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Tuesday, December 19, 2006

Cardiovascular Update: Interventional Coronary Magnetic Resonance Imaging/ New Advances

C. Joon Choi, MD, PhD of the UCSD Cardiovascular Center discusses the importance of coronary artery wall imaging in heart disease by MRI and current advances in interventional cardiovascular MRI. Series: "UCSD Cardiovascular Center: Cardiovascular Update" [Health and Medicine] [Professional Medical Education]

Friday, December 08, 2006

Latest On MRI Scans on Patients with Pacemakers

Frank G. Shellock, PhD, FACC, Has once again been at work Testing more devices to make sure they are MRI SAFE. I don't know if the day will ever come that we will be scanning pacemakers on a routine basis, but it seems to get closer every year. Here is the most recent publication from Dr. Shellock. Cardiac Pacemakers and Implantable Cardioverter
Defibrillators: In Vitro Magnetic Resonance Imaging
Evaluation at 1.5-Tesla

Thursday, December 07, 2006

New mapping technology in brain tumor surgery - Dr.Thomas Steineke

Presented by Thomas Steineke, MD, Phd at the "Diagnosis Brain Tumor- You Are Not Alone" conference at the Neuroscience Institute at JFK Medical Center, Edison, NJ Oct 15,2005.
Sponsored by:
Musella Foundation
The Brain Tumor Society
Central NJ Brain Tumor Support Group
Monmouth & Ocean Brain Tumor Support Group

Available on DVD along with many other brain tumor lectures from this and other conferences at virtualtrials.com/video.cfm

MRI Brain surface and vein

Gadolinium enhanced MRI of AVM and menigioma.
With Fat saturation technique,head capsule is easily removed.
Shaded volume rendering.
Real INTAGE(TM)

Aneurysm detection by MRI

Magnetic Resonance Angiography.
Without contrast media.
15patient case example.
Many aneurysms can be seen.
Volume Rendering.

Wednesday, November 22, 2006

3 LBS ...........................;)







Now this is a show I can watch. I like to watch the medical shows, I don't know why, I would think that when I got home I would like to leave work behind me. The thing is these characters on the shows are always doing crazy things we could never dream of doing in real life. I don't know if you have ever seen Grey's Anatomy but this show is so Dramatic. I love it, but it is not real. Another show that is very entertaining because of the brilliant acting of Hugh Laurie. He is a one man show in House. The only complaint about House is that they exaggerate allot. The MRI machine need I say more.................. If you are an MRI tech or have had an MRI you will understand how ridiculous they make themselves look when they are doing MRI's. The time that I am thinking about is when they had a 600lb patient that had to be done even though he exceeded table weight limit. They were too worried that they might get sued if they didn't try to do the patient. MY GOD, give me a break. I would be more concerned about breaking a million dollar piece of hospital equipment that can not be replaced over night. But that is enough, I do like the show.............really. Now, I want to talk about 3 lbs. Albert Einsteins brain only weighed 2.74lbs . He also had no sylvian fissure his parietal lobe was one. this show is good and I am hooked. It is on at 10:00 p.m. on Tuesday on CBS. The show Is about 2 Neurosurgeons and how they deal with patients differently. It has one Doctor who is very straight forward and ready to cut away, while the other is more emotional and willing to listen to patients needs before he makes his decisions as to what type of treatment is right for them.





I think It has the makings for a great series if they stay focused on whats important.















Monday, November 20, 2006

MEDICAL BLOOPERS




The lab test indicated abnormal lover function.
The baby was delivered, the cord clamped and cut, and handed to the pediatrician, who breathed and cried immediately.
Exam of genitalia reveals that he is circus sized.
She stated that she had been constipated for most of her life until 1989 when she got a divorce.
The patient was in his usual state of good health until his airplane ran out of gas and crashed.
Rectal exam revealed a normal size thyroid. (Long fingers?)
Between you and me, we ought to be able to get this lady pregnant.
A midsystolic ejaculation murmur heard over the mitral area.
The patient lives at home with his mother, father, and pet turtle, who is presently enrolled in day care three times a week.
Both breasts are equal and reactive to light and accommodation.
She is numb from her toes down.
Exam of genitalia was completely negative except for the right foot.
The patient was to have a bowel resection. However, he took a job as stockbroker instead.
When she fainted, her eyes rolled around the room.
Examination reveals a well-developed male lying in bed with his family in no distress.
She has no rigors or chills but her husband says she was very hot in bed last night.
She can't get pregnant with her husband, so I will work her up.
Whilst in Casualty she was examined, X-rated and sent home.
The patient states there is a burning pain in his penis which goes to his feet.
On the second day the knee was better and on the third day it had completely disappeared.
The patient has been depressed ever since she began seeing me in 1983.
I will be happy to go into her GI system, she seems ready and anxious.
Patient was released to outpatient department without dressing.
I have suggested that he loosen his pants before standing, and then, when he stands with the
help of his wife, they should fall to the floor.
The patient is tearful and crying constantly. She also appears to be depressed.
Discharge status: Alive but without permission.
The patient will need disposition, and therefore we will get Dr. Blank to dispose of him.
Healthy-appearing, decrepit 69 year old male, mentally alert but forgetful.
The patient has no past history of suicides.
The patient expired on the floor uneventfully.
Patient has left his white blood cells at another hospital.
Patient was becoming more demented with urinary frequency.
The patient's past medical history has been remarkably insignificant with only a 40 pound weight gain in the past three days.
She slipped on the ice and apparently her legs went in separate directions in early December.
The patient experienced sudden onset of severe shortness of breath with a picture of acute pulmonary oedema at home while having sex which gradually deteriorated in the emergency room.
Patient has chest pains if she lies on her left side for over a year.
He had a left-toe amputation one month ago. He also had a left-knee amputation last year.
By the time he was admitted, his rapid heart had stopped, and he was feeling much better.
The patient is a 79-year-old widow who no longer lives with her husband.
The patient refused an autopsy.
Many years ago the patient had frostbite of the right shoe.
The bugs that grew out of her urine were cultured in the Casualty and are not available. I WILL FIND THEM!!!
The patient left the hospital feeling much better except for her original complaints.





SilverHawk™ Plaque Excision System












This is the future, FoxHollow Technologies Inc.'s SilverHawk catheter is one of the hottest selling new medical devices on the market and has sent the company's stock surging since it went public in October 2005.













Titusville, Fla. (July 14, 2006)— Parrish Medical Center (PMC) recently started doing a new procedure to help fight peripheral artery disease (PAD) using the SilverHawk™ Peripheral Plaque Excision System and SilverHawk™ Cutter Driver — devices that remove the plaque that commonly blocks arteries and interrupts blood flow.








Since March 2006, Radiologist Joseph Flynn, D.O., and the Interventional Radiology department at Parrish Medical Center have been successfully performing this procedure. Dr. Flynn is continually advancing his knowledge to bring cutting-edge technology to the North Brevard community through advanced classes and seminar training. Other Interventional Radiology care partners are Tammy Flannery RT(R)(CT)(CV), Jennifer Rice RT(R), Julie Cook R.N. and Cherie Clark R.N. The SilverHawk is inserted into the patient's groin through a small puncture site and moved through the artery to the site of the blockage. The tiny rotating blade is activated and the doctor advances the SilverHawk through the vessel, shaving plaque from the artery walls as it moves forward. The plaque is collected in the tip of the device and completely removed from the patient's body. Plaque excision typically is performed as a stand alone therapy without requiring additional procedures such as stent placement. Multiple lesions and multiple arteries can be treated with a single device. A number of multi-center and single center studies have demonstrated promising early clinical results in a range of patients from those with mild leg pain to those with critical limb ischemia.



Peripheral arterial disease affects more than 30 million people worldwide, and while it can strike anyone, it's most common in people over age 65. Untreated, PAD can lead to difficulty in walking and, in its most severe stage, gangrene leading to leg amputation. Also, people who have PAD often have arterial blockages in other parts of the body and are, therefore, at greater risk of suffering a heart attack or stroke.














PRE POST




















DR. Gary J. Fishbein, (of The Dayton Heart Center), crossed the occluded distal ATA using a 0.035" angled Terumo Glidewire® and a 4 French straight taper Glidecath. A 5.5 French SilverHawk™ catheter was advanced through the occlusion, with a total of 6 cutting passes made. Again the results were excellent: the previously occluded ATA was left with 30% residual stenosis and improved collateral flow to the peroneal. There was now straight-line blood flow restored to the foot. It was not felt to be technically feasible to cross the long occlusion in the peroneal artery, so the intervention was stopped at this point. There were no complications with the procedure. Hemostasis was obtained with a Closer AT. Read more here.....




































Sunday, November 05, 2006

The Pituitay, Empty Sella, & Ruptured Aneurysms



The Pituitary is such a small part of the brain, about the size of a pea, and yet in controls so many functions. Its main function is to control the release of hormones throughout the body. The Pituitary is is conected to the hypothalmus by nerve fibers. There are several hormones that the pituiatry control the release of:


Prolactin


Melanocyte-Stimulating Hormone (MSH)


Gonadotropins: Luteinizing and Follicle Stimulating Hormones


Adrenocorticotropic Hormone (ACTH, corticotropin)


Growth Hormone (Somatotropin)


Follicle-stimulating hormone


Empty sella syndrome occurs in patients when spinal fluid is found within the space created for the pituitary. The most common cause is a large openening a membrane which sits on top of the pituitary. When this opening is large, the spinal fluid pressure is forcred down onto the pituitary and flattens it out within the sella. In most cases, the pituitary functions normally as evidenced by normal thyroid functions, normal tests of adrenal function, normal somatomedin-C levels, and regular menses. Some patients have empty sella syndrome as a result of other processes such as neurosarcoidosis pituitary tumors that have degenerated, etc. Rare patients have a congenital empty sella and a coexisting pituitary tumor.





Pituitary tumors are associated by function.Usually by what hormone they release.Pituitary adenomas are the fourth most common intracranial tumor after gliomas, meningiomas and schwannomas. The large majority of pituitary adenomas are benign (not malignant) and are fairly slow growing. Even malignant pituitary tumors rarely spread to other parts of the body. Adenomas are by far the most common disease affecting the pituitary. They more commonly affect people in their 30s or 40s, although they are diagnosed in children as well. Most of these tumors can be successfully treated. Pituitary tumors can vary in size and behavior. Tumors that produce hormones are called functioning tumors, while those that do not produce hormones are called nonfunctioning tumors.









Pituitarary Apoplexy Can occur When An Aneurysm near the pituitary ruptures. This can cause bleeding or hemorage in the pituitary . Pituitary aneurysms can be enough to cause symptoms and they often include headache, nausea, visual loss, double vision and altered mental status. Most patients also have undiagnosed hormone insufficiency prior to the apoplectic event. In patients with such symptoms, the diagnosis of pituitary apoplexy is best confirmed with an MRI of the brain with special attention to the pituitary. Conditions to consider when trying to establish the diagnosis of pituitary apoplexy include ruptured intracranial aneurysm, meningitis, brain stem stroke, cavernous sinus thrombosis, intracerebral hemorrhage, temporal arteritis and ophthalmoplegic migraine headache, but typicaly pituitary apoplexy is a condition that develops over hours to several days, typically resulting from hemorrhage and/or infarction of a pituitary macroadenoma.

Treatment for pituiray tumors




Wednesday, November 01, 2006

Brain Aneurysms


The Brain is an amazing thing but when things go wrong it sure gets scary. When a person has an aneurysm they can go for years without knowing it. It is only when they start to experience new symptoms that they start to wonder what is going on. Some of these symptoms include loss of feeling in the face or problems with the eyes. Immediately before an aneurysm ruptures, an individual may experience such symptoms as a sudden and unusually severe headache, nausea, vision impairment, vomiting, and loss of consciousness. I have a friend at work that came in with several of these symptoms one day and now she has 2 aneurysm clips in her cerebral arteries. She had the clips put in at Shands in Florida. There are other methods including embolization coils to fix aneurysms. Many MRI centers will not scan a patient with a Aneurysm clip in their brain, but will scan a patient with embolization coils. CTA's of the brain are another great way to see the cerebellar arteries at little risk to the patient. Science has made diagnosing aneurysm much easier than ever before, and advancements in surgery have made it possible for people to recover from a very scary diagnosis.












Monday, October 30, 2006

Mirror Neurons & Autism

Have you ever seen someone take a bite out of a red juicey apple and almost tasted it youself. That is the work of your "mirror neurons" doing their job. They were first discovered in the early 1990s, when a team of Italian researchers found individual "mirrror neurons" in the brains of macaque monkeys that fired both when the monkeys grabbed an object and also when the monkeys watched another primate grab the same object. Disgust, embarassment, and lust are based on a uniquely human mirror neuron system found in a part of the brain called the insula.
There has been new research done into the area of these mirror cells and Autism. Ever since autism was identified It has been a struggle to find out what causes it. We know It can be inherited, but the enviroment may also play some part. In people with autism their main signs are lack of eye contact and absence of empathy. They may also have problems understanding metaphors, sometimes taking them literally. Another very unusual behavior is an extreme dislike or complete aversion to certain sounds or noises that sets off bells in their heads. This Is A GREAT article by
Vilayanur S. Ramachandran and Lindsay M. Oberman in Scientific American
about Autistic children and the reserch done on the mirror cells. I could not stop reading.
I hope Every one likes it.

Monday, October 16, 2006

paramagnetic effects of supplemental oxygen on FLAIR images

This is an Intersting paper on the effects oxygen has on the FLAIR sequences. Oxygen can have an effect on CSF on patiens recieveing oxygen during an MR exam. http://www.ajnr.org/cgi/reprint/25/2/274.pdf
****Since I first posted this article I have witnessed this first hand sevral times now. The patients have been on ventilators with high levels of oxygen and the Rads have refered back to this article when reading the brain scan.**** Thanks again to the contributors of the article
Yoshimi Anzai, Makiko Ishikawa, Dennis W. W. Shaw, Alan Artru,
Vasily Yarnykh, and Kenneth R. Maravilla.

Wednesday, October 11, 2006

WHEN THE BONE FLAP HITS THE FLOOR

I Had to post this .............I saw this Info online I thought I would Share with everyone.




When the Bone Flap Hits the Floor. Neurosurgery. 59(3):585-590, September 2006.Brian T. Jankowitz, M.D.; Douglas S. Kondziolka, M.D.
Links: Abstract HTML PDF (447 K)
Abstract: OBJECTIVE: There is no published data in the neurosurgical literature describing the incidence, treatment, or outcome of contaminating a bone flap. We reviewed our departmental experience to determine methods of prevention and assess our treatment strategies.
METHODS: We retrospectively reviewed all incidents of dropped bone flaps during a craniotomy at a single medical center during a 16-year period. In addition, a questionnaire was mailed to neurosurgeons in the United States and abroad asking their own experience and method of management.
RESULTS: Fourteen incidents of dropped bone flaps occurred during a 16-year period. Follow-up varied from 2 to 176 months. The bone flap was dropped while elevating the bone (n = 4), when handing the bone off the field (n = 4), and during plating (n = 4). The context was unknown in two cases. Management included soaking the flap in betadine and/or antibiotic solution (n = 8), autoclaving (n = 2), or discarding the bone flap and replacing with a mesh cranioplasty (n = 3). The treatment remains unknown in one case. No instances of infection were noted in follow-up. In response to the survey, 66% (33 out of 50) of the polled neurosurgeons had experienced this complication during their practice, and 83% would replace the bone flap after disinfection.
CONCLUSION: Dropping a bone flap during neurosurgery remains an uncommon but preventable complication. Treatment options include discarding the bone followed by cranioplasty versus replacing the bone after treatment with antibiotic irrigation, betadine, and/or autoclaving. Replacement after disinfection is an appropriate option for contaminated bone flaps that avoids the expense and time of cranioplasty.
Copyright (C) by the Congress of Neurological Surgeons

live webcast

MRI-Guided Brain Tumor Removal With Cortical Mapping
Children's intraoperative MRI system is the 1st and only system of its kind in a pediatric hospital
October 25, 2006 at 1:00 PM EDT (17:00 UTC)
From Children's Hospital Boston
Neurosurgery Webcast: Neurosurgeons at Children's Hospital Boston to perform MRI- guided brain tumor removal with cortical mapping on a 13-year-old during live Webcast
On Wednesday, Oct. 25, at 1:00 p.m. EDT, neurosurgeons at Children's Hospital Boston will remove a brain tumor employing functional mapping of the cortex on a 13-year-old pediatric patient during a live Webcast. Children's hosts three to four Webcasts annually to showcase its pioneering care and technology to specialists and referring physicians around the world, and to educate consumers on the latest and MORE...
Neurosurgery Webcast: Neurosurgeons at Children's Hospital Boston to perform MRI- guided brain tumor removal with cortical mapping on a 13-year-old during live Webcast
On Wednesday, Oct. 25, at 1:00 p.m. EDT, neurosurgeons at Children's Hospital Boston will remove a brain tumor employing functional mapping of the cortex on a 13-year-old pediatric patient during a live Webcast. Children's hosts three to four Webcasts annually to showcase its pioneering care and technology to specialists and referring physicians around the world, and to educate consumers on the latest and most innovative medical treatments available.
The Webcast will feature Children's intraoperative MRI system, known as the MR-OR, the first and only system of its kind at a pediatric hospital in the country. Developed by IMRIS, the iSPACE surgical imaging suite captures digital images through a unique, ceiling-mounted, movable MRI scanner that can be used to take high-resolution, real-time patient scans before, during and after a surgical procedure. This advanced technology allows surgeons to determine the extent of a tumor while the patient is undergoing surgery to ensure its accurate removal.
"Unlike other intraoperative MR machines, the mobile MRI lets surgeons use their usual metal surgical tools because the unit is moved into the shielded garage when surgeons are operating," says Joseph R. Madsen, MD, a neurosurgeon in the Department of Neurosurgery at Children's Hospital Boston and associate professor of Surgery at Harvard Medical School.
Dr. Madsen will operate on a patient with oligodendroglioma, a low-grade tumor arising from glial cells in the central nervous system. The tumor lies near motor and sensory areas of the brain, which will require electrocorticography and physiological tests to map the normal brain around the tumor before the surgery. Once the mapping has been completed, Dr. Madsen will then perform a microsurgical resection of the tumor.
Brain tumors are the most common solid tumors in children—approximately 1,800 are diagnosed in the United States each year. Today, more than half of all children diagnosed with a brain tumor will be cured of the disease. The most effective form of treatment is the surgical removal of all or part of the tumor without jeopardizing any of the brain's critical functions. In order to decide which areas of the tumor can safely be removed, neurosurgeons use the technique of brain mapping.
"The cutting edge of neurosurgery is to identify and remove as much of the undesirable pathologically damaging brain tissue without disturbing the functioning areas of the brain," says Dr. Madsen. "Through the use of physiological mapping and the MR-OR, we are able to achieve this and assure our patients the best possible surgical outcomes."
Dr. Madsen will be assisted by neurologist Frank H. Duffy, MD, radiologist Carolyn Robson, MB, ChB, and associate anesthesiologist-in-chief Mark A. Rockoff, MD. They will also serve as Webcast commentators, providing additional information about the procedure throughout the surgery.
Moderating the live broadcast will be neurosurgeon Mark R. Proctor, MD. Neurosurgeon-in-chief R. Michael Scott, MD, will introduce the Webcast and offer insight into pediatric brain tumors. Liliana C. Goumnerova, MD, and Mark Kieran, MD, PhD, the surgical and medical directors of the Brain Tumor Clinic, a collaborative program with Dana-Farber Cancer Institute, will also be on-hand to discuss the neuro-oncological aspects of the procedure, while Craig D. McClain, MD, and Keith Ligon, MD, will comment on the anesthesia and neuropathology, respectively. An 11-year-old brain tumor patient, who recently underwent a similar procedure in the MR-OR, and his family will also answer questions during the Webcast.
View CBS4 Boston news story with Dr. Goumnerova regarding a successful brain surgery on a 13 year old girl. Click Here
Founded in 1869 as a 20-bed hospital for children, Children's Hospital Boston today is the nation's leading pediatric medical center, the largest provider of health care to Massachusetts children, and the primary pediatric teaching hospital of Harvard Medical School. In addition to 347 pediatric and adolescent inpatient beds and comprehensive outpatient programs, Children's houses the world's largest research enterprise based at a pediatric medical center, where its discoveries benefit both children and adults. More than 500 scientists, including eight members of the National Academy of Sciences, nine members of the Institute of Medicine and 11 members of the Howard Hughes Medical Institute comprise Children's research community. For more information about the hospital visit: http://www.childrenshospital.org/newsroom
IMRIS Inc. designs and manufactures advanced surgical imaging systems for use in cranial, spinal and general surgery applications. IMRIS is focused exclusively on providing fully integrated surgical imaging solutions that support the effectiveness of the surgical team. For more information about the IMRIS iSPACE™ solution visit: www.imris.com

MR Angiography


MR angiography has come such a long way in such a short time. We are doing so many MRA runoff's. We have been doing many MRA's from the ER for cold legs, becuase of the speed of which the procedure can be done. We are will do an MRA first then the DR will decide weather to take the patient to Surgery or to the Angio suite for angioplasty. The Radiologist like this becuase they don't have to do an angiogram anymore, unless they already know for sure they will be putting in stents doing angioplasty.

Friday, September 29, 2006

When life throws wheel chairs at you what do you do?

Well, I know some of you out there are well aware of the safety concerns involving MRI. We take every precuation at our hospital to ensure the saftey of our patients, and yet still there is room for improvement. Take for example, The day I scaned a pateint who needed quite a bit of assistance. His wife was his only caretaker and knew how to help him in every way. She was fantastic. Unfourtounately, becuase he was in such bad condition, we decided to use his own wheel chair and stop at the end of the table outside the magnetic field. We moved his chair over to the back of the room, far, far, away. When the scan was done I went in the room to help him get up his wife came into the room to help her husband and she grabbed the chair and moved closer to the magnet. I did not see her becuase my back was turned and I was lifting the patient up from the table. When she eventually got too close the wheel chair flew out of her hands and slammed against the magnet. I can only describe the sound as an aluminum baseball bat hitting a stopsign. I was so scared I had been standing about two feet away from where the wheel chair flew by. It could very easily hit me in the head or the patient. I was lucky. This Is why SAFETY in MRI is ALWAYS FIRST!!!!

Rare and unusal cases (Erdheim-Chester Disease)













Recently, I had a patient come in for a Brain MRI. She had Erdheim-Chester disease. It is a type of histiocytosis. This disease is a rare non-Langerhans cells histiocytosis affecting multiple organ systems . Symmetric sclerosis of the long bones is usually reported, but the central nervous system and sinus can also be affected. Among patients with central nervous system involvement, the most frequent manifestations are diabetes insipidus, cerebellar syndromes, orbital lesions, and extra-axial masses involving the dura . The patient is coming in to be scanned about every 6 months. She is on cobalt and it seems to be helping. Her chemotherapy looks like it is making her very weak, but seems to be helping the disease. I was supprised at how little information there was about this disease on the web when I started looking. I did find one source of information that recomended doing a T2 flair cor in addition to the T2 flair ax. I am glad I did because the lesions in her brain show up better on the flairs than anything else.The lesions enhanced post gad but in a fuzzy sort of way. The flairs offer the best images in the study. Just my $.02.




Erdheim-Chester disease (ECD) is a rare multisystem disorder of adulthood. It is characterized by excessive production and accumulation of histiocytes within multiple tissues and organs. Histiocytes are large phagocytic cells (macrophages) that normally play a role in responding to infection and injury. (A phagocytic cell is any "scavenger cell" that engulfs and destroys invading microorganisms or cellular debris.) In those with ECD, sites of involvement may include the long bones, skin, tissues behind the eyeballs, lungs, brain, pituitary gland, and/or additional tissues and organs. Associated symptoms and findings and disease course depend on the specific location and extent of such involvement. The specific underlying cause of ECD is unknown.







56-year-old woman with progressive chronic cardiac failure who was followed up for 5 years. Erdheim-Chester disease diagnosis was made on basis of typical bone involvement on femurs and perirenal biopsy. Cardiac-gated T1-weighted spin-echo chest images reveal extent of mediastinal infiltration sheathing aorta, superior vena cava, and right pulmonary artery. Infiltration appears as soft-tissue of low intensity (E and F). Pericardium is not visible because it is probably obscured by mediastinal tissue infiltration. Right atrium is obscured by wall thickening and lumen distortion (asterisk, G) associated with presence of pseudomass appearance in anterior and lateral walls (black arrow, G). Another pseudomass is also visible on interatrial septum (white arrow, G). Note dilatation of left ventricle.





48-year-old man with Erdheim-Chester disease presenting with flank and extremity pain. Contrast-enhanced axial CT image shows left perinephric hypovascular mass (arrow) associated with fat stranding. Note moderate hydronephrosis (asterisk). Appearance is nonspecific.






68-year-old woman with Erdheim-Chester disease involving both lower extremities. Coronal T1-weighted MR image (TR/TE, 520/25) of both lower extremities shows diffusely invasive bone marrow masses destroying cortical bones in both tibias.



M. D. Anderson physicians are encouraged by the results of interferon therapy used to treat complications of Erdheim-Chester disease, a rare disorder that attacks the body’s connective tissue. Two patients have experienced significant symptom improvement after receiving interferon alpha treatment at M. D. Anderson.
Erdheim-Chester disease, or ECD, is a potentially fatal disorder caused by the overproduction of histiocytes, which are large cells that help the body respond to infection or injury. These rogue histiocytes accumulate in the loose connective tissue, causing it to become thickened and dense. ECD can affect many areas of the body, including the eye cavity (orbit), skin, brain, long bones of the arm and leg and the lungs.




Treatment

Numerous treatments have been attempted for this disease [2,6,13,14].
Corticosteroids are the traditional first-line treatment and are used to control
symptoms, but generally are either ineffective or only transiently effective [2,6].
Bisphosphonates are efficient in treating osteolytic lesions in Langerhans cell
histiocytosis but have only partial or temporary success in the management of bone
involvement in Erdheim-Chester disease [15]. Chemotherapy can induce transient
partial responses, but is often ineffective [2,16]. Cladribine has been used
successfully in adult Langerhans histiocytosis, but its application in Erdheim-Chester
disease is limited to two patients, one of whom responded [16,17]. Radiation,
methotrexate, cyclosporine and azathioprine have not yielded sustained clinical
response [3,18,19,20].
We describe the successful treatment of three patients suffering from Erdheim-
Chester disease with interferon-. The initial therapeutic dose of 3 to 6x106 units s.c.
three times per week, was reduced to 1x106 units three times per week because of
fatigue. This low dose was well tolerated and response was observed within one
month with dramatic reduction in the exophthalmos and recovery of vision in two
patients (case #1 and #3) whose vision was threatened by progressive disease while
on high-dose chemotherapy and/or steroids. Response was also manifested by
- 7 -
gradual improvement in diabetes insipidus (cases #1 and #2) and in bone lesions
(case #2) (Figure 2).
The mechanism(s) underlying the salutary effects of interferon- in Erdheim-
Chester are unclear but could be due to several of the diverse biological effects of this
agent: maturation and activation of dendritic cells [9,10]; immune-mediated (e.g. via
natural killer cells) destruction of Histiocytes; or direct antiproliferative effects [21].
There is also anecdotal evidence of clinical therapeutic benefits for interferon-alpha in
other histiocytic disorders (Langerhans cell histiocytosis [22] and Rosai-Dorfaman
disease [23]).
Erdheim-Chester disease is a rare and difficult-to-treat disease. All three of our
patients with this disorder achieved a long-lasting response (3+, 3.5 and 4.5+ years)
while receiving interferon-. Our observations suggest that this well-tolerated
treatment warrants further application and investigation in this disorder.(source)


Wednesday, September 20, 2006

MRI WHAT DOES THE FUTRE HOLD ;)


Ok, lets here them. worse case sceneriors. I'm listening.
I know you, "out there" have had a few run in's with refering physicians, or maybe it was your local Radiologist, whoever the culprit I want to hear about it. Doesn't every one? So tell me your worst story, and give me all the graphic details. We want to here from you!!

Pacemakers and internal defibrilators


Well, I guess we all knew the day would come but it is getting here much too fast for me. 10 patients in Isreal were done with pacers or defibrilators, all went off without a hitch. You know what this means guys and gals. I can see the order coming across the printer now from the nuerosurgeon, STAT stealth brain MRI, pt has pacemaker. Oh, what fun!!!!

Saturday, September 02, 2006

MRI PHYSIC MADE EASY & REGISTRY REVIEW

I AM ALWAY SEARCHING FOR GOOD PHYCIS SITES, TO HELP BETTER UNDERSTAND THE PRINCIPLES OF MR. IF ANYONE HAS ANY LINKS TO SHARE PLEASE FEEL FREE TO E-MAIL THEM TO ME.


HERE IS A GREAT BOOK THAT HAS HELPED ALONG THE WAY.


THIS WEBSITE IS AN ONLINE TUTOR THAT IS VER GOOD I ALSO RECOMEND IT.

WILLIAM FAULKNER ALSO HAS A COURSE FOR REGISTRY REVIEW.

Here are a few good sites good luck!
medical student
Phillips Learning Center
Revise MRI

MRI Tutor













Friday, September 01, 2006

coolmristuff

ARCHIVE

MRI Nueroarm Video