Radiology Commons^™

Current And Future Directions Of Breast Mri, Margaret Houser, David Barreto, Anita Mehta, Rachel F. Brem

Radiology Faculty Publications

No abstract provided.

Acr Appropriateness Criteria® Parathyroid Adenoma., David Zander, Paul M Bunch, Bruno Policeni, Amy F Juliano, Denise Carneiro-Pla, Prachi Dubey, Maria K Gule-Monroe, Mari Hagiwara, Jenny K Hoang, Vikas Jain, Lawrence T Kim, Gul Moonis, Matthew S Parsons, Tanya J Rath, Carmen C Solórzano, Rathan M Subramaniam, M Reza Taheri, Kate Duchene Thoma, Andrew T Trout, Mark E Zafereo, Amanda S Corey

Radiology Faculty Publications

No abstract provided.

Acr Appropriateness Criteria® Staging And Follow-Up Of Primary Vaginal Cancer., Aoife Kilcoyne, Ravi V Gottumukkala, Stella K Kang, Esma A. Akin, Carlin Hauck, Nicole M Hindman, Chenchan Huang, Namita Khanna, Rajmohan Paspulati, Gaiane M Rauch, Tamer Said, Atul B Shinagare, Erica B Stein, Aradhana M Venkatesan, Katherine E Maturen

Radiology Faculty Publications

No abstract provided.

Ultrasound-Guided Introital Drainage Of Pyometrocolpos, I Kim, Ranjith Vellody, Hans G. Pohl, Karun Sharma, Kabir Yadav

Radiology Faculty Publications

Pyometrocolpos can be caused by congenital malformations such as distal vaginal atresia and imperforate hymen. Patients usually present with obstructive urinary tract infections, acute kidney injury, or sepsis. Percutaneous drainage of the infected fluid can help treat the patient; however, recurrence is of concern. In this case report, we present a case of a child with recurrent pyometrocolpos due to distal vaginal atresia despite initial percutaneous drainage. To our knowledge, this is the first report of ultrasound-guided introital drainage of pyometrocolpos with relief of symptoms obviating the need for repeat drainage or immediate surgery. © 2017

Successful Embolization Of A Enterocutaneous Fistula Tract With Onyx 34 Following Low Anterior Resection For Rectal Cancer., Hamza Rahimi, Anthony C Venbrux, Vincent Obias

Radiology Faculty Publications

Enterocutaneous fistulas (ECFs) can be one of the complications found after surgical intervention for rectal cancer. Interventional modalities consisting of surgical, endoscopic, and radiological methods are often implemented to treat postoperative symptomatic complications. We present the case of 61-year-old Caucasian man who presented to us with a recent diagnosis of rectal cancer that had invaded the levators as well as anteriorly into the prostate, and who underwent low anterior resection with a diverting loop ileostomy. The patient was found to have a persistent presacral abscess due to an ECF tract. This case highlights the off-label use of ethylene-vinyl alcohol copolymer …

Design And Development Of A Phantom For Tomosynthesis With Potential For Automated Analysis Via The Cloud., David Goodenough, Josh Levy, Hildur Olafsdottir, Ingvi Olafsson

Radiology Faculty Publications

This paper describes Development of a Phantom for Tomosynthesis with Potential for Automated Analysis via the Cloud. Several studies are underway to investigate the effectiveness of Tomosynthesis Mammographic Image Screening, including the large TMIST project as funded by the National Cancer Institute https://www.cancer.gov/about-cancer/treatment/clinical-trials/nci-supported/tmist. The development of the phantom described in this paper follows initiatives from the FDA, the AAPM TG245 task group, and European Reference Organization (EUREF) for Quality Assured Breast Screening and Diagnostic Services Committee report noting, that no formal endorsement nor recommendation for use has been sought, or granted by any of these groups. This paper reports on …

A Review Of Clinical Radioprotection And Chemoprotection For Oral Mucositis., Bryan Oronsky, Sharad Goyal, Michelle M Kim, Pedro Cabrales, Michelle Lybeck, Scott Caroen, Neil Oronsky, Erica Burbano, Corey Carter, Arnold Oronsky

Radiology Faculty Publications

The first tenet of medicine, "primum non nocere" or "first, do no harm", is not always compatible with oncological interventions e.g., chemotherapy, targeted therapy and radiation, since they commonly result in significant toxicities. One of the more frequent and serious treatment-induced toxicities is mucositis and particularly oral mucositis (OM) described as inflammation, atrophy and breakdown of the mucosa or lining of the oral cavity. The sequelae of oral mucositis (OM), which include pain, odynodysphagia, dysgeusia, decreased oral intake and systemic infection, frequently require treatment delays, interruptions and discontinuations that not only negatively impact quality of life but also tumor control …

The Pivotal Role Of Mri In The Diagnosis Of Listeria Rhomboencephalitis, K.R Uprety, M Reza Taheri

GW Research Days 2016 - 2020

Sixty-six year-old female presented to the Emergency Department with history of several days of headache, malaise, chills, and fatigue with accompanying nausea, vomiting, and inability to tolerate oral intake. She had no history of fever and remained afebrile at the time of presentation. Physical exam and immediate lab values were non-contributory; CSF was obtained and sent for analysis. The patient was placed preemptively on acyclovir, as viral meningitis was the admitting diagnosis. MRI of the brain showed abnormal FLAIR signal hyperintensity and enhancement involving the entire cisternal segment of the left trigeminal nerve, which extended dorsally along the nerve fiber …

Breast Lesions Detected Via Molecular Breast Imaging: Physiological Parameters Affecting Interpretation, Jason Ching, Rachel Brem

GW Research Days 2016 - 2020

Rationale and Objectives:

To evaluate correlations between molecular breast imaging (MBI) descriptor characteristics and positive predictive value (PPV) in detecting breast cancer.

Materials and Methods:

A retrospective review was performed on 193 suspicious findings from 153 women (31-81 years) with positive MBI examinations. We assessed associations between: (i) lesion pattern (mass vs. non-mass) and PPV; (ii) lesion pattern and suspected likelihood of cancer (low vs. moderate vs. high); (iii) background parenchymal uptake (BPU) (homogeneous vs. heterogeneous) and PPV; (iv) breast density (dense vs. non-dense) and PPV; (v) BPU and density.

Results:

One hundred ten of 153 patients were diagnosed with …

Enriching The Medical Student Radiology Clerkship: Simulating The Radiologist’S Experience, Liqi Shu, Faraien Bahri, Navid Mostaghni, Ramin Javan

GW Research Days 2016 - 2020

Background

Current radiology training in medical schools is still predominantly limited to passively observing the radiologist at the workstation and through lectures, textbooks and online sources. Evaluation is also mainly limited on still image interpretation or knowledge-based multiple-choice questions. Furthermore, students may have specific interests based on their choice of residency. In order to create a tailored and active learning experience, and to evaluate students’ ability in image interpretation, we utilized an open-source web-based Picture archiving and communication system (PACS) named "Weasis" and integrated a report system.

Method

We establish a new PACS teaching system by utilizing the open-source PACS …

Robust Head Ct Image Registration Pipeline For Craniosynostosis Skull Correction Surgery, Shusil Dangi, Hina Shah, Antonio Porras, Beatriz Paniagua, Cristian Linte, Marius George Linguraru, Andinent Enquobahrie

Radiology Faculty Publications

Craniosynostosis is a congenital malformation of the infant skull typically treated via corrective surgery. To accurately quantify the extent of deformation and identify the optimal correction strategy, the patient-specific skull model extracted from a pre-surgical computed tomography (CT) image needs to be registered to an atlas of head CT images representative of normal subjects. Here, the authors present a robust multi-stage, multi-resolution registration pipeline to map a patient-specific CT image to the atlas space of normal CT images. The proposed registration pipeline first performs an initial optimisation at very low resolution to yield a good initial alignment that is subsequently …

Needs Assessment Of Pediatric Radiological Equipment And Cross-Cultural Investigation Into Parental Empowerment In Pediatric Radiology Program Development In The Kingdom Of Bhutan, Danielle Canter

GW Research Days 2016 - 2020

Background:

Bhutan is a magnificent mountainous country hugged by India to the east and west and by China to the North and South. This peaceful nestled country faces challenges in combating non-communicable diseases due to the lack of radiological equipment necessary for early diagnosis. Prior to implementation of these medical devices, it is imperative to investigate the cultural attitudes, beliefs, and infrastructure, to ensure successful integration. Bhutan is beginning to implement a pediatric radiology program for the nation with the assistance of ABAH Foundation and RAD-AID International, both of whom partnered with graduate students at George Washington University School of …

Mri-Guided Stereotactic Biopsy Of Murine Gbm For Spatiotemporal Molecular Genomic Assessment, Stefanie Galban, Waid Al-Holou, Hanxiao Wang, Amanda Welton, Kevin Heist, Yuan Zhu, +Several Additional Authors

Pediatrics Faculty Publications

Brain tumor biopsies that are routinely performed in clinical settings significantly aid in diagnosis and staging. The aim of this study is to develop and evaluate a methodological image-guided approach that would allow for routine sampling of glioma tissue from orthotopic mouse brain tumor models. A magnetic resonance imaging-guided biopsy method is presented to allow for spatially precise stereotaxic sampling of a murine glioma coupled with genome-scale technology to provide unbiased characterization of intra- and intertumoral clonal heterogeneity. Longitudinal and multiregional sampling of intracranial tumors allows for successful collection of tumor biopsy samples, thus allowing for a pathway-enrichment analysis and …

Peritoneal Mesothelioma In A Young Woman: Case Report Of Radiopathologic Findings And Review Of The Literature, Amy L Ellenbogen, Stephanie Barak, Esma A. Akin

Radiology Faculty Publications

Peritoneal mesothelioma is a rare diagnosis most often seen in middle-aged men and exceedingly rarely in individuals in their teens and twenties. Diagnosis is often delayed secondary to nonspecific presenting symptoms and a misconception that there must be a history of asbestos exposure to garner such a diagnosis. Here, we present the case of a 21 year-old female with a histologically confirmed diagnosis of peritoneal mesothelioma and review the key radiologic and histologic findings of this rare diagnosis.

Altered Cerebellar Biochemical Profiles In Infants Born Prematurely, Marie Brossard-Racine, Jonathan Murnick, Marine Bouyssi-Kobar, Janie Coloumbe, Taeun Chang, Catherine Limperopoulos

Radiology Faculty Publications

This study aims to compare the cerebellar biochemical profiles in preterm (PT) infants evaluated at term equivalent age (TEA) and healthy full-term newborns using proton magnetic resonance spectroscopy (1H-MRS). We explore the associations between altered cerebellar metabolite profiles and brain injury topography, severity of injury, and prematurity-related clinical complications. We prospectively collected high quality 1H-MRS in 59 premature infants born ≤32 weeks and 61 healthy full term controls. 1H-MRS data were processed using LCModel software to calculate absolute metabolite concentration for N-acetyl-aspartate (NAA), choline (Cho) and creatine (Cr). PT infants had significantly lower cerebellar NAA (p < 0.025) and higher Cho (p < 0.001) at TEA when compared to healthy controls. Creatine was not different between the two groups. The presence of cerebellar injury was consistently associated with reduced concentrations for NAA, Cho, and Cr. Postnatal infection was negatively associated with NAA and Cr (p < 005), while cerebral cortical brain injury severity was inversely associated with both Cho and Cr (p < 0.01). We report for the first time that premature birth is associated with altered cerebellar metabolite profiles when compared to term born controls. Infection, cerebellar injury and supratentorial injury are important risk factors for impaired preterm cerebellar biochemistry.

Ureterovaginal Fistula Secondary To Retained Vaginal Foreign Body In A Young Girl, Anjum Bandarkar, Adebunmi O. Adeyiga, Eglal Shalaby-Rana

Radiology Faculty Publications

We present the case of a 13-year-old girl with a recurrent urinary tract infection, malodorous vaginal discharge, and urinary incontinence caused by a retained vaginal foreign body. The foreign body, an aerosol cap retained for over 2 years, resulted in the formation of a ureterovaginal fistula, an extremely rare complication. The critical value of ultrasound and magnetic resonance urography in delineating the foreign body, the fistulous tract, and the intraperitoneal urine leak is described. Through this unique diagnostic dilemma, we wish to highlight that the evaluation of persistent unusual urinary symptoms and vaginal discharge in a young girl must include …

Ct And Pet Findings For Urachal Adenocarcinoma: A Case Report, Merissa Zeman, Ethan Silver, Esma A. Akin

Radiology Faculty Publications

As urachal adenocarcinomas are rare cancers, experience with diagnosing and staging them are limited. To help illustrate CT and PET imaging findings and the role they each play in the workup of urachal adenocarcinomas, we present the case of a 43 y.o. male who was diagnosed at our institution with a T3aN0M0 high grade mucin-producing urachal adenocarcinoma.

Composite Iron Oxide–Prussian Blue Nanoparticles For Magnetically Guided T1-Weighted Magnetic Resonance Imaging And Photothermal Therapy Of Tumors, Shraddha Kale, Rachel Burga, Elizabeth E. Sweeney, Zungho Zun, Raymond Sze, Anthony Tuesca, J Anand Subramony, Rohan Fernandes

Radiology Faculty Publications

Theranostic nanoparticles offer the potential for mixing and matching disparate diagnostic and therapeutic functionalities within a single nanoparticle for the personalized treatment of diseases. In this article, we present composite iron oxide-gadolinium-containing Prussian blue nanoparticles (Fe3O4@GdPB) as a novel theranostic agent for T1-weighted magnetic resonance imaging (MRI) and photothermal therapy (PTT) of tumors. These particles combine the well-described properties and safety profiles of the constituent Fe3O4 nanoparticles and gadolinium-containing Prussian blue nanoparticles. The Fe3O4@GdPB nanoparticles function both as effective MRI contrast agents and PTT agents as determined by characterizing studies performed in vitro and retain their properties in the presence …

Dark Blood Late Enhancement Imaging., Peter Kellman, Hui Xue, Laura J. Olivieri, Russell R. Cross, Elena K Grant, Marianna Fontana, Martin Ugander, James C Moon, Michael S Hansen

Pediatrics Faculty Publications

Background

Bright blood late gadolinium enhancement (LGE) imaging typically achieves excellent contrast between infarcted and normal myocardium. However, the contrast between the myocardial infarction (MI) and the blood pool is frequently suboptimal. A large fraction of infarctions caused by coronary artery disease are sub-endocardial and thus adjacent to the blood pool. It is not infrequent that sub-endocardial MIs are difficult to detect or clearly delineate.

Methods

In this present work, an inversion recovery (IR) T2 preparation was combined with single shot steady state free precession imaging and respiratory motion corrected averaging to achieve dark blood LGE images with good signal …

Long-Term Biocompatibility, Imaging Appearance And Tissue Effects Associated With Delivery Of A Novel Radiopaque Embolization Bead For Image-Guided Therapy, Karun Sharma, Zainab Bascal, Hugh Kilpatrick, Koorosh Ashrafi, Sean L. Willis, Matthew R. Dreher, Andrew L. Lewis

Pediatrics Faculty Publications

The objective of this study was to undertake a comprehensive long-term biocompatibility and imaging assessment of a new intrinsically radiopaque bead (LC Bead LUMI™) for use in transarterial embolization. The sterilized device and its extracts were subjected to the raft of ISO10993 biocompatibility tests that demonstrated safety with respect to cytotoxicity, mutagenicity, blood contact, irritation, sensitization, systemic toxicity and tissue reaction. Intra-arterial administration was performed in a swine model of hepatic arterial embolization in which 0.22–1 mL of sedimented bead volume was administered to the targeted lobe(s) of the liver. The beads could be visualized during the embolization procedure with …

Method And Phantom To Study Combined Effects Of In-Plane (X,Y) And Z-Axis Resolution For 3d Ct Imaging., David Goodenough, Josh Levy, Smari Kristinsson, Jesper Fredriksson, Hildur Olafsdottir, Austin Healy

Radiology Faculty Publications

Increasingly, the advent of multislice CT scanners, volume CT scanners, and total body spiral acquisition modes has led to the use of Multi Planar Reconstruction and 3D datasets. In considering 3D resolution properties of a CT system it is important to note that both the in-plane (x,y) and z-axis (slice thickness) influence the visual-ization and detection of objects within the scanned volume. This study investigates ways to consider both the in-plane resolution and the z-axis resolution in a single phantom wherein analytic or visualized analysis can yield information on these combined effects. A new phantom called the "Wave Phantom" is …

Prospective Evaluation Of The Influence Of Iterative Reconstruction On The Reproducibility Of Coronary Calcium Quantification In Reduced Radiation Dose 320 Detector Row Ct., Andrew D Choi, Eric S Leifer, Jeannie Yu, Sujata M Shanbhag, Kathie Bronson, Andrew E Arai, Marcus Y Chen

Radiology Faculty Publications

BACKGROUND: Coronary artery calcium (CAC) predicts coronary heart disease events and is important for individualized cardiac risk assessment. This report assesses the interscan variability of CT for coronary calcium quantification using image acquisition with standard and reduced radiation dose protocols and whether the use of reduced radiation dose acquisition with iterative reconstruction (IR; "reduced-dose/IR ") allows for similar image quality and reproducibility when compared to standard radiation dose acquisition with filtered back projection (FBP; "standard-dose/FBP") on 320-detector row computed tomography (320-CT).

METHODS: 200 consecutive patients (60 ± 9 years, 59% male) prospectively underwent two standard- and two reduced-dose acquisitions (800 …

Prospective Evaluation Of The Influence Of Iterative Reconstruction On The Reproducibility Of Coronary Calcium Quantification In Reduced Radiation Dose 320 Detector Row Ct., Andrew D. Choi, Eric S Leifer, Jeannie Yu, Sujata M Shanbhag, Kathie Bronson, Andrew E Arai, Marcus Y Chen

Radiology Faculty Publications

BACKGROUND: Coronary artery calcium (CAC) predicts coronary heart disease events and is important for individualized cardiac risk assessment. This report assesses the interscan variability of CT for coronary calcium quantification using image acquisition with standard and reduced radiation dose protocols and whether the use of reduced radiation dose acquisition with iterative reconstruction (IR; "reduced-dose/IR ") allows for similar image quality and reproducibility when compared to standard radiation dose acquisition with filtered back projection (FBP; "standard-dose/FBP") on 320-detector row computed tomography (320-CT).

METHODS: 200 consecutive patients (60 ± 9 years, 59% male) prospectively underwent two standard- and two reduced-dose acquisitions (800 …

Mr Imaging Findings In Xp21.2 Duplication Syndrome, Matthew T. Whitehead, Guy Helman, Andrea L. Gropman

Radiology Faculty Publications

Xp21.2 duplication syndrome is a rare genetic disorder of undetermined prevalence and clinical relevance. As the use of chromosomal microarray has become first line for the work-up of childhood developmental delay, more gene deletions and duplications have been recognized. To the best of our knowledge, the imaging findings of Xp21.2 duplication syndrome have not been reported. We report a case of a 33 month-old male referred for developmental delay that was found to have an Xp21.2 duplication containing IL1RAPL1 and multiple midline brain malformations.

Comparison Of Drug Delivery With Autoinjector Versus Manual Prefilled Syringe And Between Three Different Autoinjector Devices Administered In Pig Thigh, Robert Hill, John Wilmot, Beth Belluscio, Kevin Cleary, David Lindisch, Robin Tucker, Emmanuel Wilson, Rajesh Shukla

Radiology Faculty Publications

Parenteral routes of drug administration are often selected to optimize actual dose of drug delivered, assure high bioavailability, bypass first-pass metabolism or harsh gastrointestinal environments, as well as maximize the speed of onset. Intramuscular (IM) delivery can be preferred to intravenous delivery when initiating intravenous access is difficult or impossible. Drugs can be injected intramuscularly using a syringe or an automated delivery device (autoinjector). Investigation into the IM delivery dynamics of these methods may guide further improvements in the performance of injection technologies. Two porcine model studies were conducted to compare differences in dispersion of injectate volume for different methods …

Interrater Reliability Of Quantitative Ultrasound Using Force Feedback Among Examiners With Varied Levels Of Experience, Michael O. Harris-Love, Catheeja Ismail, Reza Monfaredi, Haniel J. Hernandez, Donte Pennington, Paula Woletz, Valerie Mcintosh, Bernadette Adams, Marc R. Blackman

Exercise and Nutrition Sciences Faculty Publications

Background. Quantitative ultrasound measures are influenced by multiple external factors including examiner scanning force. Force feedback may foster the acquisition of reliable morphometry measures under a variety of scanning conditions. The purpose of this study was to determine the reliability of force-feedback image acquisition and morphometry over a range of examiner-generated forces using a muscle tissuemimicking ultrasound phantom.

Methods. Sixty material thickness measures were acquired from a muscle tissue mimicking phantom using B-mode ultrasound scanning by six examiners with varied experience levels (i.e., experienced, intermediate, and novice). Estimates of interrater reliability and measurement error with force feedback scanning were determined …

Pediatric Neuroradiology Pre-Call Primer, Trevor Morrison, Gilbert Vezina, Nadja Kadom

E-Learning Modules

Pediatric neuroimaging can provide a challenge to radiology residents during call due to the fact that it is infrequently encountered in many institutions. The goal of this teaching tool is to provide radiology residents with background knowledge in pediatric brain anatomy and pathology in preparation for taking call. There is one teaching tool and one assessment tool with answers, all three of which are in PowerPoint format. Emergency neuroradiology topics discussed in this module are sutures, skull fractures, bleeds, sulci and mass effect, cisterns, and herniations. After implementing this teaching tool at our institution with all incoming residents and fellows, …

A Single Baseline Ultrasound Assessment Of Fibroid Presence And Size Is Strongly Predictive Of Future Uterine Procedure: 8-Year Follow-Up Of Randomly Sampled Premenopausal Women Aged 35-49 Years., Donna D. Baird, T M Saldana, D L Shore, Michael C. Hill, J M Schectman

Radiology Faculty Publications

STUDY QUESTION: How well can a single baseline ultrasound assessment of fibroid burden (presence or absence of fibroids and size of largest, if present) predict future probability of having a major uterine procedure?

SUMMARY ANSWER: During an 8-year follow-up period, the risk of having a major uterine procedure was 2% for those without fibroids and increased with fibroid size for those with fibroids, reaching 47% for those with fibroids ≥4 cm in diameter at baseline.

WHAT IS KNOWN ALREADY: Uterine fibroids are a leading indication for hysterectomy. However, when fibroids are found, there are few available data to help clinicians …

Re-Expansion Pulmonary Edema, Talal Alzahrani, Nawaf Abaalkhail, Mayssam Nehme, Jalil Ahari

GW Research Days 2015

Re-expansion pulmonary edema (RPE) is a rare complication of therapeutic thoracentesis. Unfortunately, there is no definitive treatment modality for RPE. The high mortality rate, reported up to 21%, presses the issue for finding adequate prevention and treatment. Here we report a new management modality that is very useful for a patient with RPE.

Case Report: An 80-year-old man with a history of hypertension, atrial fibrillation, congestive heart failure with preserved ejection fraction, and sacral decubitus ulcer, who was admitted for surgical debridement of his ulcer. He developed hospital-acquired pneumonia and was resolved with antibiotics and aggressive hydration. He became hypoxic, …

Minimal Increase In Contrast Enhancement After Chemo-Radiotherapy (Crt) For Glioblastoma Predicts Worse Survival And Progression-Free Survival, Sameer Aggarwal, Jason Molitoris, Cecelia Gzell, Minesh Mehta

GW Research Days 2015

No abstract provided.