Radiology Commons^™

Dti Metrics For Multi-Site/Multi-Scanner Study Of Adult Cervical Spinal Cord, Devon M. Middleton, Phd, Joshua Fisher, Bs, Adam E. Flanders, Md, Feroze Mohamed, Phd, John H. Wu, Md, Laura Krisa, Phd, Mark Elliot, Phd, Scott H. Faro, Md, Jessica Evans, Bs

Department of Radiology Posters

Background and Objective

A major variable in DTI spinal cord studies is the diversity in MRI scanner vendor and field strength. While there are several techniques proven to acquire DTI data, there are no standardized accepted methods for acquisition and processing. As more medical systems are utilizing this technology to evaluate the spinal cord, it is important to study the reproducibility of the DTI metrics among various scanner platforms, coil configurations and software implementations to determine the variance in obtaining normative spinal cord DTI data. This preliminary data for a multi-site DTI study examines the effects of these different MR …

Prevalence Of Subarachnoid Haemorrhage Among Patients With Cranial Venous Sinus Thrombosis In The Presence And Absence Of Venous Infarcts, Muhammad Azeemuddin, Muhammad Awais, Fatima Mubarak, Noor Ul-Ain Baloch

Department of Radiology

Introduction: In patients with cranial venous sinus thrombosis, the occurrence of subarachnoid haemorrhage in association with haemorrhagic venous infarcts is a well described phenomenon. However, the presence of subarachnoid haemorrhage in patients with cranial venous sinus thrombosis in the absence of a haemorrhagic venous infarct is exceedingly rare.
Methods: We retrospectively reviewed charts and scans of all patients who had cranial venous sinus thrombosis confirmed by magnetic resonance venography at our hospital between September 2004 and May 2015. The presence of subarachnoid haemorrhage was ascertained on fluid-attenuated inversion recovery, susceptibility-weighted imaging and/or unenhanced computed tomography scans by a single experienced …

Nanoparticles As Multimodal Photon Transducers Of Ionizing Radiation, Edwin C. Pratt, Travis M. Shaffer, Qize Zhang, Charles Michael Drain, Jan Grimm

Publications and Research

In biomedical imaging, nanoparticles combined with radionuclides that generate Cerenkov luminescence are used in diagnostic imaging, photon-induced therapies, and as activatable probes. In these applications, the nanoparticle is often viewed as a carrier inert to ionizing radiation from the radionuclide. However, certain phenomena such as enhanced nanoparticle luminescence and generation of reactive oxygen species cannot be explained by only Cerenkov luminescence interactions with nanoparticles. Herein, we report methods to examine the mechanisms of nanoparticle excitation by radionuclides, including interactions with Cerenkov luminescence, β particles, and γ radiation. We demonstrate that β scintillation contributes appreciably to excitation and reactivity in certain …

Comprehensive Evaluation Of Treatment And Outcomes Of Low-Grade Diffuse Gliomas, Catherine R. Garcia, Stacey A. Slone, Thomas A. Pittman, William H. St. Clair, Donita D. Lightner, John L. Villano

Markey Cancer Center Faculty Publications

Background

Low-grade gliomas affect younger adults and carry a favorable prognosis. They include a variety of biological features affecting clinical behavior and treatment. Having no guidelines on treatment established, we aim to describe clinical and treatment patterns of low-grade gliomas across the largest cancer database in the United States.

Methods

We analyzed the National Cancer Database from 2004 to 2015, for adult patients with a diagnosis of World Health Organization grade II diffuse glioma.

Results

We analyzed 13,621 cases with median age of 41 years. Over 56% were male, 88.4% were white, 6.1% were black, and 7.6% Hispanic. The most …

Labrad : Vol 44, Issue 2 - September 2018, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Inappropriate Requesting Of Glycated Haemoglobin (HBA1c) By Clinicians
• Fecal Calprotectin (S100a8/S100a9)
• Fecal Pancreatic Elastase: A Test for Pancreatic Insufficiency
• Radiology Pathology Correlation
• Myelodysplastic Syndromes (MDS)
• WHO Classification of Head and Neck Tumours: An Update
• Plasma Metanephrines in Diagnosis of Pheochromocytoma
• Megaloblastic Anemia
• Aplastic AnemiaTransfusion Associated Circulatory Overload (Taco): A Severe But Preventable Transfusion Reaction

A Narrative Review On Contrast-Enhanced Ultrasound In Aortic Endograft Endoleak Surveillance., Sriharsha Gummadi, John R. Eisenbrey, Andrej Lyshchik

Department of Radiology Faculty Papers

Endovascular repair of abdominal aortic aneurysms have been performed successfully since 1991. However, 20% to 50% of these patients may develop an endoleak or continued aneurysmal sac expansion or perfusion despite stent graft coverage. Current recommendations suggest lifelong surveillance with computed tomographic angiography (CTA) at least 1 month after intervention and yearly after that. In select patients with a stable aneurysm sac on computed tomography performed 1 year after treatment, future screening could be performed with ultrasonography. However, color Doppler ultrasound can fail to detect as many as 31% of endoleaks. Contrast-enhanced ultrasound (CEUS) provides an alternative approach to excluded …

Role Of Adc Values And Ratios Of Mri Scan In Differentiating Typical From Atypical/Anaplastic Meningiomas, Muhammad Azeemuddin, Waseem Mehmood Nizamani, Muhammad Usman Tariq, Mohammad Wasay

Department of Radiology

Atypical/anaplastic meningiomas are prone to aggressive behaviour which affects treatment planning and prognostication. Our aim was to assess the role of Apparent Diffusion Coefficient (ADC) values of MRI brain in differentiating typical from atypical/anaplastic meningioma. We reviewed 84 typical and 37 atypical/anaplastic meningiomas and compared mean ADC values and ADC ratios of their preoperative MRI brain. At 3 Tesla, mean ADC value for typical meningioma was1.03±0.10x10-3 and 0.63±0.05x10-3 for atypical/anaplastic meningioma. At 1.5 Tesla, mean ADC value for typical meningioma was 1.05±0.11x10-3 and atypical/ anaplastic meningioma was 0.70 ± 0.04x10-3. The mean ADC ratios were 1.08 ± 0.17 and 0.85 …

Use Of Ultrasound For Diagnosis Of Pneumonia In Adults, A Review, Dafang Chen, Rodrigo Cavallazzi

The University of Louisville Journal of Respiratory Infections

Pneumonia is a common lung infection with significant morbidity and mortality. Currently, the diagnosis of pneumonia is made by patient history confirmed with chest radiograph or computed tomography. These modalities, however, have limitations including low accuracy, radiation exposure, and high cost. Lung ultrasound has become more prevalent in evaluating pulmonary conditions and has shown to be highly accurate in the diagnosis of pneumonia. The purpose of this review is to discuss sonographic findings associated with pneumonia, techniques used to obtain quality images, and the evidence in literature supporting the use of lung ultrasound in the diagnosis of pneumonia. Numerous studies …

Evaluation Of Hybrid Arc And Volumetric-Modulated Arc Therapy Treatment Plans For Fractionated Stereotactic Intracranial Radiotherapy., Jun Li, David To, Vickie Gunn, Wenyin Shi, Yan Yu, Haisong Lui

Department of Radiation Oncology Faculty Papers

PURPOSE: The study was aimed to compare hybrid arc and volumetric-modulated arc therapy treatment plans for fractionated stereotactic radiotherapy of brain tumors.

METHODS: Treatment plans of 22 patients were studied. Hybrid arc and volumetric-modulated arc therapy plans were generated using Brainlab iPlanDose and Varian Eclipse treatment planning systems, respectively, with 6 MV photon beams on a Varian TrueBeam STx linear accelerator (Palo Alto, CA). Prescription dose was 54 Gy. The fractionation was 1.8 Gy per fraction and 30 fractions in total, or 2 Gy per fraction and 27 fractions in total. Planning target volume ranged from 2.4 to 28.6 cm …

The "Lightning Bolt" Sign On Computed Tomography During Percutaneous Renal Mass Cryoablation, Qian Yu, Driss Raissi

Radiology Faculty Publications

Ice‑ball fracture is a rare and often overlooked entity that may lead to intraprocedural hemorrhage after percutaneous cryoablation of renal masses. There is scant literature on ice‑ball fractures associated with percutaneous renal cryoablation. Immediate recognition of the lightning bolt sign during intraprocedural computed tomography can help identify patients who may have developed this complication.

Clinical Audit To Assess Delays In Chemotherapy Administration At Daycare Oncology Center At A Tertiary Care Hospital In Karachi, Pakistan, Arifa Arifa Aziz, Zarka Samoon, Afsheen Feroz, Nadia Ayoub, Safia Awan, Madhia Beg

Department of Radiation Oncology

Aim: There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays. Materials and Methods: The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the …

Consecutive Case Series Of Melanoma Sentinel Node Biopsy For Lymphoseek Compared To Sulfur Colloids, Caitlin Silvestri, Adrienne Christopher, Md, Charles Intenzo, Md, John C. Kairys, Md, Sung Kim, Md, Alliric Willis, Md, Adam C. Berger, Md

Department of Surgery Faculty Papers

Introduction: Sentinel lymph node biopsy (SLNB) is an important adjunct in the staging of patients with melanoma. Preoperative lymphoscintigraphy (LS) with radiolabeled isotopes is essential to localize sentinel nodes for removal. Our study compared the effectiveness of Lymphoseek to standard sulfur colloids (SC) in patients with melanoma undergoing SLNB.

Methods: We queried our IRB-approved melanoma database to identify 370 consecutive patients who underwent SLNB from 2012-2016 with at least one year of follow up. There were 185 patients in each group. Data points included characteristics of the primary melanoma lymphoscintigraphy, and SLNB. Student’s t-test and Chi-Square were used to analyze …

The Pervasive Crisis Of Diminishing Radiation Therapy Access For Vulnerable Populations In The United States—Part 4: Appalachian Patients, Shearwood Mcclelland Iii, Tasneem Kaleem, Mark E. Bernard, Hiba Z. Ahmed, Terence T. Sio, Robert C. Miller

Radiation Medicine Faculty Publications

Purpose: Compared with the rest of the United States, the population of Appalachia has lower education levels, higher rates of poverty, and limited access to health care. The presence of disparities in radiation therapy (RT) access for Appalachian patients with cancer has rarely been examined.

Methods and materials: The National Cancer Institute initiatives toward addressing disparities in treatment access for rural populations were examined. An extensive literature search was undertaken for studies investigating RT access disparities in Appalachian patients, beginning with the most common cancers in these patients (lung, colorectal, and cervical).

Results: Although the literature investigating RT access disparities …

Role Of Multi-Parametric (Mp) Mri In Prostate Cancer, Syed Muhammad Nazim, Ather Enam, Basit Salam

Section of Urology

Multi-parametric magnetic resonance imaging is increasingly being recommended as standard imaging modality for prostate cancer diagnosis and staging. It comprises structural T2 and T1 sequences supplemented by functional imaging techniques, i.e. diffusion-weighted, dynamic contrast enhanced and spectroscopic imaging. Pre-biopsy multi-parametric magnetic resonance imaging is recommended for both detection and staging as it avoids biopsy artefact, and when normal, has a negative predictive value of 95% for significant cancer. Magnetic resonance imaging-guided prostate biopsy targets only area(s) considered to be suspicious for prostate cancer, hence resulting in improved accuracy. Dynamic contrast enhancing helps in the detection of cancer and for the …

Trans-Lymphatic Contrast-Enhanced Ultrasound In Combination With Blue Dye Injection Is Feasible For Detection And Biopsy Of Sentinel Lymph Nodes In Breast Cancer, Xiangmei Chen, Md, Jieyu Zhong, Md, Zhengming Hu, Md, Wei Wei, Md, Weihua Yin, Md, Ligang Cui, Md, Ji-Bin Liu, Md, Desheng Sun, Md

Department of Radiology Faculty Papers

Objective: The best method for sentinel lymph node biopsy (SLNB) in early-staged breast cancer (EBC) remains controversial. This study aimed to evaluate a novel method by combining trans-lymphatic contrast-enhanced ultrasound (TLCEUS) with blue dye injection as a guidance of SLNB.

Methods: TLCEUS was performed in 88 patients with newly diagnosed EBC. Methylene blue dye was percutaneously injected into enhanced sentinel lymph nodes (SLNs) under ultrasound guidance, followed by standard SLNB and axillary lymph node dissection. Enhancement patterns and the arriving time (AT) of contrast agent within SLNs were evaluated. Histopathological examination of dissected nodes was performed to confirm metastasis.

Results: …

Progress Of In-Stent Restenosis After Vertebral Artery Ostium Stenosis And Imaging Assessments, Jingzhi Li, Md, John R. Eisenbrey, Phd, Yang Hua, Md

Department of Radiology Faculty Papers

Stenting has become one of the primary procedure to treat vertebral artery ostium stenosis patients. Postoperative in­stent restenosis (ISR) of the stenting is still one of the unsolved issues and requires systematic and further investigation. Through imaging assessments, ISR could be identified and evaluated in clinical practice and researches.

A Glance At Imaging Bladder Cancer., Ebru Salmanoglu, Ethan J. Halpern, Edouard J. Trabulsi, Sung Kim, Mathew L. Thakur

Department of Radiology Faculty Papers

Purpose: Early and accurate diagnosis of Bladder cancer (BCa) will contribute extensively to the management of the disease. The purpose of this review was to briefly describe the conventional imaging methods and other novel imaging modalities used for early detection of BCa and outline their pros and cons.

Methods: Literature search was performed on Pubmed, PMC, and Google scholar for the period of January 2014 to February 2018 and using such words as "bladder cancer, bladder tumor, bladder cancer detection, diagnosis and imaging".

Results: A total of 81 published papers were retrieved and are included in the review. For patients …

Advances In Modern Clinical Ultrasound, Sriharsha Gummadi, Md, John R. Eisenbrey, Phd, Jingzhi Li, Md, Zhaojun Li, Md, Flemming Forsberg, Phd, Andrej Lyshchik, Md, Ji-Bin Liu, Md

Department of Radiology Faculty Papers

Advances in modern clinical ultrasound include developments in ultrasound signal processing, imaging techniques and clinical applications. Improvements in ultrasound processing include contrast and high-fidelity ultrasound imaging to expand B-mode imaging and microvascular (or microluminal) discrimination. Similarly, volumetric sonography, automated or intelligent ultrasound, and fusion imaging developed from the innate limitations of planar ultrasound, including user-operator technical dependencies and complex anatomic spatial prerequisites. Additionally, ultrasound techniques and instrumentation have evolved towards expanding access amongst clinicians and patients. To that end, portability of ultrasound systems has become paramount. This has afforded growth into the point-of-care ultrasound and remote or tele-ultrasound arenas. In …

Prognostic Factors For Elderly Patients Treated With Stereotactic Body Radiation Therapy For Pancreatic Adenocarcinoma, Philip A. Sutera, Mark E. Bernard, Hong Wang, Dwight E. Heron

Radiation Medicine Faculty Publications

Introduction: Pancreatic ductal adenocarcinoma (PDAC) commonly presents later in life with a median age at diagnosis of 70 years. Unfortunately, elderly patients are significantly underrepresented in clinical trials. Stereotactic body radiation therapy (SBRT) is a promising treatment modality in this population as it has demonstrated excellent local control with minimal toxicity. We aimed to determine prognostic factors associated with outcomes in elderly patients treated with SBRT.

Materials and Methods: Elderly patients older than 70 treated with SBRT for PDAC at our institution, from 2004 to 2014 were included. Our primary endpoints included overall survival (OS) and local-progression-free survival (LPFS). Secondary …

The Impact Of Serum Glucose, Anti-Diabetic Agents, And Statin Usage In Non-Small Cell Lung Cancer Patients Treated With Definitive Chemoradiation, Nick A. Iarrobino, Beant S. Gill, Mark E. Bernard, Rainer J. Klement, Maria Werner-Wasik, Colin E. Champ

Radiation Medicine Faculty Publications

Introduction: Epidemiologic data indicate diabetes confers an augmented risk of lung cancer development, yet the relationship between hyperglycemia, metabolic agents, and prognosis is unclear. We analyzed the impact of hyperglycemia, anti-diabetic agents, and statins on outcomes in non-small cell lung cancer (NSCLC) patients undergoing chemoradiation.

Method and Materials: In total, data from 170 patients with stage III NSCLC treated at the University of Pittsburgh Medical Center between 2001 and 2014 were obtained for analysis. Kaplan-Meier survival analysis was used to estimate time-to-event for overall survival (OS), disease-free survival, distant metastasis (DM), and loco-regional control (LRC). Blood glucose values (n …