The Division of Diagnostic and Interventional Neuroradiology celebrated its traditional holiday party at the home of Dr. and Mrs. Westesson. Good food, good drinks and good company made for an enjoyable evening in front of the fire while the first Rochester snow fell outside.
At the 2004 Radiologic Society of North American meeting, new MR imaging was released that allows for whole body MR imaging. This image was created in multiple sequences but merged together with computer technique in order to create one unified image of the entire human body. The anatomic details of the cell body images are not as discrete as detailed images but they provide an overview of remarkable quality.
Neuroradiology Division Releases New Book at 2004 RSNA
At the Radiologic Society of North America meeting in Chicago, Illinois in November, 2004, the Division of Neuroradiology released its’ 2nd book by the Springer Publisher. Dr. Leena Ketonen is the lead author on this book entitled Pediatric Brain and Spine Imaging and the picture below shows the Springer Editor Ute Heilmann and Dr. P-L Westesson who is a co-author on this work.
This is the 2nd book in a series that started last year with Drs. Moritani, Westesson, and Ekholm’s book on Diffusion Weighted MR Imaging of the Brain. We have plans to continue with a 3rd book on Maxillofacial Imaging to be released at the 2005 RSNA and a 4th book at the 2006 RSNA on Brain Tumor Imaging.
CTAAB has approved a 3T MR scanner for the University of Rochester. This new exciting powerful MR scanner will be installed within 12 months and will be available to all Rochester patients. It has specific advantages over a regular 1.5T scanner with respect to MR angiography, heart imaging, MR spectroscopy, brain tumor imaging and for functional imaging.
We are moving towards stronger and stronger magnets. The current industry standard for MRI systems is 1.5 tesla, which limits researchers to imaging water molecules. As a result, only anatomical changes can be detected and monitored. In September of 2004 the University of Chicago installed a 9.4 Tesla human MR scanner in its new Center for Magnetic Resonance for brain research.
Former fellow, Dr. Larry Buadu, passes CAQ in Neuroradiology
CAQ (Certificate of Added Qualification) is a recognized American Board of Radiology subspecialty certification in Neuroradiology. This examination can be taken after two years of neuroradiology training and this November (2004) our former fellow, Larry Buadu, M.D., Ph.D., achieved this competency.
The successful candidate receives a ten-year, time-limited Certificate of Added Qualifications (CAQ) in neuroradiology.
The oral examination is conducted by three different examiners. The primary test material is shown in computerized format. In order to successfully pass the examination, the candidate is required to obtain passing scores in all three sections. The three sections are:
After requests from multiple clinicians Neuroradiology now offers CT-guided diagnostic and therapeutic blocks of the celiac ganglion for patients with intractable abdominal pain.
The University of Rochester has begun construction of a state-of-the-art PET CT Center with a cyclotron in Rochester's Science Park, close to the Medical Center. The vault for the cyclotron is being built with almost 3 feet thick, solid concrete walls.
Evolution of Neonatal Brain Injury as Seen with MRI
Recognition of at-risk newborns by means of advanced methods of neuroimaging, combined with rational intervention, may prevent
disabilities such as cerebral palsy and epilepsy. The New England Journal of Medicine published an important "Medical Progress" article (N Engl J Med. 2004 Nov 4;351(19):1985-95) on the value of advanced neuroimaging for detection of neonatal brain injury.
Figure 3. Evolution of Brain Injury as Seen with MRI. A normal structural image (Panel A), a diffusion-weighted MRI (Panel B), and lactate accumulation in the basal ganglia on magnetic resonance spectroscopy (Panel C, arrow) are shown in the same newborn at 1 day of life. At day 8, T1-weighted MRI (Panel D) and T2-weighted MRI (Panel E) reveal extensive damage to the deep gray nuclei, and magnetic resonance spectroscopy shows diminution of the lactate peak (Panel F, arrow).
Neuroradiologists Receive Training in Mechanical Treatment of Acute Stroke
A stroke occurs when a blood vessel in or around the brain becomes plugged or ruptures. When a stroke occurs, the area of the brain supplied by the affected blood vessel fails to work properly, and in some cases that part of the brain dies. Depending on the severity of the stroke and the part of the brain affected, severe disability or death can occur. Therefore, rapid medical intervention to remove the clot and restore blood flow is critical.
The Merci Retriever from Concentric Medical, Inc., was recently cleared
by the United States Food and Drug Administration (FDA) for the removal
of blood clots from patients experiencing an ischemic stroke. The Merci
Retriever is a novel therapy that removes the clot, restores blood flow
and offers hope for ischemic stroke patients with no other options. The
FDA granted clearance after a thorough review of patient data obtained
in a clinical study at 25 medical centers in the United States. The
MERCI (Mechanical Embolus Removal in Cerebral Ischemia) Trial evaluated
the device in 141 patients who were ineligible for "clot-busting" drugs
which can only be used within three hours of stroke onset.
After 16 years in the US and at the University of Rochester, Dr. Westesson and his family were sworn in as US citizens this October 2004. Dr. Westesson came to the University of Rochester as associate professor of radiology in 1989. He initiated extensive TMJ research and developed a clinical section for maxillofacial imaging.
Dr. P-L Westesson visited Guy's Hospital in London to learn new non-invasive methods of treating salivary gland calculus. Radiographically-guided stone removal, lithotripsy and endoscopy of the ducts of the salivary glands were the main themes of this excellent course at Guy's Hospital. Stones can be removed with image-guided minimally invasive techniques, with ultrasound shock waves or with intra-oral minimal surgery. These image-guided techniques are already being used at the University of Rochester, but will be refined according to knowledge gained in London during the October 2004 course.
Course directors were Dr. Jackie Brown and Professor Mark McGurk. Dr. Brown demonstrated minimally invasive ways to remove stones from the salivary glands and Professor McGurk showed live surgery removing salivary stones with sparing of the gland.
Visiting Researcher from Osaka Dental School Arrives
Dr. Naoya Kakimoto arrived on October 6, 2004 to be a visiting researcher in the Division of Diagnostic and Interventional
Neuroradiology. Dr. Kakimoto will stay for 2 ½ months and will be
participating in the Maxillofacial book writing. Dr. Kakimoto will come
back in April of 2005 and stay for another 10 months as a visiting
researcher. At that time he would be involved in more substantial
maxillofacial radiology imaging research.
"Diffusion-weighted MR Imaging of the Brain" has been a great success and the publisher has decided to translate the book for the Japanese market. There is a large demand for this type of information in radiology, neurosurgery, and neurology groups in Japan. Dr. Moritani and his wife will be responsible for the translation.
Dr. Matt Cham, a fourth year Diagnostic Radiology resident at the University of Rochester, was awarded a Bracco Prize for the best resident paper. The title of Dr. Cham's article was "State of the Art in CT Technology and Contrast Media in CT Pulmonary Angiography." Dr. Cham presented his award winning paper in a special lecture on September 15, 2004. We all congratulate Matt for this achievement.
Dr. Yoshimitsu Ohgiya, from Showa University in Tokyo, Japan arrives to become a visiting researcher. Dr Ohgiya has extensive MR experience with perfusion and diffusion and will do research in these areas with the neuroradiology faculty and fellows.
The Neuroradiology Division had a farewell dinner at Richardson's Canal House for Dr. Leena Ketonen who is leaving the end of August for MD Anderson Hospital in Houston, Texas.
Regina Cullen recently joined the Neuroradiology Division as secretary. Regina joins Belinda Delibero (pictured above) in the busy Neuroradiology central office.
The neuroradiology section was recently equipped with text pagers and our web page was set up with a paging section. Anyone can now send a text message directly to an individual neuroradiologist and it will be
displayed on their pager within seconds. Messages can be sent from anywhere in the world directly to the neuroradiologist's pager. Visit http://www.urmc.rochester.edu/smd/Rad/neuroradpage.htm to send a page.
Ruusu
Ketonen finished her summer research project on MR spectroscopy
by creating a MR
Spectroscopy Manual.
Ruusu (pictured above in front of the MR spectroscopy
workstation) is a medical student
at Uppsala University in Uppsala, Sweden and has spent
the summer doing MR spectroscopy research at the University
of Rochester.
Dr.
Leena Ketonen has donated her teaching file to the University
of Rochester. When leaving for MD Anderson Hospital in Houston,
Texas, Dr.
Ketonen has decided to donate her very large teaching file
to the neuroradiology division at the University
of Rochester. This material, that has been collected over a twenty year period,
will now be categorized and incorporated into the Neuroradiology Teaching File.
It includes many unique cases with special emphasis on pediatric neuroimaging.
We are grateful for this donation that will be a resource for future teaching
and research.
Dr.
Masaki Oka arrived in Rochester earlier this month. Dr.
Oka is a neuroradiologist from St. Luke's International Hospital
in Tokyo, Japan. He will stay in Rochester for two years
and will be
active in neuroradiology research. Dr. Oka has published
several articles specifically related to the use of MR imaging
in neuroradiology.
At
the Neuroradiology summer party, Dr.
Lawrence Buadu received his certificate
from
Dr. P-L Westesson for completing his two-year neuroradiology
fellowship.
Dr.
Ravinder Sidhu received her certificate for completing her
year of neuroradiology research.
At
the Radiology Annual Dinner held at the Irondequoit Country
Club, Dr.
Sven Ekholm presented Dr. Ramon DeGuzman with his certificate
for completing a two-year neuroradiology
fellowship.
Both Drs.
Lawrence Buadu and Ramon DeGuzman received The Division
of Diagnostic and Interventional Neuroradiology Teaching Award for excellence in neuroradiology teaching.
The
Neuroradiology Division celebrated its 2004 summer party at
the Rochester Canoe Club. New fellows were welcomed
and those leaving were wished good
luck. Guests enjoyed sailing, swimming, and a beautiful day at
the waterfront on Irondequoit Bay.
New
MR images showing the cortical spinal tracts were created by
the MR Research Group at the University of Rochester. This
case shows a parietal occipital tumor displacing the the corticospinal
tracts (red). The images are still at an investigation stage
but have great promise for the future.
Evidence Grows for Cardiac Pacemaker Safety at 1.5 T
Cardiac pacemakers, once a strict contraindication to MR imaging,
may be safe – with caveats – for patients undergoing
MR procedures at 1.5T. Approximately 13 patients have died
secondary to pacemakers in association with MR imaging. In
virtually each of these 13 cases the patient apparently entered
the MR environment without staff knowing that a pacemaker
was present. In contrast to this, there have been more than
200
pacemaker patients who have successfully underwent MR imaging
in a monitored, supervised environment. Roguin et al. (1)
evaluated MR-related heating, magnetic field interactions,
image artifacts
and the MR effects on the functionality of pacemakers and
concluded that modern cardiac pacemakers may be MR-safe.
Martin et al (2) studied a non-pacemaker-dependent
patient population with permanent cardiac pacemakers undergoing MR imaging. Cardiologists
monitored the patients during this study and ACLS-trained personnel
were present during the examination. Significant alteration
of
the pacing threshold was found in a small number of leads tested.
These changes required a programmed output change in only two
leads and were of no clinical significance. All patients could
complete the MR procedure and there were no instances where
it had to be interrupted. Martin et al concluded that because of
the infinite possibilities of pacing system, cardiac and lead
geometry, and variable static, gradient and radiofrequency
electromagnetic fields and conditions used for MR procedures the absolute safety
of pacemaker and MR interaction presently cannot be assured.
However, with the appropriate patient condition and continuous
monitoring and preparedness for resuscitation, performance
of
MR imaging in non-pacemaker dependent patients may be achieved
with reasonable safety.
Roguin
A, Zviman M, Meininger GR et al. Modern pacemaker and
implantable cardioverter-defibrillator systems
can be MRI-safe.
American Heart Association (abstract) 2003.
Martin
TE, Conan JA, Shellock FG et al. Magnetic resonance imaging
and cardiac pacemaker safety at 1.5 Tesla. J
Am Coll Cardiol (in press).
Shellock
FG. Evidence grows for cardiac pacemaker safety at 1.5T.
Variables among pacing
systems mandate MR
exclusion of
pacemaker-dependent patients. Diagnostic Imaging May 2004;
14-15.
Dr.
Yuji Numaguchi, our part-time faculty member now in Japan,
sends best regards with cherry blossom images from
Japan. A few days of very intense but short lived beauty.
Babies sleeping
on their back develop a flattened head
A
recent University of Rochester Study* suggests that babies
sleeping on their back might develop a flattened skull. Dr.
Manoj Ketkar, a former Neuroradiology fellow, published a
study together with co-workers in Plastic Surgery
that suggests that since 1992 when the AAP recommended
a supine sleep position for infants, the incidence of occipital
plagiocephaly has dramatically risen.
*Non-Synostotic
Occipital Plagiocephaly: Radiographic Changes of the "Sticky-Suture" By
Manoj Ketkar, MD1, Joseph E. Losee, MD1,
Scott P. Bartlett, MD2, Evan Feldman, BS1,
Richard E. Kirschner, MD2, Davinder Singh, MD2,
and Per-Lennart Westesson, MD, PhD, DDS1 1University
of Rochester, Children's Hospital at Strong, Rochester, NY
and 2University of Pennsylvania,
Children's Hospital of Philadelphia, Philadelphis, PA
Dr. Manoj Ketkar
Baby sleeping
on its back may develop a flat skull.
CT can confirm
the deformity of the skull.
Detailed
analysis of the CT will tell if it is due to position or to premature
closure of the sutures.
Precise analysis
of the shape of the skull helps the plastic surgeon determine
the best treatment.
Dr. Ketonen speaks at Rochester Regional PA Conference
Dr.
Leena Ketonen gave a lecture at the Rochester Regional PA
conference.
Dr.
Ketonen with one of the organizer, Cindy Zink.
Leena
Ketonen, MD, PhD gave a lecture on brain imaging at the Rochester
Regional Physician Assistant Association Conference in
Rochester, March 19, 2004. The PA conference, which was led
by University of Rochester PA Cindy Zink, was dedicated to Health
and Healing - Yesterday Today and Tomorrow. This one day
conference was a great success attracting the majority of PAs
from the region.
Rebuilding
for the addition of our third MR scanner takes us down into
the sub floor and the dirt under the existing building. The
renovation is now complete!
Dr.
Henry Wang presented a unique case of intracranial dissection
at the Rochester Angio Club meeting on February 26, 2004. The
dissection is seen as a double lumen on the angiographic image.
AJNR publishes Division's
paper as lead article with editorial comments
New
scientific article, "Axial Loading during MR Imaging
Can Influence Treatment Decision for Symptomatic Spinal Stenosis" by Akio Hiwatashi*, Barbro Danielson*,
Toshio Moritani*, Robert S. Bakos*, Thomas G. Rodenhause*,
Webster H. Pilcher* and Per-Lennart Westesson* in AJNR
AmericanJournal
of Neuroradiology 25:170-174, February 2004 has received
a lot of attention.
* From the Department of Diagnostic Radiology
(A.H., T.M., P.-L.W.), Division of Diagnostic and Interventional
Neuroradiology, and the Department of Neurological Surgery (R.S.B.,
T.G.R., W.H.P.), University of Rochester Medical Center, Rochester,
NY, and the Department of Radiology (B.D.), Section of Musculoskeletal
Radiology, Sahlgrenska University Hospital, Göteborg, Sweden.
Hiwatashi
et al's article received quite a lot of attention
in the February issue of AJNR. Firstly, because the article
was discussed in one of the journal's editorials, and secondly
because some of the MR images from the article were published
on the front cover of the journal.
Editorial
summary: Christopher G. Ullricha, in his editorial "My
Legs Only Hurt When I
Stand Up!", began by stating that "In this issue
of the AJNR, Hiwatashi et al. provide an important
reminder of several fundamental medical concepts that have
sometimes been forgotten by many radiologists." Ullricha
described the study and further on he mentioned that "As
spinal integrity deteriorates, abnormal motion or structural
shifting occurs, which may only be evident in a certain
position or mechanical loading situation. These more subtle
abnormalities can cause patient symptoms. Failure to recognize
these more dynamic structural abnormalities can lead to
suboptimal surgical therapy in some patients." He
then described the problems that routine MR diagnoses can
cause for spine surgeons in some patient cases, and the
help CT myelography can offer. Finally, he concluded that "With
further refinements and validation of MR axial loaded and
dynamic lumbar studies, the need for lumbar myelography
will be further diminished."
The Neuroradiology Division said farewell to Dr. Toshio Moritani
with a luncheon on Friday, February 20th. Dr. Moritani is leaving
Rochester after five years here as a visiting researcher to become
clinical faculty at the University of Iowa.
Dr.
Westesson presented Dr. Moritani with his certificate.
The
Division
of Diagnostic and Interventional Neuroradiology has hired a
new MR researcher, Dr. Xiang Liu. Dr. Liu is from Beijing,
China and
has performed advanced MR research at the Beijing Neurosurgical
Institute. He has expertise in perfusion imaging, spectroscopy,
diffusion tensor imaging and functional imaging. We well come
Dr Liu to our group.
Stone approached with a wire basket.
Dr. and Mrs. Toshio Moritani
Subdural
Hematoma
