trend < 0.01). Estrogen receptor (ER) positive patients (73%) had higher PD and dense area than ER-negative patients (𝑃 ≤ 0.02). Triple negative breast cancer (TNBC) patients (17%) had lower PD and dense area (𝑃 ≤ 0.01) compared with non-TNBCs. No associations were observed between MBD and tumor size and grade.

Conclusions: Our findings show …

Pituitary Stalk Interruption Syndrome Presenting In A Euthyroid Adult With Short Stature, Atif Nawaz, Muhammad Azeemuddin, Jehanzeb Shahid

Department of Radiology

Pituitary stalk interruption syndrome (PSIS) is a distinct and rare clinical entity responsible for congenital hypopituitarism resulting in deficiency of pituitary hormones with deficiency of the growth hormone (100%) and gonadotropins (97.2%) being its most common presentation at the time of hospital encounter (Wang et al., 2015). Isolated sparing of thyroid-stimulating hormone (TSH) with deficiency of the remaining anterior pituitary hormones may be present in PSIS, as is true in our case. Therefore, it should be kept in mind at the time of examination in suspected cases of PSIS.

Management Of Tiny Unruptured Intracranial Aneurysms: A Comparative Effectiveness Analysis, A. Malhotra, X. Wu, H. P. Forman, C. C. Matouk, D. Gandhi, P. Sanelli

Journal Articles

© 2017 American Medical Association. All rights reserved. Importance: Unruptured intracranial aneurysms (UIAs) are relatively common in the general population and are being increasingly diagnosed; a significant proportion are tiny (≤3 mm) aneurysms. There is significant heterogeneity in practice and lack of clear guidelines on the management of incidental, tiny UIAs. It is important to quantify the implications of different management strategies in terms of health benefits to patients. Objective: To evaluate the effectiveness of routine treatment (aneurysm coiling) vs 3 strategies for imaging surveillance compared with no preventive treatment or routine follow-up of tiny UIAs. Design, Setting, and Participants: …

Nuclear Medicine Imaging In Fever Of Unknown Origin: The New Paradigm, C. J. Palestro, C. Love

Journal Articles

No abstract provided.

Endoscopic Proximal Adductor Lengthening For Chronic Adductor-Related Groin Pain, S. Bharam, P. V. Bhagat, M. C. Spira, D. A. Klein

Journal Articles

© 2018 Arthroscopy Association of North America Proximal adductor injuries are relatively common groin injuries in athletes. Various tenotomy techniques have been described including open, partial, and percutaneous approaches. Current techniques help most athletes return to sport; however, many develop adductor weakness. Moreover, the procedures lack full visualization of the tendon and do not allow for return to athletes’ preinjury level of play. We describe an endoscopic z-lengthening of the proximal adductor tendon with the potential to minimize complications associated with open procedures such as incisional pain and neurovascular injury while affording a more complete tenotomy than current percutaneous techniques. …

Neuroimaging Of Meckel’S Cave In Normal And Disease Conditions, A. Malhotra, L. Tu, V. B. Kalra, X. Wu, A. Mian, R. Mangla, E. Michaelides, P. Sanelli, D. Gandhi

Journal Articles

© 2018, The Author(s). Abstract: Meckel’s cave is a dural recess in the posteromedial portion of the middle cranial fossa that acts as a conduit for the trigeminal nerve between the prepontine cistern and the cavernous sinus, and houses the Gasserian ganglion and proximal rootlets of the trigeminal nerve. It serves as a major pathway in perineural spread of pathologies such as head and neck neoplasms, automatically upstaging tumours, and is a key structure to assess in cases of trigeminal neuralgia. The purpose of this pictorial review is threefold: (1) to review the normal anatomy of Meckel’s cave; (2) to …

Remote Cerebellar Haemorrhage: A Potential Iatrogenic Complication Of Spinal Surgery, Muhammad Atif Naveed, Rajiv Mangla, Hajra Idrees, Rashi I. Mehta

Faculty & Staff Scholarship

We report the case of a 51-year-old man with no significant past medical history, who underwent elective revision spinal surgery and subsequently developed intracranial hypotension, remote cerebellar haemorrhage (RCH), and mild hydrocephalus on the fourth postoperative day. Remote cerebellar haemorrhage is a known complication of supratentorial surgery. This iatrogenic phenomenon may also occur following spinal surgery, due to dural tearing and rapid cerebral spinal fluid (CSF) leakage, resulting in intracranial hypotension and cerebellar haemorrhage. This complication may result in severe permanent neurologic sequelae; hence, it is of pertinence to diagnose and manage it rapidly in order to optimise patient outcome.

Compartment Syndrome Of The Hand: A Case Report And Review Of Literature, V. Mehta, V. Chowdhary, C. Lin, M. Jbara, S. Hanna

Journal Articles

© 2017 The Authors Elevation of pressure within tightly bound myofascial compartments has detrimental consequences if not treated promptly, leading to a loss of circulation, ischemia, myonecrosis, nerve damage, and limb loss. They are commonly seen in the distal upper and lower extremities; however, compartment syndrome of the hand is rarely encountered and prompt recognition can prevent permanent damage and tissue loss. This case study presents a complicated case of compartment syndrome of the hand and discusses the interrelationship between compartment syndrome and rhabdomyolysis. An emphasis is placed on pathophysiology of this relationship to allow a better understanding of the …

Interpreting 123i-Ioflupane Dopamine Transporter Scans Using Hybrid Scores., K. J. Nichols, B. Chen, M. B. Tomas, C. J. Palestro

Journal Articles

Dopamine transporter (DaT) 123I-FP-CIT scans most commonly are interpreted visually. Alternatively, absolute quantitation of radiopharmaceutical uptake may improve scan accuracy. However, neither approach accomodates dependence of striatal uptake on age and gender. We investigated whether demographic indexing of visual and numerical variables improve discrimination of patients with essential tremor (ET), Parkinson's disease (PD), and dementia with Lewy bodies (DLB).Data of 132 consecutive patients undergoing DaT SPECT scans were reviewed retrospectively. The clinical impression in the latest neurology note was utilized as the final clinical diagnosis. Caudate and putamen specific binding ratio (PSBR) were computed. 123I calibration phantoms were constructed to …

Acute Pulmonary Embolism: Endovascular Therapy, S. P. Reis, K. Zhao, N. Ahmad, R. S. Widemon, C. W. Root, S. M. Toomay, J. M. Horowitz, A. K. Sista

Journal Articles

© Cardiovascular Diagnosis and Therapy. All rights reserved. Pulmonary embolism (PE) is a leading cause of morbidity and mortality worldwide. PE is a complex disease with a highly variable presentation and the available treatment options for PE are expanding rapidly. Anticoagulation (AC), systemic lysis, surgery, and catheter-directed thrombolysis (CDT) play important roles in treating patients with PE. Thus, a multidisciplinary approach to diagnosis, risk stratification, and therapy is required to determine which treatment option is best for a given patient with this complex disease.

Congenital Rhabdomyosarcoma Presenting As A Neck Mass At Birth., L. E. Waldman, A. K. Williamson, J. B. Amodio, L. Collins

Journal Articles

Rhabdomyosarcoma is a malignant tumor of the soft tissues which preferentially affects the pediatric population. Neonatal rhabdomyosarcoma is rare, and much of the published literature concerning this entity consists of isolated case reports and small case series. Recent work involving the classification of rhabdomyosarcoma has helped to delineate prognostic information based on gene rearrangements. Here, we present a case of congenital rhabdomyosarcoma seen in utero which manifested as a neck mass at birth and was found to harbor a favorable gene fusion.

Transrenal Ureteral Embolization Utilizing Amplatzer Vascular Plugs And N-Butyl Cyanoacrylate Glue., M. X. Jin, A. D. Mohabir, D. M. Caplin, I. Lobko, D. N. Siegel

Journal Articles

This retrospective study presents three consecutive patients who underwent bilateral ureteral occlusion using the Amplatzer vascular plugs and N-butyl cyanoacrylate glue sandwich method. The patients were 63- and 65-year-old males and a 79-year-old female. Indications for the procedure included severe cystitis and complex vesicular fistulas unresponsive to urinary diversion. All three patients had immediate resolution of urinary leakage, resulting in symptom relief throughout the follow-up period. There were no procedure-related complications or side effects.

Sports Hernia/Athletic Pubalgia Among Women, M. P. Zoland, J. C. Iraci, S. Bharam, L. E. Waldman, J. P. Koulotouros, D. Klein

Journal Articles

© The Author(s) 2018. Background: “Athletic pubalgia,” a term that has gained acceptance over “sports hernia,” is more common in men than women; however, it represents a significant source of morbidity for patients of both sexes. Inconsistent terminology surrounding this entity poses a diagnostic challenge and makes studying the populations at risk difficult. Purpose: To review a case series of women with athletic pubalgia by analyzing their presentations, concomitant pathologies, and surgical outcomes. Study Design: Case series; Level of evidence, 4. Methods: Between 2013 and 2016, 197 patients were seen and evaluated for the diagnosis of athletic pubalgia. Eighteen patients …

A Case Of Primary Squamous Cell Carcinoma Of The Gallbladder With Local Invasion Of The Liver And Peritoneum, And Metastasis To The Omentum., A. C.J. Levy, F. Casalduc-Coca, S. Asiry, A. Goodman

Journal Articles

Primary squamous cell carcinoma of the gallbladder is a rare entity that comprises approximately 1%-3% of all primary gallbladder cancers. We report the case of a 37-year-old woman who was diagnosed with a locally invasive squamous cell carcinoma of the gallbladder. Surgical pathology revealed a predominantly squamous cell carcinoma composition of the tumor with a few microscopic foci of adenocarcinoma (

Cost-Effectiveness Of Magnetic Resonance Imaging In Cervical Clearance Of Obtunded Blunt Trauma After A Normal Computed Tomographic Finding, X. Wu, A. Malhotra, B. Geng, V. B. Kalra, K. Abbed, H. P. Forman, P. Sanelli

Journal Articles

© 2018 American Medical Association. All rights reserved. IMPORTANCE Magnetic resonance imaging (MRI) continues to be performed for cervical clearance of obtunded blunt trauma, despite poor evidence regarding its utility after a normal computed tomographic (CT) finding. OBJECTIVE To evaluate the utility and cost-effectiveness of MRI vs no follow-up after a normal cervical CT finding in patients with obtunded blunt trauma. DESIGN, SETTING AND PARTICIPANTS This cost-effectiveness analysis evaluated an average patient aged 40 years with blunt trauma from an institutional practice. The analysis used a Markov decision model over a lifetime horizon from a societal perspective with variables from …

Hybrid 3d/2d Convolutional Neural Network For Hemorrhage Evaluation On Head Ct, P. D. Chang, E. Kuoy, J. Grinband, B. D. Weinberg, M. Thompson, R. Homo, J. Chen, H. Abcede, C. G. Filippi, D. Chow, +5 Additional Authors

Journal Articles

No abstract provided.

Assessment Of The Albumin-Bilirubin (Albi) Grade As A Prognostic Indicator For Hepatocellular Carcinoma Patients Treated With Radioembolization., B. Gui, A. A. Weiner, J. Nosher, S. E. Lu, G. M. Foltz, O. Hasan, S. K. Kim, V. Gendel, N. B. Mani, S. K. Jabbour, +6 Additional Authors

Journal Articles

OBJECTIVE: As the utility of Child-Pugh (C-P) class is limited by the subjectivity of ascites and encephalopathy, we evaluated a previously established objective method, the albumin-bilirubin (ALBI) grade, as a prognosticator for yttrium-90 radioembolization (RE) treatment for patients with hepatocellular carcinoma (HCC).

MATERIALS AND METHODS: A total of 117 patients who received RE for HCC from 2 academic centers were reviewed and stratified by ALBI grade, C-P class, and Barcelona Clinic Liver Cancer stage. The overall survival (OS) according to these 3 criteria was evaluated by Kaplan-Meier survival analysis. The utilities of C-P class and ALBI grade as prognostic indicators …

Structural Parameters Of Mnd Measured By X-Ray Diffraction, Daniel J. Kuiper, Paul Harper

Summer Research

In our lungs, there are lipids and lung proteins that work together to allow us to breathe. The proteins are known to encourage non-lamellar phases in lipids, but the function of this property for letting us to breathe is not well understood. The aim of my research was to qualify the behavior of the lipid MNd without any lung protein to allow for a comparison between the effects when formed naturally and when formed with lung protein to give a better understanding of what the protein is doing. Below is a diagram of an MNd molecule. In the presence of …

A Rare Case Of Presacral Epidermoid Cyst In An Adult Male: Emphasis On Diffusion Weighted Magnetic Resonance Sequences In Preoperative Imaging., Muhammad I. Alvi, Fatima Mubarak, Kumail Khandwala, Muhammad Nanish Barakzai, Aisha Memon

Department of Radiology

Epidermoid cyst of the presacral space is a rare congenital lesion of ectodermal origin. Presacral epidermoid cysts have been previously reported in women, however are extremely rare in males. We report a case of presacral epidermoid cyst in a 55-year-old male who presented to our emergency department with acute urinary retention and history of chronic constipation. A non-contrast computed tomography scan was performed with suspicion of urolithiasis, which revealed a well circumscribed low attenuation presacral mass. Magnetic resonance imaging (MRI) of the pelvis was subsequently performed to further characterize the lesion. The mass was returning hypointense T1 and hyperintense T2 …

Intra-Arterial Nitroglycerin As Directed Acute Treatment In Experimental Ischemic Stroke, Michael E. Maniskas, Jill M. Roberts, Rebecca Trueman, Annastazia E. Learoyd, Amanda A. Gorman, Justin F. Fraser, Gregory J. Bix

Neuroscience Faculty Publications

BACKGROUND: Nitroglycerin (also known as glyceryl trinitrate (GTN)), a vasodilator best known for treatment of ischemic heart disease, has also been investigated for its potential therapeutic benefit in ischemic stroke. The completed Efficacy of Nitric Oxide in Stroke trial suggested that GTN has therapeutic benefit with acute (within 6 hours) transdermal systemic sustained release therapy.

OBJECTIVE: To examine an alternative use of GTN as an acute therapy for ischemic stroke following successful recanalization.

METHODS: We administered GTN IA following transient middle cerebral artery occlusion in mice. Because no standard dose of GTN is available following emergent large vessel occlusion, we …

Osteoid Osteoma: Contemporary Management, Shahryar Noordin, Salim Allana, Kiran Hilal, Riaz Hussain Lukhadwala, Anum Sadruddin Pidani, Nasir Ud Din

Section of Orthopaedic Surgery

Osteoid osteoma is a benign bone-forming tumor with hallmark of tumor cells directly forming mature bone. Osteoid osteoma accounts for around 5% of all bone tumors and 11% of benign bone tumors with a male predilection. It occurs predominantly in long bones of the appendicular skeleton. According to Musculoskeletal Tumor Society staging system for benign tumors, osteoid osteoma is a stage-2 lesion. It is classified based on location as cortical, cancellous, or subperiosteal. Nocturnal pain is the most common symptom that usually responds to salicyclates and non-steroidal anti-inflammatory medications. CT is the modality of choice not only for diagnosis but …

Motion-Induced Artifact Mitigation And Image Enhancement Strategies For Four-Dimensional Fan-Beam And Cone-Beam Computed Tomography, Matthew J. Riblett

Theses and Dissertations

Four dimensional imaging has become part of the standard of care for diagnosing and treating non-small cell lung cancer. In radiotherapy applications 4D fan-beam computed tomography (4D-CT) and 4D cone-beam computed tomography (4D-CBCT) are two advanced imaging modalities that afford clinical practitioners knowledge of the underlying kinematics and structural dynamics of diseased tissues and provide insight into the effects of regular organ motion and the nature of tissue deformation over time. While these imaging techniques can facilitate the use of more targeted radiotherapies, issues surrounding image quality and accuracy currently limit the utility of these images clinically.

The purpose of …