Radiology Commons^™

A Pain That Wouldn't Sleep: Osteoid Osteoma Masquerading As Lateral Epicondylitis, Madelyn Bagley, Luca Halalau, Aimee Espinosa, Terrence Metz

Conference Presentation Abstracts

Osteoid osteoma is a benign osteogenic tumor that accounts for approximately 10% of all benign bone tumors and predominantly affects adolescents and young adults. It classically presents with nocturnal pain that responds dramatically to nonsteroidal anti-inflammatory drugs, a feature attributed to increased prostaglandin production within the nidus. The femur and tibia are most commonly involved, whereas upper extremity lesions are relatively uncommon. A 19-year-old male presented with nearly two years of chronic, progressive left lateral elbow pain and left wrist weakness. The pain was nocturnal, radiated along the left arm, and was markedly relieved by nonsteroidal antiinflammatory drugs. He was …

Diffuse Marrow And Orbital Fat Signal Abnormality Mimicking Infiltrative Disease: A Case Of "Flip-Flop" On Mri, Mehdy Haidar, Alexander Pietroski, Kamil Abu-Shaban, Anant Krishnan

Conference Presentation Abstracts

Clinical History A 68-year-old male with a history of left tonsillar squamous cell carcinoma treated 5 months ago and reportedly negative recent PET and CT scans of the neck and body with eye pain with possible but uncertain remote history of trauma was sent in for imaging of the orbits. The patient has a feeding tube and was recently hospitalized and discharged for tube obstruction. Imaging Findings Orbital imaging revealed diffuse signal alterations involving the orbital and scalp fat, and marrow, characterized by low signal intensity on T1WI and high signal intensity on T2WI. In particular on the STIR sequence, …

Immune Checkpoint Inhibitor-Associated Perioptic Neuritis, Neud Kiros, Alina Sinha, Anant Krishnan

Conference Presentation Abstracts

Clinical History A 47-year-old male with history of stage IV gastric cancer on nivolumab presented with blurry vision worse at close distances. Binocular horizontal diplopia was found on exam. Fundus exam demonstrated 4+ disc edema and hemorrhage bilaterally. Recent head MRI was negative for leptomeningeal enhancement. MR venogram and MRI orbits with contrast were ordered as well as lumbar puncture. The patient’s next dose of immunotherapy was held. Opening pressure was normal, and MRV showed no evidence of dural sinus thrombosis. MRI of the orbits was positive for perioptic neuritis bilaterally, and the patient was started on a steroid taper …

When The Eagle Strikes The Vein: A Case Of Styloid-Induced Venous Sinus Thrombosis, Neud Kiros, Ahmad Chehab, Abeer Abukamil, Ali Luqman, Kamil Abu-Shaban, Mehdy Haidar, Ay-Ming Wang

Conference Presentation Abstracts

Clinical History 41-year-old male with no prior relevant medical history presented to the emergency department with severe neck pain and occipital headaches radiating bilaterally to the temporal regions. He also reported diplopia and “tunnel vision.” He had presented two weeks earlier with similar symptoms and was advised outpatient follow-up. Initial CT head and cervical spine were unremarkable. Imaging Findings Brain MRI/MRV demonstrated heterogeneous signal and enhancement in the left transverse and sigmoid sinuses and jugular bulb, initially thought to reflect possible motion artifact. However, CT venography was recommended for further assessment. The MRI also showed subtle left posterior occipital subdural …

Determining Size In An Era When Size Matters: Inter-Radiologist Variability In Lung Cancer Measurement, Katelyn Ward, Gayaneh Nazarian, Ryan Davis, Sayf Al-Katib, Kiran Nandalur, Thomas Watson

Conference Presentation Abstracts

No abstract provided.

Determining Size In An Era When Size Matters: How Accurate Are Lung Cancer Measurements On Preoperative Computed Tomography?, Katelyn Ward, Ryan Davis, Gayaneh Nazarian, Sayf Al-Katib, Kiran Nandalur, Antonela Muca, Thomas Watson

Conference Presentation Abstracts

No abstract provided.

Pericardial Effusion Of Uncommon Origin: A Diagnostic Journey, Tannoz Norouzi, Carol Lima, Sayf Al-Katib

Conference Presentation Abstracts

Tuberculous (TB) pericarditis is a rare yet serious form of extrapulmonary tuberculosis, characterized by a diverse clinical presentation and the potential to occur as an isolated extrapulmonary manifestation. In developed countries, tuberculosis is a rare cause of pericarditis, contributing to less than 5% of pericardial effusion cases and an even smaller percentage of constrictive pericarditis cases. This case describes a 27-year-old male from Mali with no significant medical history presenting with progressive fatigue, shortness of breath, and palpitations over one year. Family history revealed sudden cardiac death in his father in his 30s. Physical examination and initial investigations, including echocardiography, …

Evaluating The Impact Of Spot Position Errors On Dose Distribution: A Comparison Between Spot-Scanning Arc Therapy (Sparc) And Intensity-Modulated Proton Therapy (Impt), Peilin Liu, Lewei Zhao, Gang Liu, Xiaoda Cong, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To quantitatively investigate the impact of spot position error (PE) on the dose distribution in (Spot-scanning arc therapy) SPArc plans versus Intensity-Modulated Proton Therapy (IMPT).

Methods:

Four representative disease sites, including brain, lung, liver, and prostate cancers, were retrospectively selected. Spot position errors were simulated during dynamic SPArc treatment delivery. Two types of errors were generated, including randomized error and systematic error. For each random error scenario, they were further examined across four sub-scenarios (25%, 50%, 75%, and 100% of spots affected) at 1 mm and 2 mm deviations.The randomized errors used two categories with and without Gaussian distribution …

Against: Adoption Of New Technologies In Radiation Oncology Must Be Evidence-Based, Xuanfeng Ding

Conference Presentation Abstracts

No abstract provided.

Exploit The Potential Clinical Benefit Of Using Proton Arc Therapy For Esophageal Cancer, Peilin Liu, Xiaoda Cong, Raymond Dalfsen, Martin Soukup, James E. Dolan, Shupeng Chen, Craig Stevens, Rohan Deroniyagala, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

No abstract provided.

Quantitative Evaluation Of Gantry Rotation Perturbation Effects On Spot-Scanning Arc Therapy (Sparc), Peilin Liu, Lewei Zhao, Gang Liu, Xiaoda Cong, Xiaoqiang Li, Xuanfeng Ding

Conference Presentation Abstracts

Purpose: To quantitatively assess the impact of random gantry rotation perturbations on spot-scanning arc (SPArc) therapy.

Methods:

To simulate random gantry rotation perturbations, the initial gantry angle of SPArc treatment plans was modified using an in-house script. Four cases from different disease sites include brain, lung, liver and prostate were selected to evaluate. Original SPArc plans (SPArc_org) were developed through iterative processes, including control point re-sampling, redistribution of control points & energy layers, energy layer filtration, and re-sampling. Considering potential limitations, rotation perturbations of 1mm and 2mm were applied to al SPArc_org plans to generate perturbed SPArc …

Hydralazine Associated Neutrophilic Dermatosis: A Unique Case Observing Dile, Anca Vasculitis, And Sweet Syndrome, Nicholas Olen, Jacob Horsley, Berk Celik, Joseph Skender, Shailesh Niroula

Conference Presentation Abstracts

Introduction: This case report highlights a 73-year-old male with biopsy-proven neutrophilic dermatosis with concern for Sweet Syndrome in the context of suspected hydralazine-induced systemic lupus erythematosus and autoimmune markers that initially pointed towards hydralazine-induced ANCA vasculitis. Case Presentation: The patient is a 73-year-old male with a past medical history significant for chronic kidney disease, urothelial cancer in 2021, renal cancer in 2013, and stage 1A left lung cancer. The patient additionally underwent workup for low white count and splenomegaly in months leading up to hospitalization, with bone marrow biopsy and workup negative for myelodysplastic syndrome or malignancy. Patient initially presented …

Assessing The Diagnostic Accuracy Of Ti-Rads In Pediatric Thyroid Nodules: A Multi-Instutional Review, Shachi Srivatsa, Ameer Al-Hadidi, Joseph R. Stanek, Kyle Horvath, Lauren N. Parsons, Claudia Martinez-Rios, Amanda Hopp, Samuel Engle, Matthew Plunk, Gail Shapira-Zaltsberg, Sapna Nagar, Sean E. Masters, Sayf Al-Katib, Rennard B. Tucker, Lamya Atwah, Summit Shah, Adam Bobbey, Robert Hoffman, Jennifer H. Aldrink

Conference Presentation Abstracts

Abstract: Purpose: Thyroid nodules are uncommon in children and adolescents but carry an increased risk of malignancy when present. The Thyroid Imaging Reporting and Data System (TI-RADS) is an adult-validated ultrasound-based risk assessment providing a prediction of malignant potential for thyroid nodules, thereby guiding recommendations for fine needle aspiration biopsy (FNAB). Minimal data exist regarding the applicability of TI-RADS to predict malignancy in pediatric thyroid nodules. This study aims to analyze the performance of TI-RADS for children and adolescents with thyroid nodules, hypothesizing that applying TI-RADS criteria would improve accuracy and reduce the number of recommended FNAB compared to American …

Growth Hormone Deficiency: When Is Mri Imaging Indicated?, Haya Azouz, Kurt Tech, M Bassem Dekelbab

Conference Presentation Abstracts

Objectives The diagnosis of Growth Hormone Deficiency (GHD) is made with a combination of clinical assessment, measurement of insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein-3 (IGFBP-3) levels, and GH stimulation tests. Provocative (stimulation) GH testing is indicated for most patients to confirm a diagnosis of GHD. Traditionally, most pediatric endocrinologists defined a "normal" response by a serum GH concentration of >10 ng/ml. After the clinical and biochemical diagnosis of GHD is made, it is typical to obtain an MRI of the brain with narrow cuts through the hypothalamic-pituitary area. The aim of our study is to …

Rare Autoimmune Disease Caused By Not-So Rare Virus, Tiffany Marchewka, Acho Bernard, Molly Kempa, Kathryn Heal, Joseph M. Fullmer

Conference Presentation Abstracts

No abstract provided.

Expansion Of The Detrusor Muscular Ring Surrounding The Bladder Neck On Mri: Moving Beyond The Prostate As An Etiology Of Lower Urinary Tract Symptoms Due To Benign Prostatic Hyperplasia, Kiran Nandalur, David Walker, Hong Ye, Sayf A. Al-Katib, Brian Seifman, David Gangwish, Abhay Dhaliwal, Connor Ervin, Kayla Dobies, Channing Sesoko, Sirisha Nandalur, Bernadette Zwaans, Jennifer Nguyen, Jason Hafron

Conference Presentation Abstracts

Purpose: The etiology of lower urinary tract symptoms secondary to benign prostatic hyperplasia (LUTS/BPH) remains uncertain. The purpose of our study was to quantitatively analyze pelvic anatomic characteristics on magnetic resonance imaging (MRI) to assess for independent factors for symptoms.
*Methods and Materials: This retrospective single-institution study evaluated treatment-naïve men who underwent prostate MRI within 3 months of International Prostate Symptom Score (IPSS) from June 2021 to February 2022. Factors measured on MRI included: detrusor muscular ring surrounding the bladder neck measured as area and alternatively diameter, central gland (CG) mean apparent diffusion coefficient (ADC), levator hiatus (LH) volume, intrapelvic …

Intraorbital Transvenous Embolization Of A Direct Arteriovenous Fistula, Olivia Cheng, Stella Chung, Jeffrey Wilseck, Alon Kahana

Conference Presentation Abstracts

No abstract provided.

Irreversible Electroporation For Recurrent Pelvic Metastases: Case Series And Literature Review., Duncan A. Stevens, Jeffrey H. Savin, Brett J. Friedman, Michael A. Savin

Conference Presentation Abstracts

Purpose: Irreversible electroporation (IRE) is a nonthermal ablative technique that has potential safety advantages over thermal ablation in the treatment of tumors near critical structures. It creates an electrical field which forms permanent nanopores in the membranes of cells and triggers apoptosis. This case series reviews three patients with pelvic metastases from colorectal cancer treated with IRE.

Material and Methods: Two patients had rectal cancer and one sigmoid colon cancer. The mean age was 55 years and there were two males and one female. Thermal ablation was contraindicated due to proximity to ureter, bladder, bowel, and/or sciatic or lumbosacral nerves. …

Automating 4dct-Ventilation Imaging Generation Using Ai-Based Advanced Lung Contours, Yingxuan Chen, Sohrab Pahlavan, Paul Jacobs, Farnoush Forghani, Edward Castillo, Richard Castillo, Yevgeniy Vinogradskiy

Conference Presentation Abstracts

Purpose: Functional avoidance radiotherapy uses functional imaging to reduce pulmonary toxicity by designing radiotherapy plans that reduce doses to functional lung. A novel form of lung functional imaging applied for functional avoidance uses 4DCT imaging to calculating 4DCT-based lung ventilation (4DCT-ventilation). The process of generating 4DCT-ventilation images requires advanced lung segmentation (consisting of a standard lung with airway and vasculature removed) which is a manual and time-consuming process. The purpose of this work is to automate 4DCT-ventilation imaging generation using AI-based auto-segmentation techniques for advanced lung contouring.

Methods: 429 patients with 4DCT data from two institutions were used. Three methods …

End-To-End Commissioning & Treatment Plan Quality Assurance For Cranial Single-Isocenter Multi-Target (Simt) Radiosurgery, Cory Knill

Conference Presentation Abstracts

No abstract provided.

Pivotal Trial Of Mri-Guided Transurethral Ultrasound Ablation In Men With Localized Prostate Cancer: Three-Year Follow-Up, Steven S. Raman, Sandeep Arora, Katarzyna J. Macura, Aytekin Oto, Jurgen Fütterer, Robert Staruch, Temel Tirkes, David Bonekamp, Masoom Haider, Derek W. Cool, Kiran Nandalur

Conference Presentation Abstracts

Purpose: MRI-guided transurethral ultrasound ablation (TULSA) of prostate tissue is a novel directional ultrasound heating under real-time MRI thermometry feedback control. We report 3-year outcomes from the pivotal TULSA-PRO Ablation Clinical Trial. Materials and Methods: With IRB approval and HIPAA compliance, 115 men with organ-confined prostate cancer (≤T2b, PSA ≤15 ng/ml, Grade Group [GG] 1-2) across 13 centers underwent whole-gland ablation sparing the urethra, bladder neck, and urinary sphincter. Primary endpoints were safety and PSA reduction at 1 year. Secondary endpoints: prostate volume reduction, mpMRI, and 10 core biopsy at 1 year; quality of life, PSA, and salvage to 3 …

Aspnr Programing: Interesting Pediatric Neuroradiology Case Session (Sa-Cme): Seizures., A Krishnan

Conference Presentation Abstracts

No abstract provided.

A Rare Case Of Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy, A Dearden, J Doty, A Krishnan, J Fellows

Conference Presentation Abstracts

Purpose This is a 69-year-old male who presented with cognitive decline, hypophonia, dyspraxia, course tremor, myoclonic jerks, and gait dysfunction, all developing over 3-4 weeks. Initial head CT and MRI brain without contrast were negative. EEG demonstrated diffuse slowing. CSF analysis revealed elevated protein and elevated white blood cells (lymphocyte predominant). Given neurological worsening, MRI brain and cervical spine with contrast were performed and unique findings were identified, detailed below. The CSF autoimmune panel returned positive for Glial Fibrillary Acidic Protein (GFAP). The patient was started on steroids with rapid clinical improvement. Materials and Methods MRI brain with contrast 2 …

Benign And Malignant Cervical Lymphadenopathy: A Practical Imaging Approach To The Diagnosis Of Common And Uncommon Conditions, A Dhaliwal, J Sharma, S Noujaim

Conference Presentation Abstracts

Purpose Generally, cervical lymphadenopathy is a benign, self-limited, and reactive process that is frequently encountered, especially in the pediatric population. However, when present in the setting of a neoplastic process, cervical lymphadenopathy is an important prognostic factor that can alter patient management. Determining the etiology of cervical lymphadenopathy is as essential as its detection. Etiologies include infection, granulomatous disease, malignancy, autoimmune disorders, iatrogenic causes, and miscellaneous or unusual conditions. Careful attention to clinical history and laboratory findings and the use of appropriate radiological imaging is crucial to obtaining the correct diagnosis. A variety of cases, including benign and malignant processes, …

Spontaneous Aneurysmal Subdural Hemorrhage: A Rare Entity, M Rizk, A Khan, J Ghannam, M Waheed

Conference Presentation Abstracts

Purpose 36-year-old female who presented to our emergency department for worsening headache and new onset left sided diplopia. Physical exam confirmed a left 3rd nerve palsy. A CT of the head was obtained which showed a subdural hemorrhage which ultimately resulted in coil embolization of a ruptured aneurysm. The patient tolerated the procedure well and was closely followed for vasospasm development with routine transcranial ultrasounds which were negative. Patient remained stable and reported resolution of her headache symptoms on discharge. However, she continued to have a left 3rd nerve palsy. Materials and Methods CT of the head was obtained which …

Neuroimaging Spectrum Of Non-Compressive Non-Neoplastic Myelopathy, J Ghannam, A Dearden, R Joshi, A Wang, K Barry

Conference Presentation Abstracts

Purpose Non-compressive, non-neoplastic spinal cord lesions represent a broad range of disease processes and entities. Most commonly, spinal cord lesions demonstrate T2 signal abnormality on magnetic resonance imaging, a relatively nonspecific finding requiring a variety of differentiating factors to build an accurate differential diagnosis (1). Additionally, many disease entities have significant overlapping features on MRI, rendering it difficult to separate diagnoses and guide management (2). The combination of signal characteristics on MRI, timing of clinical presentation, degree of cord expansion, and contrast enhancement patterns can provide improved differentiation between disease entities. The purpose of this exhibit is to educate the …

The Onus On The Conus: A Neuroimaging Spectrum Of Conus Medullaris Pathologies, A Dearden, J Ghannam, A Wang, A Krishnan

Conference Presentation Abstracts

Purpose The conus medullaris is the tapered, cone-shaped end of the distal thoracic spinal cord, normally terminating near the L1-2 intervertebral disc space. As a junction between the cord and the cauda equina nerve roots, the conus can present with common cord pathologies in atypical presentations, as well as present with unique, complex pathologies found nowhere else in the cord. The conus is optimally evaluated with MRI of the lumbar spine before and after the administration of contrast medium. Accurate diagnosis of lesions within the conus is complicated by the nonspecific nature of increased intramedullary signal on T2-weighted MRI imaging, …

Vertebral Artery Pathology: A Review Of Diagnosis And Angiographic Intervention, R Joshi, A Abbas, J Wilseck

Conference Presentation Abstracts

Purpose The vertebral arteries are a critical component of the spinal and posterior intracranial circulation. Their associated pathologies are wide ranging including traumatic and congenital causes. Given the profound impact on patient management and outcomes, a careful evaluation of the vertebral artery with a firm understanding of normal anatomy is required to properly rule out pathology. This educational exhibit will provide an overview of the normal anatomy of the vertebral arteries and a case-based review of a large spectrum of their pathologies, including traumatic, spontaneous, iatrogenic, and congenital. Utilization of various imaging modalities including, CTA, MRA, angiography, and ultrasound will …

Neuroimaging Spectrum Of Compressive Non-Neoplastic Myelopathy, A Dearden, J Ghannam, A Wang, A Krishnan

Conference Presentation Abstracts

Purpose Compressive non-neoplastic spinal cord lesions represent a broad spectrum of neurologic disease processes contributing to back pain and neuropathy, including traumatic, inflammatory/infectious, degenerative, and metastatic etiologies. Compressive cord lesions are optimally evaluated with high-field strength magnet MRI with and without contrast. Differential diagnoses for cord lesions are inherently broad due to the nonspecific nature of increased intramedullary signal on T2-weighted images seen with many cord pathologies. However, differentiating features such as degree of cord expansion, enhancement characteristics, and extramedullary findings can provide additional information to refine the differential diagnosis. In this exhibit, we present representative cases of compressive non-neoplastic …

You’Re Testing My Patients: Clinicians’ Preferences For Structured Reporting And Measurement Data, Davit Meliksetyan, Allan Brazier, Adela Pouzar, Sayf Al-Katib

Conference Presentation Abstracts

No abstract provided.