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Altered Biodistribution on 99m Tc-Dimercaptosuccinic Acid Renal Scan [Case Report]

Mercer, Megan K; Parisi, Marguerite T; Revels, Jonathan W; Blacklock, Lisa; Elojeimy, Saeed
99m Tc-dimercaptosuccinic acid ( 99m Tc-DMSA) scans are used to evaluate renal cortical defects typically related to parenchymal scarring or pyelonephritis, and ectopic renal parenchyma. 99m Tc-DMSA binds to metalloproteins in proximal tubular cells and typically localizes to the renal cortex, with minimal excretion. Planar and SPECT images are obtained 2 to 4 hours after IV administration of 99m Tc-DMSA. Altered 99m Tc-DMSA biodistribution has been reported in various conditions, including renal injury, technical issues, infiltrative processes, and hematologic disorders. Here, we present a case of altered biodistribution, with hepatic and splenic radiotracer uptake in the setting of hepatosplenomegaly and hematologic abnormalities concerning for a systemic hematologic disorder/lymphohistiocytosis.
PMID: 36630966
ISSN: 1536-0229
CID: 5434382

Imaging evaluation of lymphoma in pregnancy with review of clinical assessment and treatment options

Dell'Aquila, Kevin; Hodges, Hannah; Moshiri, Mariam; Katz, Douglas S; Elojeimy, Saeed; Revzin, Margarita V; Tembelis, Miltiadis; Revels, Jonathan W
Lymphoma-related malignancies can be categorized as Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL) based on histologic characteristics. Although quite rare during pregnancy, HL and NHL are the fourth and fifth most common malignancies during the pregnancy period, respectively. Given the rarity of lymphoma among pregnant patients, radiologists are usually unfamiliar with the modifications required for staging and treatment of this population, even those who work at centers with busy obstetrical services. Therefore, this manuscript serves to not only review the abdominopelvic imaging features of lymphoma in pregnancy, but it also discusses topics including birthing parent and fetal lymphoma-related prognosis, both antenatal and postpartum, current concepts in the management of pregnancy-related lymphoma, as well as the current considerations regarding birthing parent onco-fertility.
PMID: 36595067
ISSN: 2366-0058
CID: 5409882

MR Defecating Proctography with Emphasis on Posterior Compartment Disorders

Revels, Jonathan W; Mansoori, Bahar; Fadl, Shaimaa; Wang, Sherry S; Olson, Michael C; Moran, Shamus K; Terrazas, Martha F; Fletcher, Joel G; Perry, William R G; Chernyak, Victoria; Mileto, Achille
MR defecating proctography (MRDP) is a noninvasive examination that can be used for evaluating posterior compartment disorders. MRDP has several advantages over conventional fluoroscopic defecography. These benefits include high-contrast resolution evaluation of the deep pelvic organs, simultaneous multicompartmental assessment that is performed statically and dynamically during defecation, and lack of ionizing radiation. MRDP also provides a highly detailed anatomic evaluation of the pelvic floor supportive structures, including direct assessment of the pelvic floor musculature and indirect assessment of the endopelvic fascia. As the breadth of knowledge regarding anatomic and functional posterior compartment disorders expands, so too does the advancement of noninvasive and surgical treatment options for these conditions. High-quality MRDP examinations, with key anatomic and functional features reported, guide treatment planning. Reporting of MRDP examination findings with use of standardized terminology that emphasizes objective measurements rather than subjective grading aids consistent communication among radiologists, clinicians, and surgeons. Familiarity with commonly encountered posterior compartment pelvic floor pathologic entities that contribute to posterior compartment disorders and awareness of the essential information needed by surgeons are key to providing an optimal multidisciplinary discussion for planning pelvic floor dysfunction treatment. The authors provide an overview of the basic concepts of the MRDP acquisition technique, the anatomic abnormalities of posterior compartment pelvic floor pathologic entities associated with defecatory disorders, and recently developed interdisciplinary MRDP reporting templates and lexicons. In addition, the associated imaging findings that are key for surgical treatment guidance are highlighted. © RSNA, 2022 Online supplemental material is available for this article.
PMID: 36459493
ISSN: 1527-1323
CID: 5374162

Upper Gastrointestinal Fluoroscopic Examination: A Traditional Art Enduring into the 21st Century

Revels, Jonathan W; Moran, Shamus K; O'Malley, Ryan; Mansoori, Bahar; Revzin, Margarita; Katz, Douglas S; Moshiri, Mariam; DiSantis, David J
PMID: 35984751
ISSN: 1527-1323
CID: 5300312

Imaging review of penile pathologies encountered in the emergency department

Albasha, Heba; Wang, Sherry S; Revels, Jonathan W; Beckett, Katrina; Flink, Carl C
While penile pathology is uncommon, prompt diagnosis and treatment of emergent and urgent penile pathology are necessary to prevent complications. This paper will review the imaging findings of the most common critical penile pathologies, including traumatic, vascular, infectious, foreign body-related, and urethral pathology, in addition to penile prosthesis complications. Each entity will be discussed in the context of presentation and treatment and complications of each pathology will be discussed.
PMID: 34596782
ISSN: 1438-1435
CID: 5111742

A Multimodality Review of Male Urethral Imaging: Pearls and Pitfalls with an Update on Urethral Stricture Treatment

Revels, Jonathan Wesley; Wang, Sherry S; Weaver, Jennifer S; Foreman, Jordan R; Gallegos, Maxx A; Thompson, William M; Katz, Douglas; Moshiri, Mariam
Optimum radiological assessment of the male urethra requires knowledge of the normal urethral anatomy and ideal imaging techniques based on the specific clinical scenario. Retrograde urethrography is the workhorse examination for male urethral imaging, usually utilized as the initial, and often solitary, modality of choice not only in the setting of trauma, but also in the pre- and post-operative evaluation of urethral strictures. There is, however, growing interest in utilization of ultrasound and magnetic resonance for evaluation of the male urethra owing to lack of ionizing radiation and improved delineation of the adjacent tissue. We review the various modalities utilized for imaging of the male urethra for a variety of known or suspected disorders, and provide an update on current treatments of urethral strictures. Additionally, we detail the key information needed by urologists to guide management of urethral strictures. We conclude with a brief discussion of neophallus urethral diseases following female-to-male sexual confirmation surgery.
PMID: 35001669
ISSN: 1748-880x
CID: 5111782

Medication-induced Pulmonary Injury: A Scenario- and Pattern-based Approach to a Perplexing Problem

Sridhar, Shravan; Kanne, Jeffrey P; Henry, Travis S; Revels, Jonathan W; Gotway, Michael B; Ketai, Loren H
Medication-induced pulmonary injury (MIPI) is a complex medical condition that has become increasingly common yet remains stubbornly difficult to diagnose. Diagnosis can be aided by combining knowledge of the most common imaging patterns caused by MIPI with awareness of which medications a patient may be exposed to in specific clinical settings. The authors describe six imaging patterns commonly associated with MIPI: sarcoidosis-like, diffuse ground-glass opacities, organizing pneumonia, centrilobular ground-glass nodules, linear-septal, and fibrotic. Subsequently, the occurrence of these patterns is discussed in the context of five different clinical scenarios and the medications and medication classes typically used in those scenarios. These scenarios and medication classes include the rheumatology or gastrointestinal clinic (disease-modifying antirheumatic agents), cardiology clinic (antiarrhythmics), hematology clinic (cytotoxic agents, tyrosine kinase inhibitors, retinoids), oncology clinic (immune modulators, tyrosine kinase inhibitors, monoclonal antibodies), and inpatient service (antibiotics, blood products). Additionally, the article draws comparisons between the appearance of MIPI and the alternative causes of lung disease typically seen in those clinical scenarios (eg, connective tissue disease-related interstitial lung disease in the rheumatology clinic and hydrostatic pulmonary edema in the cardiology clinic). Familiarity with the most common imaging patterns associated with frequently administered medications can help insert MIPI into the differential diagnosis of acquired lung disease in these scenarios. However, confident diagnosis is often thwarted by absence of specific diagnostic tests for MIPI. Instead, a working diagnosis typically relies on multidisciplinary consensus. ©RSNA, 2021.
PMID: 34826256
ISSN: 1527-1323
CID: 5111762

Infiltrative endometriosis without endometrioma: A case report and imaging findings mimicking a bladder malignancy [Case Report]

Dominguez, Jennifer Ledezma; Mattinson, Ty J; Wang, Sherry S; Revels, Jonathan W
Endometriosis affects 10%-15% of women of childbearing age, but the incidence can be as high as 90% in those with chronic pelvic pain. Endometriosis is categorized into ovarian endometriomas, superficial peritoneal implants, and deep infiltrating endometriosis. In this case report a 40-year-old woman gravida 1, para 1 with a history of hysterectomy in Mexico presented with chronic abdominal pain and severe hematuria. Magnetic resonance imaging revealed an infiltrative pelvic mass involving the bladder concerning for a neoplasm that demonstrated subtle hyperintense components on T1-weighted images. The diagnosis of infiltrative endometriosis was established following cystoscopy and tissue sampling. This case highlights the importance of considering endometriosis in the differential for patients with pelvic masses, and recognizing potential features that could suggest the diagnosis.
PMID: 34765057
ISSN: 1930-0433
CID: 5111752

Sarcoidosis, the master mimicker

Jameson, Austin; Revels, Jonathan; Wang, Lily L; Wang, David T; Wang, Sherry S
Sarcoidosis is an idiopathic multisystem disorder characterized by noncaseating granulomas. The article focuses on the typical imaging manifestations of sarcoid and the common differentials that need to be included when appropriate. Mistaking a sarcoid-mimicking disease for sarcoid can result in increased patient morbidity and mortality. The pulmonary system is the most common system involved and is typically the best understood by the radiologist, however a deeper knowledge of the pulmonary findings and features of sarcoid in other organ systems is critical. There is a myriad of sarcoid imaging manifestations that can involve every organ system. Often a confidant diagnosis of sarcoid can be made, however a broad differential may need to be considered- differential diagnoses include primary neoplasm, metastatic disease, infectious, and inflammatory etiologies. Radiologist familiarity with the multimodality multisystem imaging findings of sarcoid can help guide clinical management and optimize patient care.
PMID: 33308891
ISSN: 1535-6302
CID: 5111632

Approaching diversity and inclusion in the radiology department

Weaver, Jennifer S; Revels, Jonathan W; Wang, Sherry S
There are numerous benefits to increasing diversity and inclusion within our radiology departments, and both areas need to be a part of our core mission to garner real change. A diverse and inclusive radiology department not only benefits the radiology department, but also our patients and society as a whole. Our paper provides our thoughts on a practical step-by-step guide on how to increase both diversity and inclusion within the radiology workplace, such that every voice can be heard, and every person can be seen.
PMID: 34129056
ISSN: 2366-0058
CID: 5111702