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Lewis DV, Voyvodic J, Shinnar S, Chan S, Bello JA, Moshé SL, Nordli DR, Frank LM, Pellock JM, Hesdorffer DC, Xu Y, Shinnar RC, Seinfeld S, Epstein LG, Masur D, Gallentine W, Weiss E, Deng X, Sun S. Hippocampal sclerosis and temporal lobe epilepsy following febrile status epilepticus: The FEBSTAT study. Epilepsia 2024. [PMID: 38606600 DOI: 10.1111/epi.17979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/28/2024] [Accepted: 03/28/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE This study was undertaken to determine whether hippocampal T2 hyperintensity predicts sequelae of febrile status epilepticus, including hippocampal atrophy, sclerosis, and mesial temporal lobe epilepsy. METHODS Acute magnetic resonance imaging (MRI) was obtained within a mean of 4.4 (SD = 5.5, median = 2.0) days after febrile status on >200 infants with follow-up MRI at approximately 1, 5, and 10 years. Hippocampal size, morphology, and T2 signal intensity were scored visually by neuroradiologists blinded to clinical details. Hippocampal volumetry provided quantitative measurement. Upon the occurrence of two or more unprovoked seizures, subjects were reassessed for epilepsy. Hippocampal volumes were normalized using total brain volumes. RESULTS Fourteen of 22 subjects with acute hippocampal T2 hyperintensity returned for follow-up MRI, and 10 developed definite hippocampal sclerosis, which persisted through the 10-year follow-up. Hippocampi appearing normal initially remained normal on visual inspection. However, in subjects with normal-appearing hippocampi, volumetrics indicated that male, but not female, hippocampi were smaller than controls, but increasing hippocampal asymmetry was not seen following febrile status. Forty-four subjects developed epilepsy; six developed mesial temporal lobe epilepsy and, of the six, two had definite, two had equivocal, and two had no hippocampal sclerosis. Only one subject developed mesial temporal epilepsy without initial hyperintensity, and that subject had hippocampal malrotation. Ten-year cumulative incidence of all types of epilepsy, including mesial temporal epilepsy, was highest in subjects with initial T2 hyperintensity and lowest in those with normal signal and no other brain abnormalities. SIGNIFICANCE Hippocampal T2 hyperintensity following febrile status epilepticus predicted hippocampal sclerosis and significant likelihood of mesial temporal lobe epilepsy. Normal hippocampal appearance in the acute postictal MRI was followed by maintained normal appearance, symmetric growth, and lower risk of epilepsy. Volumetric measurement detected mildly decreased hippocampal volume in males with febrile status.
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Affiliation(s)
- Darrell V Lewis
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, North Carolina, USA
| | - James Voyvodic
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shlomo Shinnar
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Stephen Chan
- Department of Radiology, Harlem Hospital Center, Columbia University, New York, New York, USA
| | - Jacqueline A Bello
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Solomon L Moshé
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Departments of Neuroscience and Pediatrics, Albert Einstein College of Medicine, and Montefiore Medical Center, Bronx, New York, USA
| | - Douglas R Nordli
- Department of Pediatrics, Section of Child Neurology, University of Chicago, Chicago, Illinois, USA
| | - L Matthew Frank
- Department of Neurology, Children's Hospital of the King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - John M Pellock
- Department of Neurology, Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dale C Hesdorffer
- Department of Epidemiology, G. H. Sergievsky Center, Columbia University, New York, New York, USA
| | - Yuan Xu
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, North Carolina, USA
| | - Ruth C Shinnar
- Isabelle Rapin Division of Child Neurology, Saul R. Korey Department of Neurology and Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Syndi Seinfeld
- Pediatric Epilepsy Program, Joe DiMaggio Children's Hospital, Hollywood, Florida, USA
| | - Leon G Epstein
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - David Masur
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - William Gallentine
- Stanford University Lucile Packard Children's Hospital, Palo Alto, California, USA
| | - Erica Weiss
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Xiaoyan Deng
- Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Shumei Sun
- Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, Virginia, USA
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Slanetz PJ, Almeky S, Narayan AK, Bello JA. Pursuing Imaging Equity-Overcoming Barriers, Finding Opportunities. J Am Coll Radiol 2023; 20:1075-1077. [PMID: 37619799 DOI: 10.1016/j.jacr.2023.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/06/2023] [Accepted: 06/14/2023] [Indexed: 08/26/2023]
Affiliation(s)
- Priscilla J Slanetz
- Vice Chair of Academic Affairs, Department of Radiology, and Associate Program Director of the Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center, Boston, Massachusetts, and is also from the Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Director of Early Career Faculty Development and Academic Writing Programs for Boston University Medical Group; Past President of Massachusetts Radiological Society; President of the Association of University Radiologists; and Subspecialty Chair of the ACR Appropriateness Criteria Breast Imaging Panels.
| | - Somiah Almeky
- Department of Radiology, Boston University Medical Center, Boston, Massachusetts, and Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts; Vice President of the Massachusetts Radiological Society; Resident, Fellow Section; President-Elect for the next academic year; Radiology Advocacy Network Leader; member Medical Student and Resident teaching committee; and Diversity Equity and Inclusion Council Fellow at Boston Medical Center
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin; Associate Director of the University of Wisconsin Carbone Cancer Center for Diversity, Equity, and Inclusion; Vice Chair of the ACR's Patient- and Family-Centered Care Outreach Committee; and Director at Large of the Wisconsin Radiological Society
| | - Jacqueline A Bello
- Director of Neuroradiology, Department of Radiology, Montefiore Medical Center, Bronx, New York; Zimmer-Hardy Professor of Neuroradiology, Department of Radiology, Albert Einstein College of Medicine; Chair, ACR Board of Chancellors; and a Past President of the New York Radiological Society, the New York Roentgen Society, and the American Society of Neuroradiology
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Felsen A, McClelland A, Kobi M, Bello JA, Burns J. Health Systems Science - A Primer for Radiologists. Acad Radiol 2023; 30:2079-2088. [PMID: 36966069 DOI: 10.1016/j.acra.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/27/2023]
Abstract
Health systems science (HSS) is an educational framework designed to promote improved care through enhanced citizenship and the training of systems-fluent individuals trained in the science of health care delivery. HSS education in residency builds upon foundations established during medical school, emphasizing practical skills development, and fostering a growth mindset among trainees. The HSS framework organizes elements of system-based practice for radiology trainees, promoting practice-readiness for providing safe, timely, effective, efficient, equitable and patient centered radiological care. This paper serves as a primer for radiologists to understand and apply the HSS framework. Additionally, we highlight radiology-specific curricular elements aligned with the HSS framework, and provide teaching resources both for classroom education and for resident self-study.
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Affiliation(s)
- Amanda Felsen
- Albert Einstein College of Medicine, Montefiore New Rochelle Hospital; Bronx, NY
| | - Andrew McClelland
- Department of Radiology, NYU Grossman School of Medicine; New York, NY
| | - Mariya Kobi
- Department of Radiology, Columbia University Medical Center; New York, NY
| | | | - Judah Burns
- Department of Radiology, Montefiore Medical Center; Bronx, NY; Albert Einstein College of Medicine; Bronx, NY.
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Christensen EW, Waid M, Scott J, Patel BK, Bello JA, Rula EY. Relationship between Race and Access to Newer Mammographic Technology in Women with Medicare Insurance. Radiology 2023; 306:e221153. [PMID: 36219114 DOI: 10.1148/radiol.221153] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Racial disparities in breast cancer mortality have been reported. Mammographic technology has undergone two major technology transitions since 2000: first, the transition from screen-film mammography (SFM) to full-field digital mammography (FFDM) and second, the transition to digital breast tomosynthesis (DBT). Purpose To examine the relationship between use of newer mammographic technology and race in women receiving mammography services. Materials and Methods This was a multiyear (January 2005 to December 2020) retrospective study of women aged 40-89 years with Medicare fee-for-service insurance who underwent mammography. Data were obtained using a 5% research identifiable sample of all Medicare fee-for-service beneficiaries. Within-institution and comparable-institution use of mammographic technology between Black women or women of other races and White women were assessed with multivariable logistic and linear regression, respectively, adjusted for age, race, Charlson comorbidity index, per capita income, urbanicity, and institutional capability. Results Between 2005 and 2020, there were 4 028 696 institutional mammography claims for women (mean age, 72 years ± 8 [SD]). Within an institution, the odds ratio (OR) of Black women receiving digital mammography rather than SFM in 2005 was 0.80 (95% CI: 0.70, 0.91; P < .001) when compared with White women; these differences remained until 2009. Compared with White women, the use of DBT within an institution was less likely for Black women from 2015 to 2020 (OR, 0.84; 95% CI: 0.81, 0.87; P < .001). Across institutions, there were racial differences in digital mammography use, which followed a U-shaped pattern, and the differences peaked at 3.8 percentage points less for Black compared with White women (95% CI: -6.1, -1.6; P = .001) in 2011 and then decreased to 1.2 percentage points less (95% CI: -2.2, -0.2; P = .02) in 2016. Conclusion In the Medicare population, Black women had less access to new mammographic imaging technology compared with White women for both the transition from screen-film mammography to digital mammography and then for the transition to digital breast tomosynthesis. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Lee and Lawson in this issue.
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Affiliation(s)
- Eric W Christensen
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Mikki Waid
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Jinel Scott
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Bhavika K Patel
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Jacqueline A Bello
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
| | - Elizabeth Y Rula
- From the Neiman Health Policy Institute, 1891 Preston White Dr, Reston, VA 20191 (E.W.C., M.W., E.Y.R.); Health Services Management, University of Minnesota, St Paul, Minn (E.W.C.); Department of Radiology, SUNY Downstate Health Sciences University, Brooklyn, NY (J.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (B.K.P.); and Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY (J.A.B.)
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Tomei KL, Selby LV, Kirk LM, Bello JA, Nolan NS, Varma SK, Turner PL, Elliott VS, Brotherton SE. Beyond Training the Next Generation of Physicians: The Unmeasured Value Added by Residents to Teaching Hospitals and Communities. Acad Med 2022; 97:1592-1596. [PMID: 35731593 PMCID: PMC9592142 DOI: 10.1097/acm.0000000000004792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Following medical school, most newly graduated physicians enter residency training. This period of graduate medical education (GME) is critical to creating a physician workforce with the specialized skills needed to care for the population. Completing GME training is also a requirement for obtaining medical licensure in all 50 states. Yet, crucial federal and state funding for GME is capped, creating a bottleneck in training an adequate physician workforce to meet future patient care needs. Thus, additional GME funding is needed to train more physicians. When considering this additional GME funding, it is imperative to take into account not only the future physician workforce but also the value added by residents to teaching hospitals and communities during their training. Residents positively affect patient care and health care delivery, providing intrinsic and often unmeasured value to patients, the hospital, the local community, the research enterprise, and undergraduate medical education. This added value is often overlooked in decisions regarding GME funding allocation. In this article, the authors underscore the value provided by residents to their training institutions and communities, with a focus on current and recent events, including the global COVID-19 pandemic and teaching hospital closures.
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Affiliation(s)
- Krystal L. Tomei
- K.L. Tomei is associate professor of pediatric neurosurgery, Rainbow Babies & Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Luke V. Selby
- L.V. Selby is assistant professor of surgery, Department of Surgery, Division of Colorectal and Oncologic Surgery, University of Kansas Medical Center, Kansas City, Kansas; ORCID: https://orcid.org/0000-0002-0202-9646
| | - Lynne M. Kirk
- L.M. Kirk is chief of accreditation and recognition, Accreditation Council for Graduate Medical Education, Chicago, Illinois
| | - Jacqueline A. Bello
- J.A. Bello is director of neuroradiology and professor of radiology and neurosurgery, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, New York
| | - Nathan S. Nolan
- N.S. Nolan is medical education fellow and infectious disease physician, Washington University Hospital, St. Louis, Missouri
| | - Surendra K. Varma
- S.K. Varma is executive associate dean for graduate medical education and resident affairs, university distinguished professor, and vice chair, Department of Pediatrics, Texas Tech University Health Sciences Center School of Medicine, Lubbock, Texas
| | - Patricia L. Turner
- P.L. Turner is executive director, American College of Surgeons, and clinical associate professor of surgery, University of Chicago Medicine, Chicago, Illinois
| | - Victoria Stagg Elliott
- V.S. Elliott is a technical writer, Medical Education Outcomes, American Medical Association, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1223-0084
| | - Sarah E. Brotherton
- S.E. Brotherton is director, Data Acquisition Services, American Medical Association, Chicago, Illinois
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Goldman-Yassen AE, Strauss SB, Vlismas PP, Jagannath AD, Yuan M, Farinhas JM, Burns J, Bello JA. Face-to-Face: Resident-led Radiology Medicine Rounds Facilitate Evidence-based Processes for Clinical Decision Support. Curr Probl Diagn Radiol 2021; 50:580-584. [DOI: 10.1067/j.cpradiol.2020.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/09/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
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Burns J, Ciccarelli S, Mardakhaev E, Erdfarb A, Goldberg-Stein S, Bello JA. Handoffs in Radiology: Minimizing Communication Errors and Improving Care Transitions. J Am Coll Radiol 2021; 18:1297-1309. [PMID: 33989534 DOI: 10.1016/j.jacr.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/13/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022]
Abstract
Handoffs are essential to achieving safe care transitions. In radiology practice, frequent transitions of care responsibility among clinicians, radiologists, and patients occur between moments of care such as determining protocol, imaging, interpreting, and consulting. Continuity of care is maintained across these transitions with handoffs, which are the process of communicating patient information and transferring decision-making responsibility. As a leading cause of medical error, handoffs are a major communication challenge that is exceedingly common in both diagnostic and interventional radiology practice. The frequency of handoffs in radiology underscores the importance of using evidence-based strategies to improve patient safety in the radiology department. In this article, reliability science principles and handoff improvement tools are adapted to provide radiology-focused strategies at individual, team, and organizational levels with the goal of minimizing handoff errors and improving care transitions.
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Affiliation(s)
- Judah Burns
- Chair, Montefiore Medical Center Peer Review Board; Program Director, Montefiore Medical Center Diagnostic Radiology Residency Program; Department of Radiology, Montefiore Medical Center, Bronx, New York.
| | | | | | - Amichai Erdfarb
- Director of Quality and Safety, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Shlomit Goldberg-Stein
- Director of Operational Improvement, Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Jacqueline A Bello
- Vice Chair, Board of Chancellors, American College of Radiology; Section Chief of Neuroradiology, Montefiore Medical Center; Department of Radiology, Montefiore Medical Center, Bronx, New York
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Shifteh K, Mei J, Bello JA. A Young Patient With Painless Neck Swelling. JAMA Otolaryngol Head Neck Surg 2020; 147:2771358. [PMID: 33001160 DOI: 10.1001/jamaoto.2020.1595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Affiliation(s)
- Keivan Shifteh
- Department of Radiology, Montefiore Medical Center, Bronx, New York
| | - Janet Mei
- Department of Radiology, Montefiore Medical Center, Bronx, New York
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Bello JA, Goldman-Yassen AE. James T. Goodrich, MD, PhD. AJNR Am J Neuroradiol 2020; 41:1325. [PMID: 32661054 DOI: 10.3174/ajnr.a6628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Rezaii PG, Fredericks N, Lincoln CM, Hom J, Willis M, Burleson J, Haines GR, Chatfield M, Boothroyd D, Ding VY, Bello JA, McGinty GB, Smith CD, Yucel EK, Hillman B, Thorwarth WT, Wintermark M. Assessment of the Radiology Support, Communication and Alignment Network to Reduce Medical Imaging Overutilization: A Multipractice Cohort Study. J Am Coll Radiol 2020; 17:597-605. [PMID: 32371000 DOI: 10.1016/j.jacr.2020.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/31/2020] [Accepted: 02/18/2020] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to determine whether participation in Radiology Support, Communication and Alignment Network (R-SCAN) results in a reduction of inappropriate imaging in a wide range of real-world clinical environments. METHODS This quality improvement study used imaging data from 27 US academic and private practices that completed R-SCAN projects between January 25, 2015, and August 8, 2018. Each project consisted of baseline, educational (intervention), and posteducational phases. Baseline and posteducational imaging cases were rated as high, medium, or low value on the basis of validated ACR Appropriateness Criteria®. Four cohorts were generated: a comprehensive cohort that included all eligible practices and three topic-specific cohorts that included practices that completed projects of specific Choosing Wisely topics (pulmonary embolism, adnexal cyst, and low back pain). Changes in the proportion of high-value cases after R-SCAN intervention were assessed for each cohort using generalized estimating equation logistic regression, and changes in the number of low-value cases were analyzed using Poisson regression. RESULTS Use of R-SCAN in the comprehensive cohort resulted in a greater proportion of high-value imaging cases (from 57% to 79%; odds ratio, 2.69; 95% confidence interval, 1.50-4.86; P = .001) and 345 fewer low-value cases after intervention (incidence rate ratio, 0.45; 95% confidence interval, 0.29-0.70; P < .001). Similar changes in proportion of high-value cases and number of low-value cases were found for the pulmonary embolism, adnexal cyst, and low back pain cohorts. CONCLUSIONS R-SCAN participation was associated with a reduced likelihood of inappropriate imaging and is thus a promising tool to enhance the quality of patient care and promote wise use of health care resources.
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Affiliation(s)
- Paymon G Rezaii
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California
| | | | | | - Jason Hom
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Marc Willis
- Department of Radiology and Orthopedics, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Derek Boothroyd
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, California
| | - Victoria Y Ding
- Department of Medicine, Quantitative Sciences Unit, Stanford University, Stanford, California
| | - Jacqueline A Bello
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, New York, New York
| | | | - Cynthia Daisy Smith
- Medical Education Division, American College of Physicians, Philadelphia, Pennsylvania
| | - E Kent Yucel
- Department of Radiology, Tufts Medical Center, Boston, Massachusetts
| | - Bruce Hillman
- Department of Radiology, University of Virginia, Charlottesville, Virginia
| | | | - Max Wintermark
- Department of Radiology, Neuroradiology Division, Stanford University, Stanford, California.
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Strauss SB, Gordon SR, Burns J, Bello JA, Slasky SE. Differentiation between Tuberculous and Pyogenic Spondylodiscitis: The Role of the Anterior Meningovertebral Ligament in Patients with Anterior Epidural Abscess. AJNR Am J Neuroradiol 2019; 41:364-368. [PMID: 31831466 DOI: 10.3174/ajnr.a6370] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/03/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Differentiation between tuberculous and pyogenic spondylodiscitis is a diagnostic challenge because imaging often does not reliably distinguish the 2 entities and percutaneous biopsies are often culture-negative. The purpose of this study was to determine whether violation of the anterior meningovertebral ligament in the setting of anterior epidural abscess discriminates between these entities. MATERIALS AND METHODS This was a retrospective cohort study of all patients with acid-fast bacillus testing and anterior epidural abscess diagnosed on spinal MR imaging between May 2014 and September 2019, with a final diagnosis of tuberculous or pyogenic spondylodiscitis. Six cases of tuberculous spondylodiscitis (mean age, 45.5 years; 80% male) and 35 cases of pyogenic spondylodiscitis were evaluated (mean age, 56.6 years; 49% male). Demographic characteristics were recorded. Cases were assessed for anterior meningovertebral ligament destruction on MR imaging, as demonstrated by the shape of the epidural collection. Segmental location of the infection was also assessed. Independent 2-sample t tests and χ2 tests of independence were performed to evaluate the significance of the difference between the groups. RESULTS Five of 6 (83.3%) cases of tuberculous epidural abscess had an intact anterior meningovertebral ligament, and 0/35 cases of pyogenic epidural abscess demonstrated an intact ligament (P < .001). The presence of an intact anterior meningovertebral ligament had 83.3% sensitivity and 100% specificity for tuberculous spondylodiscitis, a 100% positive predictive value, and a 97.2% negative predictive value. CONCLUSIONS The presence of an intact anterior meningovertebral ligament has high sensitivity and specificity for tuberculous spondylodiscitis-associated epidural abscess, though these results should be validated in a larger sample.
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Affiliation(s)
- S B Strauss
- From the Department of Radiology (S.B.S.), Weill Cornell Medical Center, New York, New York
| | - S R Gordon
- Department of Radiology (S.R.G., J.B., J.A.B., S.E.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - J Burns
- Department of Radiology (S.R.G., J.B., J.A.B., S.E.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - J A Bello
- Department of Radiology (S.R.G., J.B., J.A.B., S.E.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - S E Slasky
- Department of Radiology (S.R.G., J.B., J.A.B., S.E.S.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York.
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12
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Slasky SE, Bello JA. Neuroradiology: Updates in Brain Imaging. Radiol Clin North Am 2019. [DOI: 10.1016/s0033-8389(19)30117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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13
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Slasky SE, Bello JA. Updates in Brain Imaging. Radiol Clin North Am 2019; 57:xiii. [PMID: 31582047 DOI: 10.1016/j.rcl.2019.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Shira E Slasky
- Division of Neuroradiology, Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467-2490, USA.
| | - Jacqueline A Bello
- Division of Neuroradiology, Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210 Street, Bronx, NY 10467-2490, USA.
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14
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Allen B, Cook TS, Bello JA. Quality and Data Science. J Am Coll Radiol 2019; 16:1237-1238. [DOI: 10.1016/j.jacr.2019.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
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15
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16
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Johnson PT, Bello JA, Chatfield MB, Flug JA, Pandharipande PV, Rohatgi S, Fishman EK, Megibow AJ. New ACR Choosing Wisely Recommendations: Judicious Use of Multiphase Abdominal CT Protocols. J Am Coll Radiol 2018; 16:56-60. [PMID: 30219345 DOI: 10.1016/j.jacr.2018.07.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 01/29/2023]
Affiliation(s)
- Pamela T Johnson
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland.
| | - Jacqueline A Bello
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
| | | | | | | | - Saurabh Rohatgi
- Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts
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17
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Lincoln CM, Fata P, Sotardi S, Pohlen M, Uribe T, Bello JA. Imaging spectrum of immunomodulating, chemotherapeutic and radiation therapy-related intracranial effects. Br J Radiol 2017; 91:20170553. [PMID: 29039692 DOI: 10.1259/bjr.20170553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE A wide range of treatment-related side effects result in specific neurologic symptoms and signs and neuroimaging features. Even to the most seasoned neuroradiologist, elucidating therapy-related side effects from other common mimics can be challenging. We provide a pictorial survey of some common and uncommon medication-induced and therapy-related neuroimaging manifestations, discuss pathophysiology and common pitfalls in imaging and diagnosis. METHODS A case-based review is utilized to depict scenarios on a routine basis in a general radiology or neuroradiology practice such as medication-induced posterior reversible encephalopathy syndrome to the more challenging cases of pseudoprogression and pseudoregression in temozolmide and bevacizumab therapy in gliobastoma treatment protocols. CONCLUSION Knowledge of the treatment-induced imaging abnormalities is essential in the accurate interpretation and diagnosis from the most routine to most challenging of clinical situations. We provide a pictorial review for the radiologist to employ in order to be an invaluable provider to our clinical colleagues and patients.
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Affiliation(s)
- Christie M Lincoln
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Peter Fata
- 2 Department of Radiology, Houston Methodist , Houston, TX , USA
| | - Susan Sotardi
- 3 Department of Neuroradiology, Massachusetts General Hospital , Boston, MA , USA
| | - Michael Pohlen
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Tomas Uribe
- 1 Department of Radiology, Baylor College of Medicine , Houston, TX , USA
| | - Jacqueline A Bello
- 4 Albert Einstein College of Medicine, Montefiore Medical Center , Bronx, NY , USA
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18
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Cho JK, Ow TJ, Lee AY, Smith RV, Schlecht NF, Schiff BA, Tassler AB, Lin J, Moadel RM, Valdivia A, Abraham T, Gulko E, Neimark M, Ustun B, Bello JA, Shifteh K. Preoperative 18F-FDG-PET/CT vs Contrast-Enhanced CT to Identify Regional Nodal Metastasis among Patients with Head and Neck Squamous Cell Carcinoma. Otolaryngol Head Neck Surg 2017; 157:439-447. [PMID: 28608737 DOI: 10.1177/0194599817703927] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective Our objective was to compare the accuracy of preoperative positron emission tomography (PET)/computed tomography (CT) and contrast-enhanced CT (CECT) in detecting cervical nodal metastases in patients treated with neck dissection and to scrutinize the ability of each modality to determine nodal stage. Study Design Case series with chart review. Setting Montefiore Medical Center, Bronx, New York. Subjects and Methods Patients who underwent neck dissection at our institution for primary treatment of head and neck squamous cell carcinoma (HNSCC) and had received preoperative PET/CT and CECT were included in this study. Imaging studies were reinterpreted by 3 specialists within the field and compared for interreader agreement. Concordance between radiology and histopathology was measured using neck levels and sides, along with patient nodal stage. Sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and agreement coefficients were calculated. Results Seventy-three patients were included in the study. Sensitivity was 0.69 and 0.94 (level and side) for PET/CT vs 0.53 and 0.66 for CECT ( P = .056, P = .001). Specificity was 0.86 and 0.56 for PET/CT vs 0.91 and 0.76 for CECT ( P = .014, P = .024). No significant difference was found in overall accuracy ( P = .33, P = .88). The overall agreement percentages between N stage called by imaging modality and pathology were 52% and 55% for PET/CT and CECT, respectively. Conclusion No significant difference in sensitivity was found between PET/CT and CECT. CECT was found to have superior specificity compared with PET/CT. The information gleaned from each modality in the pretreatment evaluation of HNSCC appears to be complementary.
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Affiliation(s)
- Joshua K Cho
- 1 Albert Einstein College of Medicine, Bronx, New York, USA
| | - Thomas J Ow
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Andrew Y Lee
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Richard V Smith
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Nicolas F Schlecht
- 1 Albert Einstein College of Medicine, Bronx, New York, USA.,3 Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Bradley A Schiff
- 2 Montefiore Medical Center, Department of Otorhinolaryngology-Head and Neck Surgery, Bronx, New York, USA
| | - Andrew B Tassler
- 4 Weill Cornell Medical College, Department of Otolaryngology-Head and Neck Surgery, New York, New York, USA
| | - Juan Lin
- 1 Albert Einstein College of Medicine, Bronx, New York, USA
| | - Renee M Moadel
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Ana Valdivia
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Tony Abraham
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Edwin Gulko
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Matthew Neimark
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Berrin Ustun
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Jacqueline A Bello
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
| | - Keivan Shifteh
- 5 Montefiore Medical Center, Department of Radiology, Bronx, New York, USA
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19
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Wintermark M, Fredericks N, Burleson J, Bello JA, McGinty G, Smith C(D, Weinberger SE, Thorwarth WT, Haines GR. R-SCAN: Why We Should Care! J Am Coll Radiol 2016; 13:1247-1248.e1. [DOI: 10.1016/j.jacr.2016.06.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 06/24/2016] [Accepted: 06/24/2016] [Indexed: 10/21/2022]
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20
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McClelland AC, Gomes WA, Shinnar S, Hesdorffer DC, Bagiella E, Lewis DV, Bello JA, Chan S, MacFall J, Chen M, Pellock JM, Nordli DR, Frank LM, Moshé SL, Shinnar RC, Sun S. Quantitative Evaluation of Medial Temporal Lobe Morphology in Children with Febrile Status Epilepticus: Results of the FEBSTAT Study. AJNR Am J Neuroradiol 2016; 37:2356-2362. [PMID: 27633809 DOI: 10.3174/ajnr.a4919] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/04/2016] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE The pathogenesis of febrile status epilepticus is poorly understood, but prior studies have suggested an association with temporal lobe abnormalities, including hippocampal malrotation. We used a quantitative morphometric method to assess the association between temporal lobe morphology and febrile status epilepticus. MATERIALS AND METHODS Brain MR imaging was performed in children presenting with febrile status epilepticus and control subjects as part of the Consequences of Prolonged Febrile Seizures in Childhood study. Medial temporal lobe morphologic parameters were measured manually, including the distance of the hippocampus from the midline, hippocampal height:width ratio, hippocampal angle, collateral sulcus angle, and width of the temporal horn. RESULTS Temporal lobe morphologic parameters were correlated with the presence of visual hippocampal malrotation; the strongest association was with left temporal horn width (P < .001; adjusted OR, 10.59). Multiple morphologic parameters correlated with febrile status epilepticus, encompassing both the right and left sides. This association was statistically strongest in the right temporal lobe, whereas hippocampal malrotation was almost exclusively left-sided in this cohort. The association between temporal lobe measurements and febrile status epilepticus persisted when the analysis was restricted to cases with visually normal imaging findings without hippocampal malrotation or other visually apparent abnormalities. CONCLUSIONS Several component morphologic features of hippocampal malrotation are independently associated with febrile status epilepticus, even when complete hippocampal malrotation is absent. Unexpectedly, this association predominantly involves the right temporal lobe. These findings suggest that a spectrum of bilateral temporal lobe anomalies are associated with febrile status epilepticus in children. Hippocampal malrotation may represent a visually apparent subset of this spectrum.
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Affiliation(s)
| | - W A Gomes
- From Departments of Radiology (A.C.M., W.A.G., J.A.B.)
| | - S Shinnar
- Neurology (S. Shinnar, S.L.M., R.C.S.).,Pediatrics (S. Shinnar, S.L.M.).,Epidemiology and Population Health (S. Shinnar)
| | | | - E Bagiella
- Department of Health Evidence and Policy (E.B.), Mount Sinai School of Medicine, New York, New York
| | - D V Lewis
- Departments of Pediatrics (Neurology) (D.V.L.)
| | - J A Bello
- From Departments of Radiology (A.C.M., W.A.G., J.A.B.)
| | - S Chan
- Radiology (S.C.), Gertrude H. Sergievsky Center, Columbia University, New York, New York
| | - J MacFall
- Radiology (J.M.), Duke University Medical Center, Durham, North Carolina
| | - M Chen
- Departments of Epidemiology (D.C.H., M.C.)
| | | | - D R Nordli
- Department of Neurology (D.R.N.), Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - L M Frank
- Department of Neurology (L.M.F.), Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia
| | - S L Moshé
- Neurology (S. Shinnar, S.L.M., R.C.S.).,Pediatrics (S. Shinnar, S.L.M.).,Neuroscience (S.L.M.), Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - S Sun
- Biostatistics (S. Sun), Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia
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21
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Leslie-Mazwi TM, Bello JA, Tu R, Nicola GN, Donovan WD, Barr RM, Hirsch JA. Current Procedural Terminology: History, Structure, and Relationship to Valuation for the Neuroradiologist. AJNR Am J Neuroradiol 2016; 37:1972-1976. [PMID: 27418473 DOI: 10.3174/ajnr.a4863] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/09/2016] [Indexed: 11/07/2022]
Abstract
The year 1965 was critical for US health care policy. In that year, Medicare was created as part of the Social Security Act under President Lyndon B. Johnson after several earlier attempts by Presidents Franklin Roosevelt and Harry Truman. In 1966, the American Medical Association first published a set of standard terms and descriptors to document medical procedures, known as Current Procedural Terminology, or CPT. Fifty years later, though providers have certainly heard the term "CPT code," most would benefit from an enhanced understanding of the historical basis, current structure, and relationship to valuation of Current Procedural Terminology. This article will highlight this evolution, particularly as it relates to neuroradiology.
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Affiliation(s)
- T M Leslie-Mazwi
- From the Neuroendovascular Program (T.M.L.-M., J.A.H.), Massachusetts General Hospital, Boston, Massachusetts
| | - J A Bello
- Montefiore Medical Center (J.A.B.), Albert Einstein College of Medicine, Bronx, New York
| | - R Tu
- Progressive Radiology (R.T.), The George Washington University, Falls Church, Virginia
| | - G N Nicola
- Hackensack University Medical Center (G.N.N.), Hackensack, New Jersey
| | - W D Donovan
- Norwich Diagnostic Imaging Associates (W.D.D.), Norwich, Connecticut
| | - R M Barr
- Mecklenburg Radiology Associates P.A. (R.M.B.), Charlotte, North Carolina
| | - J A Hirsch
- From the Neuroendovascular Program (T.M.L.-M., J.A.H.), Massachusetts General Hospital, Boston, Massachusetts
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22
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Hesdorffer DC, Shinnar S, Lax DN, Pellock JM, Nordli DR, Seinfeld S, Gallentine W, Frank LM, Lewis DV, Shinnar RC, Bello JA, Chan S, Epstein LG, Moshé SL, Liu B, Sun S. Risk factors for subsequent febrile seizures in the FEBSTAT study. Epilepsia 2016; 57:1042-7. [PMID: 27265870 DOI: 10.1111/epi.13418] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify risk and risk factors for developing a subsequent febrile seizure (FS) in children with a first febrile status epilepticus (FSE) compared to a first simple febrile seizure (SFS). To identify home use of rescue medications for subsequent FS. METHODS Cases included a first FS that was FSE drawn from FEBSTAT and Columbia cohorts. Controls were a first SFS. Cases and controls were classified according to established FEBSTAT protocols. Cumulative risk for subsequent FS over a 5-year period was compared in FSE versus SFS, and Cox proportional hazards regression was conducted. Separate analysis examined subsequent FS within FSE. The use of rescue medications at home was assessed for subsequent FS. RESULTS Risk for a subsequent FSE was significantly increased in FSE versus SFS. Any magnetic resonance imaging (MRI) abnormality increased the risk 3.4-fold (p < 0.05), adjusting for age at first FS and FSE and in analyses restricted to children whose first FS was FSE (any MRI abnormality hazard ratio [HR] 2.9, p < 0.05). The risk for a second FS of any type or of subsequent FS lasting >10 min over the 5-year follow-up did not differ in FSE versus SFS. Rectal diazepam was administered at home to 5 (23.8%) of 21 children with subsequent FS lasting ≥10 min. SIGNIFICANCE Compared to controls, FSE was associated with an increased risk for subsequent FSE, suggesting the propensity of children with an initial prolonged seizure to experience a prolonged recurrence. Any baseline MRI abnormality increased the recurrence risk when FSE was compared to SFS and when FSE was studied alone. A minority of children with a subsequent FS lasting 10 min or longer were treated with rectal diazepam at home, despite receiving prescriptions after the first FSE. This indicates the need to further improve the education of clinicians and parents in order to prevent subsequent FSE.
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Affiliation(s)
- Dale C Hesdorffer
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, New York, U.S.A
| | - Shlomo Shinnar
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Daniel N Lax
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - John M Pellock
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - Douglas R Nordli
- Department of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois, U.S.A
| | - Syndi Seinfeld
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, U.S.A
| | - William Gallentine
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, North Carolina, U.S.A
| | - L Matthew Frank
- Department of Neurology, Children's Hospital of The King's Daughters and Eastern Virginia Medical School, Norfolk, Virginia, U.S.A
| | - Darrell V Lewis
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, North Carolina, U.S.A
| | - Ruth C Shinnar
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Jacqueline A Bello
- Department Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Stephen Chan
- Department of Radiology, Columbia University, New York, New York, U.S.A
| | - Leon G Epstein
- Department of Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Illinois, U.S.A
| | - Solomon L Moshé
- Departments of Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, U.S.A
| | - Binyi Liu
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, New York, U.S.A
| | - Shumei Sun
- Department of Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond, Virginia, U.S.A
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23
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Dooneief GH, Bello JA, Todak GG, Tang MX, Marder KS, Stern Y, Mayeux RP. Serial MRI in HIV Infection With and Without Neurologic Impairment. ACTA ACUST UNITED AC 2016; 1:49-57. [PMID: 16873178 DOI: 10.1300/j128v01n04_05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
To assess the relationship of longitudinal brain magnetic resonance imaging (MRI) and infection with human immunodeficiency virus (HIV), a cohort of HIV+ and HIV− gay men and injection drug users (IDU) were evaluated prospectively. Subjects underwent two evaluations including MRI scans, neurologic examinations, neuropsychological assessments and lymphocyte subset determinations one year apart. MRI changes over a one year period were analyzed with respect to serostatus, risk group, CD4 counts, neurological findings and neuropsychological performance. The frequency of MRI changes was no different in subjects with or without HIV infection and no new opportunistic infections or neoplasms were seen. However, among HIV+ subjects with CD4 count < 200 at the time of the initial scan, an increase in white matter hyperintensities was significantly more common. Also among HIV+ subjects, atrophy increased in association with declining CD4 count. Finally, subjects who developed significant neurologic deterioration in one year were much more likely to have increased atrophy. These results suggest that while there are morphological brain changes associated with HIV infection, they are most often seen in association with immunologic or neurologic deterioration.
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Affiliation(s)
- G H Dooneief
- , College of Physicians and Surgeons, New York, NY
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24
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Wojak JC, Abruzzo TA, Bello JA, Blackham KA, Hirsch JA, Jayaraman MV, Dariushnia SR, Meyers PM, Midia M, Russell EJ, Walker TG, Nikolic B. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS). J Vasc Interv Radiol 2015; 26:1596-608. [DOI: 10.1016/j.jvir.2015.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/19/2022] Open
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25
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Donovan WD, Leslie-Mazwi TM, Silva E, Woo HH, Nicola GN, Barr RM, Bello JA, Tu R, Hirsch JA. Diagnostic carotid and cerebral angiography: a historical summary of the evolving changes in coding and reimbursement in a complex procedure family. J Neurointerv Surg 2014; 6:712-7. [PMID: 25179635 DOI: 10.1136/neurintsurg-2014-011416] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Carotid and cerebral angiography have been a mainstay of neurointerventional and neuroradiologic practice for years. Centers for Medicare and Medicaid Services (CMS) and Relative Value Scale Update Committee (RUC) initiatives have compelled the professional societies to bundle component codes under threat of unilateral CMS revision and revaluation. Code bundling usually results in a decrease in the professional Relative Value Unit (RVU) valuation, and thus the MD reimbursement. The year 2013 saw a dramatic revision to the Current Procedural Terminology (CPT) code set that defines carotid and cerebral procedures. This paper reviews the process that led to that code set being revised and estimates the impact on professional reimbursement. We show the current and previous carotid angiography CPT codes and use clinical examples to assess professional RVU valuation before and after code revision.
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Affiliation(s)
| | - Thabele M Leslie-Mazwi
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ezequiel Silva
- South Texas Radiology Group, Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Henry H Woo
- Department of Neurological Surgery and Radiology, Cerebrovascular Center, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - Gregory N Nicola
- Department of Radiology, Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Robert M Barr
- Mecklenburg Radiology Associates P.A., Charlotte, North Carolina, USA
| | - Jacqueline A Bello
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Raymond Tu
- Department of Progressive Radiology, The George Washington University, Falls Church, Virginia, USA
| | - Joshua A Hirsch
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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26
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Salama GR, Farinhas JM, Pasquale DD, Wertenbaker C, Bello JA. Central venous occlusion mimics carotid cavernous fistula: a case report and review of the literature. Clin Imaging 2014; 38:884-7. [PMID: 25128089 DOI: 10.1016/j.clinimag.2014.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Revised: 06/21/2014] [Accepted: 06/30/2014] [Indexed: 10/25/2022]
Abstract
A patient presented with signs and symptoms of a left carotid cavernous fistula (CCF). Computed tomography angiography confirmed filling of the cavernous sinus in the arterial phase. Cerebral digital subtraction angiography demonstrated no evidence of CCF. The workup, diagnosis, and treatment of this patient are discussed, and the literature is reviewed.
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Affiliation(s)
- Gayle R Salama
- (a)Department of Neuroradiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA.
| | - Joaquim M Farinhas
- (a)Department of Neuroradiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA
| | - David D Pasquale
- (a)Department of Neuroradiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA
| | - Christian Wertenbaker
- (b)Department of Ophthalmology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA
| | - Jacqueline A Bello
- (a)Department of Neuroradiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10647, USA
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27
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Abstract
In 1966, The American Medical Association (AMA) working with multiple major medical specialty societies developed an iterative coding system for describing medical procedures and services using uniform language, the Current Procedural Terminology (CPT) system. The current code set, CPT IV, forms the basis of reporting most of the services performed by healthcare providers, physicians and non-physicians as well as facilities allowing effective, reliable communication among physician and other providers, third parties and patients. This coding system and its maintenance has evolved significantly since its inception, and now goes well beyond its readily perceived role in reimbursement. Additional roles include administrative management, tracking new and investigational procedures, and evolving aspects of 'pay for performance'. The system also allows for local, regional and national utilization comparisons for medical education and research. Neurointerventional specialists use CPT category I codes regularly--for example, 36,215 for first-order cerebrovascular angiography, 36,216 for second-order vessels, and 37,184 for acute stroke treatment by mechanical means. Additionally, physicians add relevant modifiers to the CPT codes, such as '-26' to indicate 'professional charge only,' or '-59' to indicate a distinct procedural service performed on the same day.
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Affiliation(s)
- Joshua A Hirsch
- Neuroendovascular Program, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Gregory N Nicola
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Robert M Barr
- Mecklenburg Radiology Associates P.A., Charlotte, North Carolina USA
| | - Jacqueline A Bello
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Raymond Tu
- Department of Progressive Radiology, The George Washington University, Falls Church, Virginia, USA
| | - Mark D Alson
- Sierra Imaging Associates, Clovis, California, USA
| | - Laxmaiah Manchikanti
- Pain Management Center of Paducah, Paducah, Kentucky, USA Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, Kentucky, USA
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28
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Lewis DV, Shinnar S, Hesdorffer DC, Bagiella E, Bello JA, Chan S, Xu Y, MacFall J, Gomes WA, Moshé SL, Mathern GW, Pellock JM, Nordli DR, Frank LM, Provenzale J, Shinnar RC, Epstein LG, Masur D, Litherland C, Sun S. Hippocampal sclerosis after febrile status epilepticus: the FEBSTAT study. Ann Neurol 2014; 75:178-85. [PMID: 24318290 DOI: 10.1002/ana.24081] [Citation(s) in RCA: 164] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Revised: 10/30/2013] [Accepted: 11/18/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Whether febrile status epilepticus (FSE) produces hippocampal sclerosis (HS) and temporal lobe epilepsy (TLE) has long been debated. Our objective is to determine whether FSE produces acute hippocampal injury that evolves to HS. METHODS FEBSTAT and 2 affiliated studies prospectively recruited 226 children aged 1 month to 6 years with FSE and controls with simple febrile seizures. All had acute magnetic resonance imaging (MRI), and follow-up MRI was obtained approximately 1 year later in the majority. Visual interpretation by 2 neuroradiologists informed only of subject age was augmented by hippocampal volumetrics, analysis of the intrahippocampal distribution of T2 signal, and apparent diffusion coefficients. RESULTS Hippocampal T2 hyperintensity, maximum in Sommer's sector, occurred acutely after FSE in 22 of 226 children in association with increased volume. Follow-up MRI obtained on 14 of the 22 with acute T2 hyperintensity showed HS in 10 and reduced hippocampal volume in 12. In contrast, follow-up of 116 children without acute hyperintensity showed abnormal T2 signal in only 1 (following another episode of FSE). Furthermore, compared to controls with simple febrile seizures, FSE subjects with normal acute MRI had abnormally low right to left hippocampal volume ratios, smaller hippocampi initially, and reduced hippocampal growth. INTERPRETATION Hippocampal T2 hyperintensity after FSE represents acute injury often evolving to a radiological appearance of HS after 1 year. Furthermore, impaired growth of normal-appearing hippocampi after FSE suggests subtle injury even in the absence of T2 hyperintensity. Longer follow-up is needed to determine the relationship of these findings to TLE.
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Affiliation(s)
- Darrell V Lewis
- Department of Pediatrics (Neurology), Duke University Medical Center, Durham, NC
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Hesdorffer DC, Shinnar S, Lewis DV, Nordli DR, Pellock JM, Moshé SL, Shinnar RC, Litherland C, Bagiella E, Frank LM, Bello JA, Chan S, Masur D, MacFall J, Sun S. Risk factors for febrile status epilepticus: a case-control study. J Pediatr 2013; 163:1147-51.e1. [PMID: 23809042 PMCID: PMC3989363 DOI: 10.1016/j.jpeds.2013.05.038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/11/2013] [Accepted: 05/15/2013] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To identify risk factors for developing a first febrile status epilepticus (FSE) among children with a first febrile seizure (FS). STUDY DESIGN Cases were children with a first FS that was FSE drawn from the Consequences of Prolonged Febrile Seizures in Childhood and Columbia cohorts. Controls were children with a first simple FS and separately, children with a first complex FS that was not FSE. Identical questionnaires were administered to family members of the 3 cohorts. Magnetic resonance imaging protocol and readings were consistent across cohorts, and seizure phenomenology was assessed by the same physicians. Risk factors were analyzed using logistic regression. RESULTS Compared with children with simple FS, FSE was associated with younger age, lower temperature, longer duration (1-24 hours) of recognized temperature before FS, female sex, structural temporal lobe abnormalities, and first-degree family history of FS. Compared with children with other complex FS, FSE was associated with low temperature and longer duration (1-24 hours) of temperature recognition before FS. Risk factors for complex FS that was not FSE were similar in magnitude to those for FSE but only younger age was significant. CONCLUSIONS Among children with a first FS, FSE appears to be due to a combination of lower seizure threshold (younger age and lower temperatures) and impaired regulation of seizure duration. Clinicians evaluating FS should be aware of these factors as many episodes of FSE go unnoticed. Further work is needed to develop strategies to prevent FSE.
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Affiliation(s)
- Dale C. Hesdorffer
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, NY
| | - Shlomo Shinnar
- Departments of Pediatrics and Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Darrell V. Lewis
- Department of Pediatrics and Neurology, Duke University Medical Center, Durham, NC
| | - Douglas R. Nordli
- Department of Neurology, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - John M. Pellock
- Department of Neurology, Virginia Commonwealth University, Richmond, VA
| | - Solomon L. Moshé
- Departments of Pediatrics and Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Ruth C. Shinnar
- Departments of Pediatrics and Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Claire Litherland
- Department of Epidemiology and GH Sergievsky Center, Columbia University, New York, NY
| | - Emilia Bagiella
- Department of Health Evidence, Mount Sinai Medical Center, New York, NY
| | - L. Matthew Frank
- Department of Neurology, Children’s Hospital of The King’s Daughters and Eastern Virginia Medical School, Norfolk, VA
| | - Jacqueline A. Bello
- Department Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - Stephen Chan
- Department of Radiology, Columbia University, New York, NY
| | - David Masur
- Departments of Pediatrics and Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
| | - James MacFall
- Department of Radiology, Duke University Medical Center, Durham, NC
| | - Shumei Sun
- Department of Biostatistics and International Epilepsy Consortium, Virginia Commonwealth University, Richmond VA
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Belilos E, Oleske JM, Medow NB, Sadovsky R, Campese CL, Bello JA, Swan KG. The Greater Metropolitan Medical Alumni Council (GMMAC): TABLE 1. J Investig Med 2013; 61:967-71. [DOI: 10.2310/jim.0b013e318297d249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Matsumoto AH, Adams MJ, Bello JA, Lozano KD, Ma L, Rosenthal SA, Swan TL. Commentary on ‘Culture Shift’–Radiologists and Radiation Oncologists Adding Value to the Health Care System. J Am Coll Radiol 2013; 10:99-100. [DOI: 10.1016/j.jacr.2012.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 10/31/2012] [Indexed: 11/30/2022]
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Hirsch JA, Silva E, Nicola GN, Barr RM, Bello JA, Manchikanti L, Donovan WD. The RUC: a primer for neurointerventionalists: Table 1. J Neurointerv Surg 2013; 6:61-4. [DOI: 10.1136/neurintsurg-2012-010636] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Shinnar S, Bello JA, Chan S, Hesdorffer DC, Lewis DV, Macfall J, Pellock JM, Nordli DR, Frank LM, Moshe SL, Gomes W, Shinnar RC, Sun S. MRI abnormalities following febrile status epilepticus in children: the FEBSTAT study. Neurology 2012; 79:871-7. [PMID: 22843278 DOI: 10.1212/wnl.0b013e318266fcc5] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The FEBSTAT study is a prospective study that seeks to determine the acute and long-term consequences of febrile status epilepticus (FSE) in childhood. METHODS From 2003 to 2010, 199 children age 1 month to 5 years presenting with FSE (>30 minutes) were enrolled in FEBSTAT within 72 hours of the FSE episode. Of these, 191 had imaging with emphasis on the hippocampus. All MRIs were reviewed by 2 neuroradiologists blinded to clinical details. A group of 96 children with first simple FS who were imaged using a similar protocol served as controls. RESULTS A total of 22 (11.5%) children had definitely abnormal (n = 17) or equivocal (n = 5) increased T2 signal in the hippocampus following FSE compared with none in the control group (p < 0.0001). Developmental abnormalities of the hippocampus were more common in the FSE group (n = 20, 10.5%) than in controls (n = 2, 2.1%) (p = 0.0097) with hippocampal malrotation being the most common (15 cases and 2 controls). Extrahippocampal imaging abnormalities were present in 15.7% of the FSE group and 15.6% of the controls. However, extrahippocampal imaging abnormalities of the temporal lobe were more common in the FSE group (7.9%) than in controls (1.0%) (p = 0.015). CONCLUSIONS This prospective study demonstrates that children with FSE are at risk for acute hippocampal injury and that a substantial number also have abnormalities in hippocampal development. Follow-up studies are in progress to determine the long-term outcomes in these children.
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Affiliation(s)
- Shlomo Shinnar
- Neurology and Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
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Hesdorffer DC, Shinnar S, Lewis DV, Moshé SL, Nordli DR, Pellock JM, MacFall J, Shinnar RC, Masur D, Frank LM, Epstein LG, Litherland C, Seinfeld S, Bello JA, Chan S, Bagiella E, Sun S. Design and phenomenology of the FEBSTAT study. Epilepsia 2012; 53:1471-80. [PMID: 22742587 DOI: 10.1111/j.1528-1167.2012.03567.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE Febrile status epilepticus (FSE) has been associated with hippocampal injury and subsequent hippocampal sclerosis (HS) and temporal lobe epilepsy. The FEBSTAT study was designed to prospectively examine the association between prolonged febrile seizures and development of HS and associated temporal lobe epilepsy, one of the most controversial issues in epilepsy. We report on the baseline phenomenology of the final cohorts as well as detailed aims and methodology. METHODS The "Consequences of Prolonged Febrile Seizures in Childhood" (FEBSTAT) study is a prospective, multicenter study. Enrolled are children, aged 1 month to 6 years of age, presenting with a febrile seizure lasting 30 min or longer based on ambulance, emergency department, and hospital records, and parental interview. At baseline, procedures included a magnetic resonance imaging (MRI) study and electroencephalography (EEG) recording done within 72 h of FSE, and a detailed history and neurologic examination. Baseline development and behavior are assessed at 1 month. The baseline assessment is repeated, with age-appropriate developmental testing at 1 and 5 years after enrollment as well as at the development of epilepsy and 1 year after that. Telephone calls every 3 months document additional seizures. Two other groups of children are included: a "control" group consisting of children with a first febrile seizure ascertained at Columbia University and with almost identical baseline and 1-year follow-up examinations and a pilot cohort of FSE from Duke University. KEY FINDINGS The FEBSTAT cohort consists of 199 children with a median age at baseline of 16.0 months (interquartile range [IQR] 12.0-24.0) and a median duration of FSE of 70.0 min (IQR 47.0-110.0). Seizures were continuous in 57.3% and behaviorally intermittent (without recovery in between) in 31.2%; most were partial (2.0%) or secondary generalized (65.8%), and almost all (98.0%) culminated in a generalized tonic-clonic seizure. Of the 199 children, 86.4% had normal development and 20% had prior febrile seizures. In one third of cases, FSE was unrecognized in the emergency department. The Duke existing cohort consists of 23 children with a median age of FSE onset of 18.0 months (IQR 14.0-28.0) and median duration of FSE of 90.0 min (IQR 50.0-170.0). The Columbia control cohort consists of 159 children with a first febrile seizure who received almost the same workup as the FEBSTAT cohort at baseline and at 1 year. They were followed by telephone every 4 months for a median of 42 months. Among the control cohort, 64.2% had a first simple FS, 26.4% had a first complex FS that was not FSE, and 9.4% had FSE. Among the 15 with FSE, the median age at onset was 14.0 months (IQR 12.0-20.0) and the median duration of FSE was 43.0 min (IQR 35.0-75.0). SIGNIFICANCE The FEBSTAT study presents an opportunity to prospectively study the relationship between FSE and acute hippocampal damage, the development of mesial temporal sclerosis, epilepsy (particularly temporal lobe epilepsy), and impaired hippocampal function in a large cohort. It is hoped that this study may illuminate a major mystery in clinical epilepsy today, and permit the development of interventions designed to prevent the sequelae of FSE.
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Affiliation(s)
- Dale C Hesdorffer
- GH Sergievsky Center, Columbia University, 630 West 168th Street, P & S Unit 16, New York, NY 10032, USA.
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Lui YW, Farinhas JM, Basalely AM, Hsu KA, Freeman K, Bello JA. Assessment of an introductory cervicocerebral catheter angiography learning program: a pilot study. AJNR Am J Neuroradiol 2012; 33:1041-5. [PMID: 22282448 DOI: 10.3174/ajnr.a2931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE There is no standardized curriculum currently available at most institutions for establishing procedural competency in trainees performing cervicocerebral angiography. The purpose of this study was to evaluate a simple learning program to supplement the teaching of basic cervicocerebral angiography. MATERIALS AND METHODS An 11-session interactive curriculum was implemented covering anatomic, clinical, and radiographic topics for the novice cervicocerebral angiographer. The target learner was the neuroradiology fellow. Data were gathered regarding fellow comfort level on topics relating to cervicocerebral angiography by using a 5-point Likert scale. Improvement in scores on knowledge-based questions after completion of the curriculum was calculated (McNemar test). Trainee-perceived utility of the program was also recorded by using a 5-point Likert scale. Focus sessions were held at the completion of the curriculum to gather feedback regarding the strengths and weaknesses of the program from participants. RESULTS Ten subjects were enrolled in this pilot study for 3 years. Topics where participants reported a poor initial comfort level (4 or higher) included selection of injection rates and volumes and reformation of reverse-curve catheters. Trainees demonstrated a statistically significant change in the distribution of scores of 29.3% (49.4%-78.7% correct response rate, P < .0001). The average perceived utility was 1.5 (1 = most useful, 5 = least useful). CONCLUSIONS This simple learning program was a useful adjunct to the training of fellows in diagnostic cervicocerebral angiography, resulting in quantitative improvements in knowledge.
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Affiliation(s)
- Y W Lui
- Department of Radiology, NYU Langone Medical Center, New York 10016, USA.
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Miller T, Burns J, Farinhas J, Pasquale D, Haboosheh A, Bello JA, Brook A. Covered stents safely utilized to prevent catastrophic hemorrhage in patients with advanced head and neck malignancy. J Neurointerv Surg 2011; 4:426-34. [PMID: 21990527 DOI: 10.1136/neurintsurg-2011-010083] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to review the use of covered stents in patients with squamous cell carcinoma of the head and neck threatening bilateral neurovascular structures. METHODS The radiology information system was searched for all patients with bilateral head and neck carcinoma treated with covered stents in the carotid vasculature from 2006 through 2009. Five patients (one woman) of mean age 60.5 years (range 45-69) were identified. All had carotid blowout syndrome after treatment for primary squamous cell carcinoma of the head and neck with subsequent tumor recurrence or metastases immediately threatening bilateral carotid vasculature. Covered stents were placed. Long-term follow-up included clinical progress, verification of stent patency and detection of tumor progression via ultrasound or contrast-enhanced CT after the first month and then every 3-6 months. All patients were maintained on antiplatelet medication after treatment. RESULTS Covered stents were safely deployed in all patients. Mean survival was 5 months with one outlier surviving for 3 years. There were no subsequent uncontrollable hemorrhages. CONCLUSION The use of covered stents for avoidance of catastrophic hemorrhage following treatment in patients with head and neck tumors with bilaterally threatened carotid arteries was successful.
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Affiliation(s)
- Todd Miller
- Department of Radiology, Albert Einstein College of Medicine, Bronx, New York 10463, USA.
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Oshikoya KA, Bello JA, Ayorinde EO. Prescribing knowledge and skills of final year medical students in Nigeria. Indian J Pharmacol 2011; 40:251-5. [PMID: 21279180 PMCID: PMC3025141 DOI: 10.4103/0253-7613.45150] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2007] [Revised: 12/06/2007] [Accepted: 11/22/2008] [Indexed: 11/04/2022] Open
Abstract
Objectives: To assess the knowledge of final year medical students in Nigeria, about good prescribing and the application of this knowledge to their prescribing skills. Materials and Methods: Thirty four final year medical students of the Lagos State University College of Medicine (LASUCOM), Ikeja, were interviewed with a structured questionnaire that assessed their knowledge on the principles of good prescribing. They were also requested to write a prescription, based on a paediatric clinical scenario of malaria and upper respiratory tract infection. The prescription was used to assess their prescribing skills. Results: Thirty one (91.18%) students knew that rational prescribing involved prescribing correct dosage of an appropriate medicine formulation. Factors considered important by the students to prescribe rationally were: Potential benefit: risk ratio of a medicine - 33 (97.06%); good knowledge of pharmacology - 29 (85.29%) and pathophysiology of the disease to be treated - 24 (70.59%); and safety of an alternative medicine to be used - 24 (70.59%). An average of 3.71 medicines was prescribed for a child suspected to have malaria. Antimalarials (38.24%) and paracetamol (20%) were the most frequently prescribed medicines. The name and signature of the prescriber were available in 51.61% and 58.06% prescriptions, respectively. Less than 50% prescriptions had the name, case file number, age and gender of the patient. Conclusion: The final year medical students of LASUCOM would require theoretical and practical teaching of principles of rational prescribing to improve their prescribing knowledge and skills.
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Affiliation(s)
- K A Oshikoya
- Department of Pharmacology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
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Owen RP, Khan SA, Negassa A, Beitler JJ, Bello JA, Brook A, Farinhas J, Garg MK, Haigentz M, Miller TS, Hsu MS, Ravikumar TS, Shifteh K, Smith RV, Silver CE. Radiofrequency Ablation of Advanced Head and Neck Cancer. ACTA ACUST UNITED AC 2011; 137:493-8. [DOI: 10.1001/archoto.2011.62] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Gamss RP, Slasky SE, Bello JA, Miller TS, Shinnar S. Prevalence of hippocampal malrotation in a population without seizures. AJNR Am J Neuroradiol 2009; 30:1571-3. [PMID: 19541778 DOI: 10.3174/ajnr.a1657] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Hippocampal malrotation (HIMAL) is a failure of hippocampal inversion that occurs during normal fetal development and has been seen on MR imaging examinations of people with epilepsy, but it has not been studied in patients without epilepsy. We intended to evaluate the prevalence of HIMAL in MR imaging examinations of patients without seizures to better understand the significance of HIMAL in the population with seizure. MATERIALS AND METHODS A total of 497 MR imaging examinations with thin-section imaging through the temporal lobes of patients referred for conditions other than seizures were reviewed. The examinations were performed on 1.5T magnets. Sagittal T1-weighted and coronal T2-weighted images were used to evaluate each MR image for the distinctive features of HIMAL. As previously described in the literature, the criteria for HIMAL include unilateral involvement and incomplete rotation of a hippocampus that is normal in size and signal intensity but abnormally rounded in shape, with blurred inner structure. In addition, ipsilateral findings of an atypical collateral sulcus angle and atypical position and size of the fornix were noted. The corpus callosum is normal, and the temporal lobe remains normal in size, though the temporal horn may appear enlarged. RESULTS None of the patients' examinations fulfilled all of the HIMAL criteria. Six studies satisfied 2 or more criteria, which included an abnormally rounded hippocampus and a vertical collateral sulcus. These HIMAL findings were all seen on the left. Forniceal asymmetry was the most prevalent abnormality, with 289 patients manifesting a low position of 1 fornix. CONCLUSIONS Hippocampal malrotation is a rare finding in patients without seizures. HIMAL is therefore likely to be a pathologic finding.
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Affiliation(s)
- R P Gamss
- Department of Radiology, Montefiore Medical Center, 111 E. 210th St., Bronx, NY 10467, USA
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Abstract
Sinus pericranii (SP) is an abnormal communication between the intra- and extracranial venous drainage pathways. Treatment of this condition has mainly been recommended for reasons of cosmesis and prevention of hemorrhage. The authors report a novel endovascular transvenous route for definitive treatment of SP.
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Affiliation(s)
- Allan L Brook
- Departments of Radiology Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York 10467, USA
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Lipton ML, Gellella E, Lo C, Gold T, Ardekani BA, Shifteh K, Bello JA, Branch CA. Multifocal white matter ultrastructural abnormalities in mild traumatic brain injury with cognitive disability: a voxel-wise analysis of diffusion tensor imaging. J Neurotrauma 2009; 25:1335-42. [PMID: 19061376 DOI: 10.1089/neu.2008.0547] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The purpose of the present study is to identify otherwise occult white matter abnormalities in patients suffering persistent cognitive impairment due to mild traumatic brain injury (TBI). The study had Institutional Review Board (IRB) approval, included informed consent and complied with the U.S. Health Insurance Portability and Accountability Act (HIPAA) of 1996. We retrospectively analyzed diffusion tensor MRI (DTI) of 17 patients (nine women, eight men; age range 26-70 years) who had cognitive impairment due to mild TBI that occurred 8 months to 3 years prior to imaging. Comparison was made to 10 healthy controls. Fractional anisotropy (FA) and mean diffusivity (MD) images derived from DTI (1.5 T; 25 directions; b = 1000) were compared using whole brain histogram and voxel-wise analyses. Histograms of white matter FA show an overall shift toward lower FA in patients. Areas of significantly decreased FA (p < 0.005) were found in the subject group in corpus callosum, subcortical white matter, and internal capsules bilaterally. Co-located elevation of mean diffusivity (MD) was found in the patients within each region. Similar, though less extensive, findings were demonstrated in each individual patient. Multiple foci of low white matter FA and high MD are present in cognitively impaired mild TBI patients, with a distribution that conforms to that of diffuse axonal injury. Evaluation of single subjects also reveals foci of low FA, suggesting that DTI may ultimately be useful for clinical evaluation of individual patients.
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Affiliation(s)
- Michael L Lipton
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York 10467, USA.
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Abstract
The authors describe a technique for lumbar drain placement using CT guidance. Midline or paramidline interlaminar approaches to the thecal sac can be used. The major advantage to CT guidance is direct visualization of the needle tip in relation to the thecal sac. This technical approach is a safe and rapid alternative to fluoroscopic guidance for the placement of lumbar drains in patients in whom standard lumbar drain placement techniques have failed.
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Affiliation(s)
| | | | | | - David J. Altschul
- 2Neurosurgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
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Brook AL, Gold MM, Miller TS, Gold T, Owen RP, Sanchez LS, Farinhas JM, Shifteh K, Bello JA. CT-guided Radiofrequency Ablation in the Palliative Treatment of Recurrent Advanced Head and Neck Malignancies. J Vasc Interv Radiol 2008; 19:725-35. [DOI: 10.1016/j.jvir.2007.12.439] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2007] [Revised: 12/02/2007] [Accepted: 12/03/2007] [Indexed: 11/17/2022] Open
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Oshikoya KA, Bello JA, Ayorinde EO. Medical students' view on the methods of teaching pharmacology at the Lagos State University College of Medicine, Nigeria. ACTA ACUST UNITED AC 2008; 17:101-7. [PMID: 18318104 DOI: 10.4314/nqjhm.v17i3.12554] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study was aimed at determining the perception of the medical students of a relatively new medical school in Nigeria about the teaching of Pharmacology, the best way of learning and retaining the subject. Suggestions on the ways of making pharmacology more interesting to them were also sought. METHODS A total of forty eight 400 level medical students of the Lagos State University College of Medicine (LASUCOM), who were due to write 2nd Professional M.B; B.S degree examinations in 2007 and 26 successful older students that had passed the 2nd Professional M.B; B.S degree examinations in 2006, were interviewed with a structured questionnaire. Some of the questions were close-ended but the ones related to suggestion on impaired teaching of the subject were open-ended. The pharmacology lecturers were also interviewed with another questionnaire, different from the one used in interviewing the students, to assess their views on the non-inclusion of clinical pharmacology topics to the curriculum and to suggest ways of improving the teaching of the subject. RESULTS Sixteen (41.02%) respondents and 26 (92.86%) successful older students wanted audiovisual aids teaching and inclusion of clinically oriented pharmacology lectures. Fourteen (35.89%) respondents respectively and all the successful older students wanted seminars and group discussions introduced into their programme. Over half (58.97%) of the respondents and all the successful older students wanted case studies and treatment as part of the regular teaching schedule, 20 (51.28%) respondents and 20 (76.92%) successful older students preferred inclusion of clinical pharmacology. Most of the students (respondents and older successful students) felt that special topics in clinical pharmacology should be taught both in the lectures and practical. CONCLUSION Medical students are very willing to learn pharmacology from both clinical and therapeutic angles that encompass both theoretical and practical approaches. It is therefore imperative to modify the Pharmacology programme of the LASUCOM in line with the global trend.
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Affiliation(s)
- K A Oshikoya
- Department Pharmacology and Therapeutics, Lagos State University College of Medicine, P.M.B 21266, Ikeja, Lagos, Nigeria
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Scheinfeld MH, Lui YW, Kolb EA, Engel HM, Gomes WA, Weidenheim KM, Bello JA. The neuroradiological findings in a case of Revesz syndrome. Pediatr Radiol 2007; 37:1166-70. [PMID: 17874088 DOI: 10.1007/s00247-007-0592-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2007] [Revised: 07/03/2007] [Accepted: 07/13/2007] [Indexed: 10/22/2022]
Abstract
Revesz syndrome is a variant of dyskeratosis congenita characterized by aplastic anemia, retinopathy, and central nervous system abnormalities. We describe a 3-year-old boy in whom the spectrum of neuroimaging findings, including intracranial calcifications, cerebellar hypoplasia and unusual brain lesions were found by biopsy to be gliosis despite their enhancement and progression. In patients with dyskeratosis-related syndromes, non-neoplastic parenchymal brain lesions occur and gliosis should be considered in the differential diagnosis for progressive enhancing brain lesions. Should this finding be confirmed consistently in additional cases, brain biopsy could potentially be avoided.
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Affiliation(s)
- Meir H Scheinfeld
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
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Parikh T, Shifteh K, Lipton ML, Bello JA, Brook AL. Deep brain reversible encephalopathy: association with secondary antiphospholipid antibody syndrome. AJNR Am J Neuroradiol 2007; 28:76-8. [PMID: 17213428 PMCID: PMC8134088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We present a case of a patient with systemic lupus erythematosus and secondary antiphospholipid syndrome. The patient presented with acute right cerebellar infarction and clinical and imaging evidence of brain stem and bilateral thalamic encephalopathy that resolved completely.
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Affiliation(s)
- T Parikh
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
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Abstract
Sturge-Weber syndrome is a neurocutaneous syndrome with a facial port-wine nevus and neurologic features, typically including seizures and hemiparesis. Glaucoma may also occur. MRI features include leptomeningeal angiomatosis, cortical and pial calcifications, and angiomatous change of the choroid plexus. We reviewed a subset of patients with Sturge-Weber syndrome with the rare finding of deep venous occlusion, and present such a case, unusual by comparison to previously reported cases of Sturge-Weber syndrome with deep venous occlusion. Six previously reported cases were reviewed. All cases presented with seizures; five of six had evidence of leptomeningeal angiomatosis; half had cerebral hemiatrophy. This report presents a unique case lacking clinical seizures, but with a port-wine stain and congenital glaucoma. This patient lacked the radiologic findings of leptomeningeal angiomatosis and hemicerebral atrophy, but demonstrated deep venous occlusion with frontal venous collaterals. There is a wide spectrum of findings in Sturge-Weber syndrome. The lack of seizures and angiomatosis in this case are likely "true-true" and related. The case illustrates the unusual finding of deep venous occlusion in Sturge-Weber syndrome occurring without leptomeningeal angiomatosis. Additionally, it demonstrates that although the initial evaluation is normal, patients may later manifest clinical characteristics of Sturge-Weber syndrome.
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Affiliation(s)
- Shira E Slasky
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, NY 10467, USA.
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Gold MM, Shifteh K, Bello JA, Lipton M, Kaufman DM, Brown AD. Chorea-acanthocytosis: A Mimicker of Huntington Disease Case Report and Review of the Literature. Neurologist 2006; 12:327-9. [PMID: 17122731 DOI: 10.1097/01.nrl.0000245817.18773.f4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neuroacanthocytosis consists of a group of rare heterogeneous neurodegenerative disorders associated with acanthocytosis. Chorea-acanthocytosis, a variety of neuroacanthocytosis, is an autosomal recessive condition with clinical and radiologic features similar to Huntington disease. Although difficult, distinguishing between these entities is crucial as the implications for genetic counseling are significant. REVIEW SUMMARY We report the case of a 33-year-old female who presented to our institution with a 3-year history of chorea. The patient's prominent orofacial symptoms and the presence of acanthocytes on peripheral blood smear led to the correct diagnosis of chorea-acanthocytosis. CONCLUSIONS The significant similarities between chorea-acanthocytosis and Huntington disease at the clinical and radiologic levels can lead to an initial misdiagnosis. Clinical clues suggestive of chorea-acanthocytosis include prominent orofacial dyskinesias, often causing dysarthria and dysphagia. Acanthocytosis, when present on peripheral blood smear, can confirm the diagnosis.
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Affiliation(s)
- Menachem M Gold
- Department of Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
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Brook AL, Mirsky DM, Bello JA. Stroke prevention: carotid intervention based on catheter angiography versus noninvasive vascular imaging. Tech Vasc Interv Radiol 2005; 7:196-201. [PMID: 16084445 DOI: 10.1053/j.tvir.2005.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Historically, imaging evaluation before carotid revascularization by endarterectomy or stenting has relied on targeting the cervical carotid using catheter angiography as the gold standard. This approach underestimates the anatomic and functional importance of the brain as the target organ by focusing the decision-making process on an isolated segment of the circulation. Since revascularization alternatives have been expanded to include the more proximal aortic and more distal intracranial circulations, it is essential to image the vascular tree from the heart to the brain. Equally important is accurate clinical correlation and functional imaging correlation, so that unnecessary surgery is avoided and there is no lost opportunity for stroke prevention.
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Affiliation(s)
- Allan L Brook
- Department of Neuroradiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467-2490, USA.
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