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Pharyngeal atrophy in the context of aging: A retrospective MRI analysis [Meeting Abstract]

Molfenter, S; Amin, M R; Branski, R C; Brumm, J; Hagiwara, M; Roof, S; Lazarus, C L
Purpose: Age-related loss of muscle bulk and strength has been documented in the tongue and geniohyoid. Our goal was to explore this phenomenon in the pharynx, specifically by measuring pharyngeal wall thickness (PWT) and pharyngeal lumen area (PLA) in a sample of young vs older women. Method(s): MRI scans of the neck were retrospectively reviewed from 60 women equally stratified by 3 age groups (20s, 60s, 70+). Exclusion criteria included dysphagia, c-spine surgery, neurological illness, head and neck malignancy and obstructive sleep apnea. Three de-identified axial slices were extracted per scan for randomized, blinded analysis: at the levels of the anterior inferior border of C2 and C3, and at the pit of the vallecula (Vpit). Pixel-based measures of PWT and PLA were completed using ImageJ and converted to metric units using the calibration markers on the original images. Measures of PWT and PLA (at three levels) were compared between age groups with one-way ANOVAs using Sidak adjustments for post-hoc pairwise comparisons. Result(s): A significant main effect of age was observed for all variables whereby PWT decreases and PLA increases with advancing age (Table 1). Pairwise comparisons revealed significant differences between 20s vs 70+ for all variables and 20s vs 60s for all variables except PWT and PLA at C2. Effect sizes ranged from 0.56-1.34. Conclusions (Including Clinical Relevance): Consistent with the existing sacropenia literature, the pharyngeal muscles appear to atrophy with age and consequently, PLA increases as well. Future work should explore the relationship between pharyngeal muscle size/ atrophy and functional swallowing outcomes. (Table Presented)
EMBASE:613971889
ISSN: 1432-0460
CID: 2401662

Identification of Endolymphatic Hydrops in Meniere's Disease Utilizing Delayed Postcontrast 3D FLAIR and Fused 3D FLAIR and CISS Color Maps

Hagiwara, Mari; Roland, J Thomas Jr; Wu, Xin; Nusbaum, Annette; Babb, James S; Roehm, Pamela C; Hammerschlag, Paul; Lalwani, Anil K; Fatterpekar, Girish
OBJECTIVE: The preferential delayed enhancement of the perilymphatic space enables detection of the non-enhancing endolymphatic hydrops present in patients with Meniere's disease. The aim of this study was to evaluate the diagnostic utility of delayed postcontrast 3D FLAIR images and a color map of fused postcontrast FLAIR and constructive interference steady state (CISS) images in the identification of endolymphatic hydrops in patients with clinically diagnosed Meniere's disease. STUDY DESIGN: Case control, blinded study. SETTING: Tertiary referral center. PATIENTS: Ten patients with Meniere's disease and five volunteer controls. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURE: Two neuroradiologists blinded to the clinical history independently evaluated for the presence of endolymphatic hydrops on the images of both inner ears for test and control subjects. Both the standard gray-scale FLAIR images and the fused color map images were independently reviewed. RESULTS: The gray-scale 3D FLAIR images demonstrated 68.2% sensitivity and 97.4% specificity, and the fused color map images demonstrated 85.0% sensitivity and 88.9% specificity in the identification of endolymphatic hydrops in Meniere's disease. There was significant correlation between the gray-scale 3D FLAIR images and fused color map images with the categorization of involvement (p = 0.002). Inter-evaluator reliability was excellent (kappa = 0.83 for gray-scale images, kappa = 0.81 for fused color map). CONCLUSION: Delayed 3D FLAIR and fused 3D FLAIR-CISS color map images of the inner ears after intravenous contrast administration are potentially useful diagnostic tools in the evaluation of patients with suspected Meniere's disease.
PMID: 25251300
ISSN: 1531-7129
CID: 1259452

Contrast-Enhanced Radial 3D Fat-Suppressed T1-Weighted Gradient-Recalled Echo Sequence Versus Conventional Fat-Suppressed Contrast-Enhanced T1-Weighted Studies of the Head and Neck

Wu, Xin; Raz, Eytan; Block, Tobias K; Geppert, Christian; Hagiwara, Mari; Bruno, Mary T; Fatterpekar, Girish M
OBJECTIVE. Traditional fat-suppressed T1-weighted spin-echo or turbo spin-echo (TSE) sequences (T1-weighted images) may be degraded by motion and pulsation artifacts in head-and-neck studies. Our purpose is to evaluate the role of a fat-suppressed T1-weighted 3D radial gradient-recalled echo sequence (radial-volumetric interpolated breath-hold examination [VIBE]) in the head and neck as compared with standard contrast-enhanced fat-suppressed T1-weighted images. MATERIALS AND METHODS. We retrospectively evaluated 21 patients (age range, 9-67 years) who underwent head-and-neck MRI at 1.5 T. Both contrast-enhanced radial-VIBE and conventional fat-suppressed TSE contrast-enhanced T1-weighted imaging were performed. Two radiologists evaluated multiple parameters of image quality, graded on a 5-point scale. Mixed-model analysis of variance and interobserver variability assessment were performed. RESULTS. The following parameters were scored as significantly better for the contrast-enhanced radial-VIBE sequence than for conventional contrast-enhanced T1-weighted imaging: overall image quality (p < 0.0001), degree of fat suppression (p = 0.006), mucosal enhancement (p = 0.004), muscle edge clarity (p = 0.049), vessel clarity (p < 0.0001), respiratory motion artifact (p = 0.002), pulsation artifact (p < 0.0001), and lesion edge sharpness (p = 0.004). Interobserver agreement in qualitative evaluation of the two sequences showed fair-to-good agreement for the following variables: overall image quality (intraclass correlation coefficient [ICC], 0.779), degree of fat suppression (ICC, 0.716), mucosal enhancement (ICC, 0.693), muscle edge clarity (ICC, 0.675), respiratory motion artifact (ICC, 0.516), lesion enhancement (ICC, 0.410), and lesion edge sharpness (ICC, 0.538). Excellent agreement was shown for vessel clarity (ICC, 0.846) and pulsation artifact (ICC, 0.808). CONCLUSION. The radial-VIBE sequence is a viable motion-robust improvement on the conventional fat-suppressed T1-weighted sequence.
PMID: 25247956
ISSN: 0361-803x
CID: 1252482

Phase II study of everolimus in children and adults with neurofibromatosis type 2 and progressive vestibular schwannomas

Karajannis, Matthias A; Legault, Genevieve; Hagiwara, Mari; Giancotti, Filippo G; Filatov, Alexander; Derman, Anna; Hochman, Tsivia; Goldberg, Judith D; Vega, Emilio; Wisoff, Jeffrey H; Golfinos, John G; Merkelson, Amanda; Roland, J Thomas; Allen, Jeffrey C
Background Activation of the mammalian target of rapamycin (mTOR) signaling pathway is thought to be a key driver of tumor growth in Merlin (NF2)-deficient tumors. Everolimus is an oral inhibitor of mTOR complex 1 (mTORC1) with antitumor activity in a variety of cancers. Methods We conducted a single-institution, prospective, 2-stage, open-label phase II study to estimate the response rate to everolimus in neurofibromatosis type 2 (NF2) patients with progressive vestibular schwannoma (VS). Ten eligible patients were enrolled, including 2 pediatric patients. Everolimus was administered at a daily dose of 10 mg (adults) or 5 mg/m(2)/day (children <18 y) orally in continuous 28-day courses, for up to 12 courses. Response was assessed every 3 months with MRI, using 3-dimensional volumetric tumor analysis, and audiograms. Nine patients were evaluable for the primary response, defined as >/=15% decrease in VS volume. Hearing response was evaluable as a secondary endpoint in 8 patients. Results None of the 9 patients with evaluable disease experienced a clinical or MRI response. No objective imaging or hearing responses were observed in stage 1 of the trial, and the study was closed according to predefined stopping rules. Conclusion Everolimus is ineffective for the treatment of progressive VS in NF2 patients. We are currently conducting a pharmacokinetic/pharmacodynamic ("phase 0") study of everolimus in presurgical VS patients to elucidate the biological basis for apparent treatment resistance to mTORC1 inhibition in these tumors.
PMCID:3895376
PMID: 24311643
ISSN: 1522-8517
CID: 759702

Idiopathic pachymeningitis presenting with progressive sensorineural hearing loss, tinnitus and confusion

Pollack, Aron; Cohen, Brandon E; Hagiwara, Mari; Roehm, Pamela C
PMCID:3713081
PMID: 23739554
ISSN: 1531-7129
CID: 438822

PHASE II STUDY OF RAD001 IN CHILDREN AND ADULTS WITH NEUROFIBROMATOSIS TYPE 2 AND PROGRESSIVE VESTIBULAR SCHWANNOMAS [Meeting Abstract]

Karajannis, Matthias; Legault, Genevieve; Hagiwara, Mari; Vega, Emilio; Merkelson, Amanda; Wisoff, Jeffrey; Golfinos, John; Roland, J. Thomas; Allen, Jeffrey
ISI:000318570500124
ISSN: 1522-8517
CID: 386802

Parotid gland atrophy in patients with chronic trigeminal nerve denervation

Raz, E; Saba, L; Hagiwara, M; Hygino de Cruz, L C Jr; Som, P M; Fatterpekar, G M
BACKGROUND AND PURPOSE: Trigeminal nerve injury or dysfunction is associated with denervation atrophy of muscles innervated by the mandibular branch of the trigeminal nerve. The purpose of our study was to evaluate the association between chronic CN V denervation and parotid gland atrophy. MATERIALS AND METHODS: Twenty-six patients with chronic masticator muscle atrophy were retrospectively identified and evaluated for the presence of ipsilateral parotid gland atrophy. Twenty-six age-matched control subjects with no clinical or imaging evidence of chronic masticator space atrophy were also identified. Segmentation of the parotid gland was performed to calculate a parotid asymmetry index. The Fisher exact test and t test were respectively used to determine the correlation between parotid gland atrophy and ipsilateral masticator muscle atrophy and to evaluate any difference in the size of the involved parotid gland when compared with that in the control subjects. RESULTS: Ipsilateral parotid gland atrophy was seen in 9/26 (42.8%) patients with fatty replacement of the masticator group of muscles, suggesting a correlation between parotid gland atrophy and CN V denervation (P < .001). The parotid asymmetry index was significantly different in patients with CN V denervation (0.59 +/- 0.25) compared with control subjects (0.92 +/- 0.03) (P < .001). CONCLUSIONS: Ipsilateral parotid gland atrophy can accompany chronic CN V denervation change, and its clinical significance remains to be determined.
PMID: 23042921
ISSN: 0195-6108
CID: 287112

MRI Characterization and Longitudinal Study of Focal Cerebellar Lesions in a Young Tuberous Sclerosis Cohort

Vaughn, J; Hagiwara, M; Katz, J; Roth, J; Devinsky, O; Weiner, H; Milla, S
BACKGROUND AND PURPOSE:There are few articles characterizing cerebellar lesions in patients with TSC and no published series documenting longitudinal evaluation of these lesions, to our knowledge. Recent suggestion of a correlation between autism and cerebellar lesions in patients with TSC heightens the importance of understanding these lesions. Our purpose was to characterize cerebellar lesions in a cohort of young patients with TSC with specific interest in assessing longitudinal changes.MATERIALS AND METHODS:We retrospectively reviewed MR images from 145 pediatric and young adult patients with tuberous sclerosis (mean age, 7.6 years). A number of imaging characteristics of cerebellar tubers were recorded, and patients were evaluated for SGAs. Patients with follow-up scans >3 months from the original scan were further analyzed for longitudinal tuber characterization.RESULTS:There were 24.1% of patients with focal cerebellar lesions; 52.4% of patients with cerebellar lesions demonstrated change in imaging characteristics during longitudinal analysis. Fifty-one percent of the lesions were enhanced after gadolinium administration. Twenty percent of the patients with cerebellar lesions had pathologically confirmed SGAs compared with the incidence of 11% in the 145 patients with TSC reviewed.CONCLUSIONS:In our large cohort of young patients with TSC, cerebellar tubers were common and 52% of patients had tubers that changed with time. A higher percentage of patients with cerebellar lesions developed SGAs than patients with TSC without cerebellar lesions. Because this is the first reported longitudinal study of cerebellar lesions in TSC, further investigation may provide additional insight into TSC pathology and associated clinical manifestations, such as autism, developmental delay, and seizures.
PMID: 22954744
ISSN: 0195-6108
CID: 214232

Radiologic Evaluation/Diagnostic Imaging of Paranasal Sinuses and Chronic Rhinosinusitis

Chapter by: Fatterpekar, Girish; Chen, Si; Pramanik, Bidyut; Hagiwara, Mari; Galheigo, Diogo
in: Encyclopedia of Otolaryngology, Head and Neck Surgery by Kountakis, Stilianos E [Eds]
Berlin, Heidelberg : Springer Berlin Heidelberg, 2013
pp. 2256-2265
ISBN: 3642234992
CID: 1808122

Imaging the facial nerve: a contemporary review

Gupta, Sachin; Mends, Francine; Hagiwara, Mari; Fatterpekar, Girish; Roehm, Pamela C
Imaging plays a critical role in the evaluation of a number of facial nerve disorders. The facial nerve has a complex anatomical course; thus, a thorough understanding of the course of the facial nerve is essential to localize the sites of pathology. Facial nerve dysfunction can occur from a variety of causes, which can often be identified on imaging. Computed tomography and magnetic resonance imaging are helpful for identifying bony facial canal and soft tissue abnormalities, respectively. Ultrasound of the facial nerve has been used to predict functional outcomes in patients with Bell's palsy. More recently, diffusion tensor tractography has appeared as a new modality which allows three-dimensional display of facial nerve fibers.
PMCID:3676972
PMID: 23766904
ISSN: 2090-195x
CID: 394102