Correlation of benign incidental findings seen on whole-body PET-CT with knee MRI: patterns of 18F-FDG avidity, intra-articular pathology, and bone marrow edema lesions
Burke, Christopher J; Walter, William R; Gaddam, Sushma; Pham, Hien; Babb, James S; Sanger, Joseph; Ponzo, Fabio
OBJECTIVES/OBJECTIVE:F-FDG uptake on whole-body PET-CT with MR findings and compare the degree of FDG activity between symptomatic and asymptomatic knees. MATERIALS AND METHODS/METHODS:Retrospective database query was performed using codes for knee MRI as well as whole-body PET-CT. Patients with malignant disease involving the knee or hardware were excluded. Patients who had both studies performed within 1Â year between 2012 and 2017 were included for analysis. Knee joint osteoarthrosis, meniscal and ligamentous integrity, presence of joint effusion, and synovitis were assessed and recorded. Bone marrow edema lesions (BMELs) were identified, segmented, and analyzed using volumetric analysis. SUVmax was assessed over the suprapatellar joint space, intercondylar notch and Hoffa's fat pad. Symptomatic and asymptomatic knees were compared in patients with unilateral symptoms. RESULTS:Twenty-two cases (20 patients) with mean age 63.3Â years (range, 36-91Â years) were included. Two patients had bilateral pain. The most FDG avid regions in both symptomatic and asymptomatic knees were the intercondylar notch (SUVmaxâ€‰=â€‰1.84 vs. 1.51), followed by suprapatellar pouch (SUVmaxâ€‰=â€‰1.74 vs. 1.29) and Hoffa's fat pad (SUVmaxâ€‰=â€‰1.01 vs. 0.87). SUVmax was significantly associated with cartilage loss (mean modified Outerbridge score) (râ€‰=â€‰0.60, pâ€‰=â€‰0.003) and degree of synovitis (râ€‰=â€‰0.48, pâ€‰=â€‰0023). Overall, mean SUVmax was significantly higher in the presence of a meniscal tear (1.83â€‰Â±â€‰0.67 vs. 1.22â€‰Â±â€‰0.40, pâ€‰=â€‰0.030). Nine patients had BMELs (volume: rangeâ€‰=â€‰0.6-27.8, meanâ€‰=â€‰7.79) however there was no significant association between BMEL volume and SUVmax. CONCLUSIONS:Higher FDG activity correlates with intra-articular derangement and the intercondylar notch represents the most metabolically active region of the knee.
Ultrasound and PET-CT Correlation in Shoulder Pathology: A 5-Year Retrospective Analysis
Burke, Christopher J; Walter, William R; Adler, Ronald S; Babb, James S; Sanger, Joseph; Ponzo, Fabio
PURPOSE: To correlate shoulder ultrasound and radiography with F-FDG PET-CT to establish FDG uptake and therefore range of metabolic activity, as defined by SUV analysis, in various symptomatic shoulder pathologies. METHODS: Retrospective database query was performed for shoulder ultrasound and PET-CT scans between January 2012 and January 2017. Patients who had both studies within 1 year were included. Age- and sex-matched control patients with PET-CT scans only were also included. Retrospective image review determined shoulder pathology, and F-FDG SUVmax was measured using regions of interest placed at the glenohumeral joint, rotator cuff/bursa, and bicipital groove. Glenohumeral and acromioclavicular osteoarthrosis was assessed by radiography using the Kellgren-Lawrence classification system. RESULTS: Thirty-three patients had both imaging studies within 1 year. Ten patients (11 cases) were included, ranging in age from 56 to 90 years (mean, 67.9 years). Control subjects were selected among patients receiving PET-CT within 1 week of symptomatic patients. Glenohumeral osteoarthrosis was mild in 3 (27%), moderate in 2 (18%), and severe in 2 (18%). Six full-thickness rotator cuff tears (55%) were identified. SUVmax means were compared between the pathologic and control groups and were significantly higher in the former: glenohumeral joint (1.96 vs 1.32; P = 0.016), rotator cuff/bursa (2.80 vs 2.0; P = 0.005), and bicipital groove (2.19 vs 1.48; P = 0.007). The highest values were seen in full-thickness rotator cuff tear and severe biceps tenosynovitis. CONCLUSIONS: Increased metabolic activity about the shoulder is associated with a spectrum of rotator cuff, glenohumeral joint, and other soft tissue pathology that can be correlated with diagnostic ultrasound findings.
Use of a web-based image reporting and tracking system for assessing abdominal imaging examination quality issues in a single practice
Rosenkrantz, Andrew B; Johnson, Evan; Sanger, Joseph J
This article presents our local experience in the implementation of a real-time web-based system for reporting and tracking quality issues relating to abdominal imaging examinations. This system allows radiologists to electronically submit examination quality issues during clinical readouts. The submitted information is e-mailed to a designate for the given modality for further follow-up; the designate may subsequently enter text describing their response or action taken, which is e-mailed back to the radiologist. Review of 558 entries over a 6-year period demonstrated documentation of a broad range of examination quality issues, including specific issues relating to protocol deviation, post-processing errors, positioning errors, artifacts, and IT concerns. The most common issues varied among US, CT, MRI, radiography, and fluoroscopy. In addition, the most common issues resulting in a patient recall for repeat imaging (generally related to protocol deviation in MRI and US) were identified. In addition to submitting quality problems, radiologists also commonly used the tool to provide recognition of a well-performed examination. An electronic log of actions taken in response to radiologists' submissions indicated that both positive and negative feedback were commonly communicated to the performing technologist. Information generated using the tool can be used to guide subsequent quality improvement initiatives within a practice, including continued protocol standardization as well as education of technologists in the optimization of abdominal imaging examinations.
Important nonurgent imaging findings: use of a hybrid digital and administrative support tool for facilitating clinician communication
Johnson, Evan; Sanger, Joseph; Rosenkrantz, Andrew B
A departmental tool that provides a digital/administrative solution for communication of important imaging findings was evaluated. The tool allows the radiologist to click a button to mark an examination for ordering physician follow-up with subsequent fax and confirmation. The tool's log was reviewed. Of 466 entries; 99.4% were successfully faxed with phone confirmation. Most common reasons for usage were lung nodule/mass (29.2%) and osseous fracture (12.4%). Subsequent clinical action was documented in 41.0% of entries. Our data show the reliability of the tool in assisting the communication of findings, as well as providing documentation of notification, with minimal workflow disruption.
Fissural Nodular Densities: Inherent Stability and Benignity and Variability in Descriptive Nomenclature [Meeting Abstract]
Pryluck, D; Shiau, M; Wnorowski, A; Naidich, D; Sanger, J; Rom, W
Promoting professionalism through an online professional development portfolio: successes, joys, and frustrations
Kalet, Adina L; Sanger, Joseph; Chase, Julie; Keller, Allen; Schwartz, Mark D; Fishman, Miriam L; Garfall, Alfred L; Kitay, Alison
Medical educators strive to promote the development of a sound professional identity in learners, yet it is challenging to design, implement, and sustain fair and meaningful assessments of professionalism to accomplish this goal. The authors developed and implemented a program built around a Web-based Professional Development Portfolio (PDP) to assess and document professional development in medical students at New York University School of Medicine. This program requires students to regularly document their professional development through written reflections on curricular activities spanning preclinical and clinical years. Students post reflections, along with other documents that chronicle their professional growth, to their online PDP. Students meet annually with a faculty mentor to review their portfolios, assess their professional development based on predetermined criteria, and establish goals for the coming year. In this article, the authors describe the development of the PDP and share four years of experience with its implementation. We describe the experiences and attitudes of the first students to participate in this program as reported in an annual student survey. Students' experiences of and satisfaction with the PDP was varied. The PDP has been a catalyst for honest and lively debate concerning the meaning and behavioral manifestations of professionalism. A Web-based PDP promoted self-regulation on an individual level because it facilitated narrative reflection, self-assessment, and goal setting, and it structured mentorship. Therefore, the PDP may prepare students for the self-regulation of the medical profession--a privilege and obligation under the physician's social contract with society
Tc-99m LL-2 Fab' monoclonal antibody imaging in acquired immune deficiency syndrome-related lymphoma
Kramer EL; Volm M; Donahue B; Wasserheit C; Chapnick J; Sanger J; Koslow M
BACKGROUND: Both systemic and primary central nervous system (CNS) non-Hodgkin's lymphomas (NHL) occur in people with acquired immune deficiency syndrome (AIDS). The radiographic manifestations may be similar to other neoplasms and opportunistic infections that are also found frequently in AIDS. Furthermore, these diseases may coexist with NHL in the AIDS patient. METHODS: To evaluate the use of Tc-99m Lymphoscan (the Fab' fragment of the anti-CD-22 antibody LL-2; Immunomedics, Inc., Morris Plains, NJ) in patients with suspected AIDS lymphoma, we studied 7 patients with 35 sites of suspected disease. Six had CNS lesions suspicious for parenchymal brain lymphoma. Each patient underwent planar and single photon emission computed tomography imaging at 3-5 and 18-24 hours after administration of Lymphoscan. Scintigraphic results were compared with results of conventional diagnostic modalities. RESULTS: Overall, the sensitivity of Lymphoscan was 92% and the specificity was 86%. In brain lesions, there was 100% sensitivity and 100% specificity. Lymphoscan also had 100% sensitivity for sites of lymphomatous lymphadenopathy and for liver involvement. Although less specific in extracranial sites, Lymphoscan was correctly negative in sites of coexisting adenocarcinoma and pneumonia. Two patients had both parenchymal CNS and systemic lymphoma proven by biopsy. CONCLUSIONS: Lymphoscan appears to be a sensitive and specific method for diagnosing CNS lymphoma in AIDS patients. Although slightly less specific in extracranial sites, it may be helpful in differentiating lymphoma from other etiologies in these patients at risk for multiple neoplasms and opportunistic infections
HUMAN SPECT STUDIES OF AMPHETAMINE-INDUCED CHANGE IN DOPAMINE ACTIVITY [Meeting Abstract]
SIMKOWITZ, P; BRODIE, JD; SMITH, GS; LANDSMAN, D; KRAMER, EL; SANGER, J; NOZ, M; BARTLETT, E; DEWEY, S; FRIEDHOFF, AJ
Clinical SPECT imaging
Kramer, Elissa Lipcon; Sanger, Joseph J
New York : Raven Press, c1995
Extent: xii, 259 p. : ill. (some col.) ; 29 cm
Graphic user interface-based nuclear medicine reporting system [see comments] [Comment]
A graphically based, computerized report generation program has been developed and deployed at a dozen nuclear medicine facilities. The system is based on the Macintosh graphical user interface (GUI) and has been designed to be easy to learn and use. The system allows the nuclear medicine practitioner to generate reports for any nuclear medicine or nuclear cardiology procedure without transcriptionist support, dramatically decreasing report turnaround time. The system includes a relational database engine that allows cost-effective storage and rapid retrieval of final reports and also supports facsimile transmission of reports directly to referring clinicians' offices